JAMA : the journal of the American Medical Association
-
Comparative Study
Black-white differences in stroke incidence in a national sample. The contribution of hypertension and diabetes mellitus.
Although national data have consistently shown an increased risk of death from stroke among blacks, few studies have addressed the reasons for this excess mortality. We compared the incidence of stroke among 1298 blacks and 7814 whites, aged 35 to 74 years, in the 10-year follow-up of the respondents from the First National Health and Nutrition Survey. ⋯ The relative risks for stroke associated with hypertension and diabetes mellitus were unrelated to race. Although efforts to treat hypertension and diabetes are among the most important public health measures for reducing stroke, a more complete understanding of the determinants of stroke may be required to account for the excess stroke risk experienced by blacks.
-
Hospital policies typically require that cardiopulmonary resuscitation be attempted unless a do-not-resuscitate order has been written, and they further require that family permission for the order be obtained. This sometimes forces physicians to perform procedures that are useless or that add to the patient's suffering without corresponding benefit. Policies should be changed to allow physicians to write a do-not-resuscitate order over family objections when (1) the patient lacks decision-making capacity, (2) the burdens of treatment clearly outweigh the benefits, (3) the surrogate does not give an appropriate reason in terms of patient values, preferences, or best interests, and (4) the physician has made serious efforts to communicate with the family and to mediate the disagreement. Furthermore, when resuscitation would clearly provide no medical benefit to the patient, policy should not require that it be discussed with either the patient or the family.
-
Many studies have shown that selected cardiac patients can be safely and economically cared for in intermediate care units rather than intensive care units. However, there are only limited data concerning intermediate care units for pulmonary patients. ⋯ The overall cost savings were greater than $173,000, while high-quality medical care was maintained. We conclude that a noninvasive monitoring unit can be effectively used as an alternative to the intensive care unit for selected pulmonary patients.