JAMA : the journal of the American Medical Association
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After a defibrillation attempt started a fire in an oxygen-enriched intensive care unit environment, seven popular electrode gels were tested for spark-generating properties by repeated 360-J electrical discharges into a 50-omega test load. Gels with low initial impedance (7 +/- 1 omega) allowed a high current flow (51 +/- 1 A), maintained a cool temperature (27 degrees C to 33 degrees C), and did not spark. Gels with high initial impedance (125 +/- 14 omega) allowed less current (26 +/- 2 A), heated to 52 degrees C +/- 2 degrees C, liquified, and generated an electrical spark after the fourth or fifth discharge. Federal standards should be developed to identify and label electrode gels that can be used safely for high-current applications such as defibrillation.
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Despite the large number of elderly patients in nursing homes and the intensity of medication use there, few current data are available on patterns of medication use in this setting. We studied all medication use among 850 residents of 12 representative intermediate-care facilities in Massachusetts. Data on all prescriptions and patterns of actual use were recorded for all patients during one month. ⋯ These data indicate that despite growing evidence of the risks of psychoactive drug use in elderly patients, the nursing home population studied was exposed to high levels of sedative/hypnotic and antipsychotic drug use. Suboptimal choice of medication within a given class was common, and use of standing vs as-needed orders was often not in keeping with current concepts in geriatric psychopharmacology. Additional research is needed to assess the impact of such drug therapy on cognitive and physical functioning, as well as to determine how best to improve patterns of medication use in this vulnerable population.
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The relationship between hyperglycemia, measured by glycosylated hemoglobin at the initial examination, and the four-year incidence and progression of diabetic retinopathy was examined in a population-based study in Wisconsin. Younger- (n = 891) and older-onset (n = 987) persons participating in baseline and follow-up examinations were included. Glycosylated hemoglobin was measured by microcolumn. ⋯ Among older-onset persons not taking insulin, relative risks were 4.0 for any retinopathy and 6.2 for progression. A positive relationship between incidence and progression of retinopathy and glycosylated hemoglobin remained after controlling for duration of diabetes, age, sex, and baseline retinopathy. These data suggest a strong and consistent relationship between hyperglycemia and incidence and progression of retinopathy.