JAMA : the journal of the American Medical Association
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To describe current "do not resuscitate" (DNR) order writing practices, we studied 7,265 intensive care unit (ICU) admissions at 13 hospitals. All of the ICUs used DNR orders and 39% of all in-unit deaths were preceded by them. Patients with DNR orders were often elderly and in severely failing health. ⋯ These variations could not be explained by differences in patient characteristics, and may reflect varying physician attitudes. Do not resuscitate orders are now an accepted practice in ICUs and their use follows basic ethical and scientific guidelines. The brief interval between writing a DNR order and death or ICU discharge suggests that they often represent a decision point for placing broader limits on therapy.
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In its 1982 report on toxic shock syndrome, the institute of Medicine, Washington, DC, identified population-based studies of the incidence of toxic shock syndrome over time based on hospital records as being a high priority for further research. We conducted such a study using records of hospitalizations in Northern California Kaiser-Permanente Medical Care Program facilities for the period from 1972 through 1983 among women and men aged 15 through 34 for illnesses considered possibly to be toxic shock syndrome. Of 6,688 hospitalizations reviewed, 54 were considered definite cases of toxic shock syndrome, and an additional nine were considered probable toxic shock syndrome. ⋯ In women, an increase in the incidence of toxic shock syndrome was apparent by 1977; the rate peaked in 1980, decreased slightly in 1981 and 1982, and then almost doubled again in 1983. The temporal trend in the incidence of hospitalized toxic shock syndrome in women in the years 1977 through 1982 is consistent with the best available information on patterns of use of tampons containing higher-absorbency materials. The sharp increase in the incidence of hospitalized toxic shock syndrome in 1983 remains unexplained.
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Differences in mean birth weight and low birth weight (less than 2.5 kg) are analyzed among Asians, blacks, Hispanics, and whites who were enrolled in the Northern California Kaiser-Permanente Birth Defects Study, a prospective study of 29,415 pregnancy outcomes. Large differences in birth weight among babies of different ethnic groups persist after controlling for the joint effects of maternal smoking and alcohol use during pregnancy, sex of child, parity, length of prenatal care, and maternal weight-for-height percentile. ⋯ After controlling for the effects of 22 factors, the odds ratios for a low-birth-weight infant are 2.41 for blacks, 1.37 for Asians, 1.93 for others, and 1.25 for Hispanics. It is concluded that factors currently used to control for ethnic differences in birth weight are insufficient to explain the observed differences.