The American journal of medicine
-
To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value. ⋯ In a large cohort of unselected patients with chest pain syndromes, new wall motion abnormalities induced by dobutamine provide additional information for late cardiac events, independent of clinical variables.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Natural history and course of acquired lactic acidosis in adults. DCA-Lactic Acidosis Study Group.
To determine the pathogenesis and clinical course of lactic acidosis in adults receiving standard medical care. ⋯ In this first prospective study of the clinical course of acute lactic acidosis in adults, nearly all subjects had both hemodynamic and nonhemodynamic (metabolic) underlying causes, many of which independently predicted survival and most of which were refractory to standard care.
-
A patient's automony and right to determine his or her treatment is widely recognized in current ethical theory and medical practice. However, conflicts between the desire to respect a competent patient's religious conviction not to be violated and society's interest in preserving life do arise. This paper examines two cases involving Jehovah's Witnesses who signed cards refusing blood transfusions and who were subsequently transfused. ⋯ In the American case, the courts upheld the appointment of a guardian who authorized the transfusion. In the emergency situation, if there is a reasonable doubt about the validity of a treatment refusal, the presumption must be to render life-saving treatment. The author believes, however, that a written advance directive could be developed that respects he religious convictions of Jehovah's Witnesses and the ethical and legal responsibilities of physicians.
-
To study the accuracy of substituted judgments regarding life-sustaining therapies and other therapies made by surrogate decision makers and to investigate factors associated with more accurate predictions. ⋯ When pressed to choose, surrogates can predict the preferences of patients for life-sustaining therapies with an imperfect accuracy that nonetheless significantly exceeds the agreement expected due to chance alone. Exhorting surrogates to give their "best estimate" and encouraging prior discussions may improve accuracy. Houses of worship might be important target sites for campaigns to improve public awareness about advance directives.