Journal of general internal medicine
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Multicenter Study
Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study.
To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. ⋯ Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline-even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.
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To describe the prevalence of benzodiazepine use, sociodemographic and physical health factors associated with use, dosages taken, and directions for use among individuals aged 65 years and older. ⋯ One in 10 participants reported taking a benzodiazepine, most frequently an anxiolytic, often at a lower dose than prescribed and usually PRN. The high prevalence of OTC sleep aid medication and benzodiazepine use may place the patient at increased risk of psychomotor impairment. Physicians should assess OTC sleep aid medication use when prescribing benzodiazepines.
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Oscar Thompson, a third-year medical student on a shift in the emergency department, is eager to participate in as many procedures as possible. According to the triage nurse's history, the next patient to be seen is a 58-year-old man who has had fever, headache, and neck stiffness. ⋯ The student pauses, draws back the curtain, and says, “Hello, I'm Dr. Thompson, how can I help you today?”
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Comparative Study
A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts.
To compare physicians' and their patients' attitudes toward pharmaceutical gifts. ⋯ Patients feel pharmaceutical gifts are more influential and less appropriate than do their physicians. Physicians may want to consider this in deciding whether to accept particular gifts. Broader dissemination of guidelines may be one means of changing physician behavior. At the same time, future guidelines should further consider the potentially different viewpoints of patients and physicians.