Clinical and investigative medicine. Médecine clinique et experimentale
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To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated with survival to the time of hospital discharge. ⋯ Survival to hospital discharge after cardiac arrest remains static. Initial cardiac rhythm and duration of resuscitation before spontaneous return of circulation were the most important risk factors for survival. These factors and the patient's functional status are relevant when discussing cardiac resuscitation with patients or when considering whether to discontinue resuscitation efforts.
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Comparative Study
Vancomycin use in 2 Ontario tertiary care hospitals: a survey.
Use of vancomycin is a risk factor for acquiring vancomycin-resistant enterococci (VRE). To optimize the use of vancomycin in hospitals, the Hospital Infection Control Practices Advisory Committee (HICPAC) published recommendations in 1995. The objectives of this study were to determine the frequency, indications, and risk factors for inappropriate inpatient vancomycin prescriptions before and after publication of the HICPAC recommendations. ⋯ A high proportion of vancomycin prescriptions, surveyed before and after publication of the HICPAC recommendations on vancomycin use, were inappropriate. Excessive vancomycin use in surgical prophylaxis was an important factor. Our findings suggest that the use of standardized peri-operative order forms and of penicillin-allergy testing may help optimize vancomycin use in tertiary care hospitals.
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Review Historical Article
The challenge for basic science education in problem-based medical curricula.
There has been intense debate about medical curriculum reform since the early 1950s. The last 25 years have seen a steady shift ward problem-based learning curriculum design in schools of medicine and allied health sciences. This trend has been less challenging for clinical departments than for departments of basic science, where it has often evoked anxiety, antipathy, lack of cooperation, and general mistrust. ⋯ The process of change in medical education initiated by Abraham Flexner early in this century remains incomplete. One reason why curricular changes have proved frustrating to basic scientists is that much of clinical medicine remains unnecessarily unscientific. Until clinical medicine itself changes, the utility of science in the training of a physician will remain difficult to demonstrate.