JAMA : the journal of the American Medical Association
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Delirium (acute confusional states), a common and often overlooked psychiatric disorder, can occur at any age, but elderly persons are especially prone to develop it. In later life, it is often a conspicuous feature of systemic or cerebral disease and drug (notably anticholinergic) toxicity, and it may constitute a grave prognostic sign. ⋯ Acute onset of a fluctuating level of awareness, accompanied by sleep-wake cycle disruption, lethargy or agitation, and nocturnal worsening of symptoms, are diagnostic. Early recognition of delirium and treatment of its underlying cause are essential.
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The relationship of cardiovascular disease (CVD) to the control of blood pressure (BP) and serum cholesterol levels was studied in 686 treated, middle-aged hypertensive men whose condition was followed up for 12 years. Both mean in-study BP (P less than .001) and serum cholesterol levels (P less than .001) were better predictors for CVD than the respective entry levels (both not significant) in multivariate analysis. ⋯ Analyses of CVD morbidity in relationship to changes in BP and serum cholesterol levels clearly showed that a combined reduction of both risk factors was necessary to achieve a substantial reduction in morbidity. These study findings indicate that (1) it may be unfavorable to reduce BP below a certain level in middle-aged hypertensive men; and (2) other risk factor interventions must be improved to improve the patient's prognosis.
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Case Reports
Envenomation by the Eastern coral snake (Micrurus fulvius fulvius). A study of 39 victims.
We gathered data on 39 victims of Eastern coral snake bite over a 12-year period. The most common situation resulting in snakebite was erroneous identification of the snake as the nonpoisonous scarlet king snake. ⋯ Envenomation occurs in 75% of the persons bitten by a coral snake. Antivenin is effective and should be intravenously administered early to patients who have been bitten by a positively identified coral snake, depending on the clinical presentation.
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Comparative Study
Efficiency of intensive care. A comparative analysis of eight pediatric intensive care units.
To calculate overall pediatric intensive care unit (PICU) efficiency rates, 1668 patients representing 6962 patient-days were studied in eight PICUs. The contributions to inefficiency by two patient groups--low-risk monitored patients and potential early-discharge patients--were quantified using measures of daily mortality risk and therapeutic assessments. Low-risk monitored patients never received a unique PICU therapy and had daily mortality risks less than 1%. ⋯ Potential early-discharge patients constituted from 12% to 29% of the populations and the potential early-discharge days of care ranged from 5.1% to 17.2% of the total days of care. These results indicate that large disparity exists in efficiency among PICUs. Efficiency rates of greater than 0.80 seem to be a reasonable goal.