Arch Intern Med
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Multicenter Study
The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study.
The hospital admission decision directly influences the magnitude of resource use in patients with community-acquired pneumonia, yet little information exists on how medical practitioners make this decision. ⋯ Practitioners' survey responses suggest that the availability of outpatient intravenous antimicrobial therapy and home nursing care would allow outpatient care for a large proportion of low-risk patients who are hospitalized for community-acquired pneumonia. These data also suggest that methods to improve practitioners' identification of low-risk patients with community-acquired pneumonia could decrease the hospitalization of such patients. Future studies are required to help physicians identify which low-risk patients could safely be treated in the outpatient setting on the basis of clinical information readily available at presentation.
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Mistakes are an inevitable part of the practice of medicine. While the frequency and severity of medical errors are documented, little is known about patients' attitudes toward physician mistakes. ⋯ Patients desire an acknowledgment from their physicians of even minor errors, and doing so may actually reduce the risk of punitive actions. These findings reinforce the importance of open communication between patients and physicians.
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The principal motive for organ donation in the United States remains altruism. Surveys suggest that if the life-threatening and critical shortage of cadaveric donor organs were appropriately understood by the public, an altruistic response would lead to increased donation. However, despite intense educational efforts appealing to altruism, cadaveric organ donation has not increased substantially while the number of patients in need of a life-saving organ has grown markedly. ⋯ The donors in the focus groups, on the other hand, believed that the system worked equitably, although their knowledge about organ donation and transplantation was equivalent to that of nondonors. For organ donation to increase, efforts must be directed toward those who are not convinced that donation is for the common welfare. One way to increase organ donation is for physicians to educate their patients better regarding the equity and success of transplantation.
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A better understanding of the impact of vertebral fractures on physical functioning would help clinicians gauge the potential benefits of identifying patients at high risk and prevent vertebral fractures due to osteoporosis. ⋯ Recent vertebral fractures may lead to long-term poor physical functioning. Clinicians should take appropriate measures to identify those at risk, to prevent progression of osteoporosis, and to limit associated disability.
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Comparative Study
Thirty-day case-fatality rates for pulmonary embolism in the elderly.
Short-term race- and sex-specific case- fatality rates for pulmonary embolism (PE) in the elderly have not been studied previously, to our knowledge. ⋯ Our results indicate that there are racial and gender differences in 30-day case-fatality rates for PE in elderly patients. The high fatality risk associated with PE as a comorbid factor among common primary concurrent conditions and procedures calls attention to the need for more effective prophylaxis of deep vein thrombosis and rapid diagnosis and treatment of PE when it occurs.