Chest
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Ten otherwise healthy cigarette smokers (mean, 31 cigarettes per day), and ten nonsmoking control volunteers matched for age, weight, and sex received single intravenous doses of diazepam (5 to 10 mg), midazolam (5 mg), and lorazepam (2 mg) on three separate occasions. Kinetics of each benzodiazepine were determined from multiple serum concentrations measured after each dose. In non-smoking vs smoking subjects, there was no significant difference in mean clearance of diazepam (0.44 vs 0.47 ml/min/kg), midazolam (9.6 vs 7.1 ml/min/kg), or lorazepam (0.96 vs 1.08 ml/min/kg). Thus, differences in pharmacokinetics are unlikely to account for altered sensitivity to benzodiazepines that may occur in cigarette smokers.
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Medicare prospective payment by diagnosis-related groups (DRGs) has intensified the debate over the use and costs of medical technology. In this study, we examine the financial impact of DRG payment for medicare patients receiving medical intensive care. During a one-year period, payment for 446 Medicare patients receiving medical intensive care at a large teaching hospital was calculated to be +4.7 million below costs, representing an average loss per discharge of +10,567. ⋯ For this group, the average payment per discharge was projected to be +21,651 below the average per discharge cost. We conclude that the results send strong financial messages to hospitals providing medical intensive care to severely ill, elderly patients. Further exploration and research must occur to ensure hospital responses will be consistent with public policy expectations.
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Continuous positive airway pressure (CPAP) administered at intervals with a mask and incentive spirometry (IS) were compared with a regimen of coughing and deep breathing (CDB) to determine which promoted the most rapid recovery of pulmonary function after upper abdominal operations in 65 adults. Postoperatively, FRC of patients in all groups was similar relative to preoperative values. However, mean FRC of patients who received CPAP increased more rapidly than did mean FRC of those receiving CDB when compared to the values obtained following operation (p less than 0.05). ⋯ The low incidence of pneumonia regardless of the type of therapy may be attributable to vigorous, vigilant respiratory care in a population at high risk for developing pneumonia. Frequency and supervision of respiratory therapy may be more important than the type of therapy delivered after upper abdominal operations. Mask CPAP offers advantages because it requires no effort from the patient, and therapy is not painful.