Arch Intern Med
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Multicenter Study
A multi-institutional study of care given to patients dying in hospitals. Ethical and practice implications.
Relatively little attention has been paid to how physicians care for dying patients once an initial decision to forgo life-sustaining treatment is made. ⋯ The majority of patients dying at these institutions did so after decisions to limit treatment, but few patients were able to participate in these decisions. Forgoing life-sustaining treatment generally occurred in a sequential manner over several days; the rationale for this stepwise retreat is not, however, clinically or ethically obvious.
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Review Multicenter Study
1995 update of the working group reports on chronic renal failure and renovascular hypertension. National High Blood Pressure Education Program Working Group.
To update 2 National High Blood Pressure Education Program working group reports on hypertension and chronic renal failure and renovascular hypertension, a working group was appointed by the director of the National Heart, Lung, and Blood Institute. Literature was searched through MEDLINE and the National Heart, Lung, and Blood Institute information center library. Scientific evidence was given precedence over clinical anecdotal experience. ⋯ It seems reasonable to recommend angiotensin-converting enzyme inhibitors as initial therapy for patients with diabetes and microalbuminuria or overt diabetic nephropathy with and without hypertension. Renovascular disease has emerged as a major cause of end-stage renal disease, especially in the elderly. Newer screening procedures for the noninvasive screening of renovascular disease include the captopril test, renal scintigraphy following captopril administration, duplex scanning, and magnetic resonance angiography.
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Multicenter Study Comparative Study
Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study.
Although Clostridium difficile is the main agent responsible for nosocomial diarrhea in adults, its prevalence in stool cultures sent to hospital microbiology laboratories is not clearly established. ⋯ This multicenter period prevalence study clearly supports the hypothesis of a common role of C difficile in infectious diarrhea in hospitalized patients. Disease associated with C difficile should therefore be systematically evaluated in diarrheal stools from inpatients.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Fecal hemoglobin excretion in elderly patients with atrial fibrillation: combined aspirin and low-dose warfarin vs conventional warfarin therapy.
Antithrombotic prophylaxis using combined aspirin and low-dose warfarin is under evaluation in several clinical trials. However, therapy may result in increased gastrointestinal blood loss and clinical bleeding vs conventional single-agent antithrombotic therapy. ⋯ Abnormal levels of fecal hemoglobin excretion were common in elderly patients with high risk of atrial fibrillation 1 month after randomization to prophylactic antithrombotic therapy. Combined warfarin and aspirin therapy was associated with greater fecal hemoglobin excretion than standard warfarin therapy, suggesting the potential for increased gastrointestinal hemorrhage.
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Multicenter Study
Functional outcomes of acute medical illness and hospitalization in older persons.
Short-stay hospitalization in older patients is frequently associated with a loss of function, which can lead to a need for postdischarge assistance and longer-term institutionalization. Because little is known about this adverse outcome of hospitalization, this study was conducted to (1) determine the discharge and 3-month postdischarge functional outcomes for a large cohort of older persons hospitalized for medical illness, (2) determine the extent to which patients were able to recover to preadmission levels of functioning after hospital discharge, and (3) identify the patient factors associated with an increased risk of developing disability associated with acute illness and hospitalization. ⋯ This study documents a high incidence of functional decline after hospitalization for acute medial illness. Although there are several potential explanations for these findings, this study suggests a need to reexamine current inpatient and postdischarge practices that might influence the functioning of older patients.