CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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To develop a predictive index for length of stay in the intensive care unit (ICU) following cardiac surgery. ⋯ Length of ICU stay and death following cardiac surgery can be predicted with a multivariate predictive index. The index has potential application as a means of stratifying cardiac surgical risk as well as in optimizing ICU resource planning when resources are limited.
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Historical views of the patient-physician relationship assumed that the physician's role was to act in the best interests of the patient and to direct care and make decisions about treatment on the patient's behalf. However, under current legal and ethical principles, beneficence is no longer sufficient; respect for autonomy is paramount, necessitating patient participation. None the less, physicians question whether patient participation is realistic in actual clinical situations. ⋯ To be understood, health information must be presented in a way that is appropriate to the patient. Format, content and timing of the material are all important. Mechanisms for incorporating such information into busy clinical practices are crucial.
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To make recommendations on the effectiveness of screening for colorectal cancer in asymptomatic patients over 40 years of age. ⋯ There is evidence that annual fecal occult blood testing with the use of the rehydrated Hemoccult test has a small but significant benefit in lowering the rate of death from cancer after more than 10 years of screening; however, the high rate of false-positive results (9.8%) and the poor sensitivity of annual (49%) and biennial (38%) screening make this a poor method for detecting colorectal cancer. There is fair evidence that screening with sigmoidoscopy may improve survival rates; however, this may be due to volunteer bias. The high cost of and poor compliance with colonoscopic screening make this an unfeasible strategy.