The American journal of medicine
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Multicenter Study
Advance directives: ambulatory patients' knowledge and perspectives.
There is a growing awareness of the need for discussion of advance directives (ADs) in the ambulatory setting, but rates of completion remain low. Clarification of patients' perceptions and knowledge would help in designing future strategies. ⋯ A large number of patients in an ambulatory internal medicine practice knew about ADs and believed they had completed such documents, but these documents were often not in the chart. Many patients believe discussions of ADs are not appropriate for them. A better understanding of this phenomenon will help in promoting effective advance care planning.
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Jehovah's Witnesses are primarily known to physicians for their refusal of blood transfusions. Conflict arises at times with the medical staff concerning how best to manage their care. This article will begin with a brief description of the beliefs of Jehovah's Witnesses and will then recommend specific clinical strategies highlighting newer potential therapies according to the principles of bloodless medicine. ⋯ The experience of organ transplantation in Jehovah's Witnesses will be detailed. Further resources for physicians with questions in the care of these patients will be listed. Stressed throughout the article will be the need for a team approach and good communication between physicians to successfully care for their patients who are Jehovah's Witnesses.
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Practice Guideline
Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators.
To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials. ⋯ The sequence for diagnostic test in patients with suspected pulmonary embolism depends on the clinical circumstances.
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Our current understanding of the prevalence of syncope is based on a few small studies of highly selected populations. We sought to estimate the prevalence and recurrence rate of syncope in the general population aged more than 45 years and to analyze their associations with age and sex. ⋯ The prevalence of syncope is estimated at 19% in the general population aged more than 45 years. Females have a higher prevalence, and there is no association of syncope prevalence with age.