Arch Intern Med
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Multicenter Study
Toward shared decision making at the end of life in intensive care units: opportunities for improvement.
In North America, families generally wish to be involved in end-of-life decisions when the patient cannot participate, yet little is known about the extent to which shared decision making occurs in intensive care units. ⋯ Shared decision making about end-of-life treatment choices was often incomplete, especially among less educated families. Higher levels of shared decision making were associated with greater family satisfaction. Shared decision making may be an important area for quality improvement in intensive care units.
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Rapid influenza testing decreases antibiotic and ancillary test use in febrile children, yet its effect on the care of hospitalized adults is unexplored. We compared the clinical management of patients with influenza whose rapid antigen test result was positive (Ag+) with the management of those whose rapid antigen test result was negative or the test was not performed (Ag0). ⋯ Rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.
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Multicenter Study
Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea.
Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP concentrations has been described. ⋯ In patients with and without acute heart failure, the NT-proBNP concentrations are relatively lower in overweight and obese patients with acute dyspnea. Despite this, the NT-proBNP concentration retains its diagnostic and prognostic capacity across all BMI categories.