Archives of internal medicine
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Multicenter Study Comparative Study
Supratherapeutic dosing of acetaminophen among hospitalized patients.
We investigated acetaminophen use and identify factors contributing to supratherapeutic dosing of acetaminophen in hospitalized patients. ⋯ Supratherapeutic dosing of acetaminophen was significantly associated with multiple factors. Interventions to reduce the incidence of some risk factors may prevent supratherapeutic acetaminophen dosing in hospitalized patients.
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Multicenter Study Comparative Study
Preoperative hyponatremia and perioperative complications.
Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain. ⋯ Preoperative hyponatremia is a prognostic marker for perioperative 30-day morbidity and mortality.
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Multicenter Study
One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T.
High-sensitivity cardiac troponin (hs-cTn) assays seem to improve the early diagnosis of acute myocardial infarction (AMI), but it is unknown how to best use them in clinical practice. Our objective was to develop and validate an algorithm for rapid rule-out and rule-in of AMI. ⋯ Using a simple algorithm incorporating hs-cTnT baseline values and absolute changes within the first hour allowed a safe rule-out as well as an accurate rule-in of AMI within 1 hour in 77% of unselected patients with acute chest pain. This novel strategy may obviate the need for prolonged monitoring and serial blood sampling in 3 of 4 patients.
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Multicenter Study
Factors important to patients' quality of life at the end of life.
When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancer patients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL. ⋯ Advanced cancer patients who avoid hospitalizations and the intensive care unit, who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.
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Multicenter Study
Six-minute walk test as a prognostic tool in stable coronary heart disease: data from the heart and soul study.
The prognostic value of the 6-minute walk test (6MWT) in patients with stable coronary heart disease is unknown. We sought to determine whether the 6MWT predicted cardiovascular events in ambulatory patients with coronary heart disease. ⋯ Distance walked on the 6MWT predicted cardiovascular events in patients with stable coronary heart disease. The addition of a simple 6MWT to traditional risk factors improved risk prediction and was comparable with treadmill exercise capacity.