JAMA : the journal of the American Medical Association
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The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). ⋯ Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.
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Meta Analysis
Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials.
Lowering low-density lipoprotein cholesterol (LDL-C) is known to reduce risk of recurrent coronary heart disease in middle-aged men. However, this effect has been uncertain in elderly people and women. ⋯ Our meta-analysis indicates that reduction in LDL-C associated with statin drug treatment decreases the risk of coronary heart disease and all-cause mortality. The risk reduction was similar for men and women and for elderly and middle-aged persons.
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Sir William Osler is one of the most admired and honored physicians in the history of medicine. He influenced the development of medicine in Canada, the United States, and Great Britain, where he held professorships at McGill University, the University of Pennsylvania, Johns Hopkins University, and Oxford University. ⋯ In this sesquicentennial of his birth, William Osler continues to serve as a model of excellence for the medical profession. This examination of the reasons for his enduring impact reveals a legacy of clinical, scientific, literary, educational, and intraprofessional accomplishments linked to a remarkable personality, and bound together by an extraordinary humanism.
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Acquired immunodeficiency syndrome-related opportunistic illnesses (Ols) continue to occur after initiation of potent antiretroviral therapy in patients with human immunodeficiency virus (HIV) infection. Risk factors for clinical progression to Ols during potent therapy are not well defined. ⋯ Our data indicate that the risk of developing an OI for a person receiving potent antiretroviral therapy is highest during the initial months of therapy. Baseline CD4 cell count and immunologic and virologic response to treatment were strong predictors of disease progression in patients receiving potent therapy. Individuals with CD4 cell counts of 50 x 10(6)/L or below may need close clinical surveillance after initiation of potent therapy.
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There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. ⋯ Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.