The Mount Sinai journal of medicine, New York
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A do-not-resuscitate (DNR) order is commonly used for hospitalized patients with advanced illness. It reflects only the desires of a patient once he or she suffers a full cardiopulmonary arrest. It does not reflect preferences about other forms of life-sustaining treatments. This article reviews the definition of a DNR order, describes the evidence suggesting that physicians use a DNR order in making determinations about other life-sustaining treatments, and will provide tools such as the use of palliative care consultations and combined directives in discussing overall goals of care.
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The promise of the hospital medicine movement is that the hospitalist model of care will provide better outcomes than the system it replaced. This means improving the quality and processes of care, reducing inefficiencies and lowering costs. ⋯ While most internal medicine residency training programs stress inpatient care they underemphasize key components of a successful hospitalist career. This paper overviews the state of the hospitalist movement, the current educational training deficiencies and the methods to deliver hospitalist-focused training.
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With the advent of continuous subcutaneous insulin infusion therapy and the findings of the Diabetes Control and Complications Trial, the management of type 1 diabetes has changed drastically. Over the past 30 years since its development, the effectiveness of continuous subcutaneous insulin infusion has been assessed in comparison with other modes of intensive treatment. ⋯ Selection criteria of patients for pump use and how to initiate pump therapy are presented. Finally, newer findings on continuous glucose sensors are discussed as the next era of pump therapy continues to focus on the goal of developing an artificial pancreas.
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This article reviews the evidence from randomized, placebo-controlled trials and meta-analyses of pharmacological treatments of the following anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. There is evidence from multiple randomized, placebo-controlled trials to support the use of selective serotonin reuptake inhibitors as first-line pharmacotherapy in these disorders, and a number of the selective serotonin reuptake inhibitors have received US Food and Drug Administration approval for these indications. ⋯ Benzodiazepines are also effective treatments for anxiety disorders, and although this medication class has the advantage of a rapid onset of action, their use is limited by their potential for abuse and lack of antidepressant properties. In addition to reviewing the clinical trials that have investigated the anxiolytic effects of these commonly used medications, we review the evidence for novel uses of other agents, including anticonvulsants and atypical antipsychotics, in anxiety disorders.