Journal of general internal medicine
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Comparative Study
Programmable infusion pumps in ICUs: an analysis of corresponding adverse drug events.
Patients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable. ⋯ The smart pumps we evaluated are unlikely to reduce preventable IV-ADEs in ICUs because they address only 4% of them. Expanding smart-pump capabilities might prevent more IV-ADEs.
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Comment Review
Within you/without you: biotechnology, ontology, and ethics.
As Implantable Cardioverter Defibrillators (ICDs) have become more common, ethical issues have arisen regarding the deactivation of these devices. Goldstein et al., have shown that both patients and cardiologists consider ICD deactivation to be different from the discontinuation of other life-sustaining treatments. It cannot be argued ethically that ICDs raise new questions about the distinction between withholding and withdrawing treatment, and neither the fact that they are used intermittently, nor the duration of therapy, nor the mere fact that they are located inside the body can be considered unique to these devices and morally decisive. ⋯ ICDs are not a "replacement" therapy in this sense. The deactivation of an ICD is best classified, under the proper conditions, as the forgoing of an extraordinary means of care. As technology becomes more sophisticated, however, and new interventions come to be best classified as "replacements" (a heart transplant would be a good example), "discontinuing" these interventions should be much more morally troubling for those clinicians who oppose euthanasia and assisted suicide.
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Variations in hospice use are not well understood. ⋯ Care before death is associated with hospice use among older women with advanced breast cancer. Additional research is needed to understand better how differences in patient characteristics and disease status influence cancer care before death and the role of various types of physicians in hospice referrals.
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Wernicke's encephalopathy is a rare disorder resulting from nutrition deficiency in thiamine (vitamin B1). It is most often associated with chronic alcohol abuse. It can accompany other disorders such as hyperemesis gravidarum and hyperthyroidism. ⋯ Wernicke's encephalopathy is a severe, life-threatening illness that can be a consequence of hyperthyroidism in addition to alcohol abuse and can be easily prevented with appropriate supplementation of thiamine.