JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Clinical Trial
The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma.
To determine whether the presence of a physician in the prehospital setting influences patient outcome, the predicted mortality of 258 patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight paramedic was compared with that of 316 similar patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight physician. All patients were randomized between the two treatment teams. The mortality of the patients treated by the flight nurse/flight paramedic team was that predicted by the methodology. The mortality of the patients treated by the flight nurse/flight physician team was 35% lower than that predicted, and significantly lower than that of the flight nurse/flight paramedic-staffed helicopter.
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Mediterranean populations have low incidence rates of cardiovascular disease and hypertension that may be due, in part, to dietary factors, particularly a relatively high intake of monounsaturated fat as olive oil. In this study, nutritional components (as grams per 4200 kJ) (1 kcal = 4.2 kJ) from three-day food records were examined in association with resting blood pressure in a cross-sectional survey of 76 sedentary middle-aged American men, aged 30 to 55 years, with resting blood pressures below 160/100 mm Hg. Systolic and diastolic blood pressures correlated significantly and inversely with monounsaturated fat consumption. ⋯ Detailed analyses of specific fatty acids showed that the correlations with monounsaturates were specific to oleic acid, and the correlation with polyunsaturates was specific to linoleic acid. Multiple regression analysis suggested that 18.2% of the variance in systolic blood pressure and 23.2% of the variance in diastolic blood pressure were related to monounsaturated and polyunsaturated fat consumption and regional adiposity. Thus, increased consumption of monounsaturated fat is related inversely to resting blood pressure, although causality remains to be determined.
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In response to several House of Delegates resolutions and Council on Scientific Affairs recommendations, the American Medical Association and the American Psychiatric Association have completed a joint study on physician suicide. Comprehensive interviews were conducted with surviving relatives and friends of 142 physicians who died by suicide and 101 physicians who died of causes other than suicide. ⋯ Bivariate relationships were found between several variables and risk for suicide, and all were examined in a multivariate framework. A preliminary profile of the physicians who took their own lives showed that they more often made prior suicide attempts, verbalized suicidal intentions, self-prescribed psychoactive drugs, and suffered financial losses.