JAMA : the journal of the American Medical Association
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To investigate variability in practices for determining brain death and organ procurement results in pediatric intensive care units (PICUs). ⋯ Substantial variability exists in the criteria used by clinicians for the diagnosis of brain death. Some practices are contradictory to the Guidelines for the Determination of Brain Death in Children and to recommendations for apnea testing. Organ procurement could be improved by increased medical examiner cooperation.
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Randomized Controlled Trial Clinical Trial
The effect of zinc supplementation on pregnancy outcome.
To evaluate whether zinc supplementation during pregnancy is associated with an increase in birth weight. ⋯ Daily zinc supplementation in women with relatively low plasma zinc concentrations in early pregnancy is associated with greater infant birth weights and head circumferences, with the effect occurring predominantly in women with a body mass index less than 26 kg/m2.
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To determine whether African-American children with asthma use more emergency department (ED) and inpatient medical services and fewer preventive services than white children with similar insurance coverage and family income. ⋯ Higher use of ED and inpatient services for asthma among African-American children using Medicaid (compared with white children) cannot be fully explained by poverty or inadequate health insurance. Furthermore, these children appear to make disproportionately few office visits for asthma, suggesting suboptimal use of preventive services for asthma. In contrast, the comparable use of well-child visits in the two groups suggests the problem may not be in access to care in general, but there may be specific problems in the successful management of chronic diseases such as asthma among African-American children.
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The field of advance directives has come a long way. It has further to go, and like other new interventions in medicine, it will continue to evolve. ⋯ An immediate agenda for action might look something like the following: (1) encouraging ambulatory care physicians to cosign advance care documents, (2) providing validated worksheets by institutions for ready office and ward use, (3) educating physicians in how to conduct advance planning, and (4) including advance planning discussions in reimbursement systems. Additional moves should include adjustment of medical law to reflect two categories of incompetence and further research on advance care planning to ensure continuing improvement.