Arch Intern Med
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Some have suggested that advance directives elicit goals of care from patients, instead of or in addition to specific intervention preferences, but little is known about whether goals of care can be used in a meaningful way on documents or whether they can predict preferences for specific interventions. ⋯ Goals have a valid role in advance directives, since the goal choices had a logical relationship to scenarios and intervention choices. However, the 2 goals attempt cure and choose quality of life were not predictive in many instances. If these findings hold true for more general populations of patients, then advance directive documents will need to rely on more than these general goal statements if they are to adequately represent patient preferences.
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Palliative medicine is an emerging medical discipline in the United States, modeled after similar efforts in Great Britain, Australia, and Canada. Increasingly, academic medical centers are starting clinical programs in palliative medicine including inpatient consultation services. A description of the essential components of a palliative medicine consultation is presented, based on the author's experience of more than 600 patient encounters at the Medical College of Wisconsin in Milwaukee. A palliative medicine consultation consists of 6 features: assessment and management of physical symptoms; assisting patients to identify personal goals for end-of-life care; assessment and management of psychological and spiritual needs; assessment of the patient's support system; assessment and communication of estimated prognosis; and assessment of discharge planning issues.
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Stethoscope diaphragms have been shown to harbor potentially pathogenic bacteria. ⋯ Most stethoscopes harbor potential pathogens but are not a source of C difficile. Physicians' stethoscopes generally had a higher bacterial load than nurses' stethoscopes. Isopropyl alcohol is an effective cleaning agent when applied to the stethoscope diaphragm. Stethoscopes transfer M luteus to human skin, making it likely that other bacteria can be transferred as well.
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The hospital admission and mortality rates of patients with diabetic emergencies, such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS), are higher in black patients than in white patients with diabetes. However, there is limited data describing the precipitating events and response to treatment in black patients. Analysis of their clinical characteristics and response to medical therapy is needed to evaluate the impact of programs designed to reduce the development of these acute metabolic complications. ⋯ In urban black patients, poor compliance with insulin therapy was the main precipitating cause of acute metabolic decompensation, and substance abuse was a significant contributing factor for noncompliance. Obesity is common in black patients with DKA; it was present in more than half of those with newly diagnosed diabetes. Improved patient education and better access to medical care might reduce the development of these hyperglycemic emergencies.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Relationships of quality-of-life measures to long-term lifestyle and drug treatment in the Treatment of Mild Hypertension Study.
To compare 5 antihypertensive drugs and placebo for changes in quality of life (QL). To assess the relationship of lifestyle factors and change in lifestyle factors to QL in participants with stage I diastolic hypertension. ⋯ In patients with stage I hypertension, antihypertensive treatment with any of 5 agents used in TOMHS does not impair QL. The diuretic chlorthali-done and the cardioselective beta-blocker acebutolol appear to improve QL the most. Success with lifestyle changes affecting weight loss and increase in physical activity relate to greater improvements in QL and show that these interventions, in addition to contributing to blood pressure control, have positive effects on the general well-being of the individual.