JAMA : the journal of the American Medical Association
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To determine whether on-site physician staffing changed test and procedure use and improved patient outcome in a community hospital intensive care unit (ICU), we studied all ICU admissions for matched periods before and after the staffing change. Compared with the 463 year-1 patients, the 491 year-2 patients were no more likely to receive life-support interventions (respirators, dialysis, or pacemakers), but had substantially more monitoring interventions, such as pulmonary artery catheters (22% v 2%, P less than .0001) and arterial catheters (9% v 0%, P less than .0001). After controlling for factors that predicted death (age, mental status at time of admission, reason for ICU admission), year-2 patients were significantly more likely to survive the ICU and subsequent hospital stay (P = .01). Nearly all of the improvement of survival rate took place among patients with intermediate likelihoods of death; this improved survival rate persisted at the 12-month follow-up (P = .01).
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Meaningful differences in nutritional value between pasteurized and unpasteurized milk have not been demonstrated, and other purported benefits of raw milk consumption have not been substantiated. Conversely, the role of unpasteurized dairy products in the transmission of infectious diseases has been established repeatedly. To effectively counsel patients attracted by the health claims made for raw milk, practicing physicians must understand both the rationale used by proponents of raw milk and the magnitude of the risk involved in drinking raw milk.
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Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The acronym "CAGE" helps the physician to recall the questions. How these questions were identified and their use in clinical and research studies are described.