Journal of the American Geriatrics Society
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The drugs prescribed for 280 women with hip fractures (mean age 83 years) were compared with those prescribed for 145 women controls (mean age 81 years) as recorded in a family practice age-sex register. Thirty-three percent of the fracture patients were taking diuretics compared with 24% of the controls (.10 greater than P greater than .05). Forty-six percent of these diuretics taken by the fracture group (compared with 40% taken by the controls) were either loop or potassium sparing diuretics in combination with another diuretic. ⋯ Thus, this population did not confirm a previously identified association between long-acting sedatives and the risk of fracture. As only 3.5% of fracture patients and 2.1% controls were receiving phenothiazines, a role for these drugs in hip fracture cannot be ruled out. In summary, hip fracture patients were slightly more likely to be taking diuretics and somewhat less likely to be taking NSAIDs than controls but there were no differences with respect to other drugs.
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A peculiar dynamic in communication exists between those who are most likely to be involved in life-prolongation decisions. We found that both the elderly and health care professionals talk about life-prolongation, but not with one another; that they consider some of the same factors as they think about the life-prolongation decision; and that most of them believe physicians should be responsible for initiating discussion. ⋯ The patient remains patient, waiting--with fears of dependency, memories of previous life-threatening experiences, and deep sensitivity for suffering--for the physician to initiate the discussion. Is a mediator such as a family member necessary in these situations? Is the hospital environment not conductive to discussion of less than heroic efforts?
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Letter Case Reports
Pneumothorax complicating small-bore nasogastric feeding tube insertion.
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Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field-tested the Diagnostic and Statistical Manual III (DSM-III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM-III criteria, 19 more patients than were reported by the primary clinician. ⋯ Sixty-five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P less than .0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM-III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM-III criteria to identify delirious patients for an immediate evaluation and treatment.