JAMA internal medicine
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JAMA internal medicine · May 2013
Multicenter StudyFailure to engage hospitalized elderly patients and their families in advance care planning.
Advance care planning can improve patient-centered care and potentially reduce intensification of care at the end of life. ⋯ Many elderly patients at high risk of dying and their family members have expressed preferences for medical treatments at the EOL. However, communication with health care professionals and documentation of these preferences remains inadequate. Efforts to reduce this significant medical error of omission are warranted.
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JAMA internal medicine · May 2013
Firearm legislation and firearm-related fatalities in the United States.
Over 30,000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain. ⋯ A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.
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JAMA internal medicine · May 2013
Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study.
Excess endogenous cortisol has been linked to venous thromboembolism (VTE) risk, but whether this relationship applies to exogenous glucocorticoids remains uncertain. Because the prevalence of glucocorticoid use and the incidence of VTE are high, an increased risk of VTE associated with glucocorticoid use would have important implications. ⋯ The risk of VTE is increased among glucocorticoid users. Although residual confounding may partly explain this finding, we consider a biological mechanism likely because the association followed a clear temporal gradient, persisted after adjustment for indicators of severity of underlying disease, and existed also for noninflammatory conditions. Hence, our observations merit clinical attention.