Journal of general internal medicine
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To assess the risk of mortality in patients with hyponatremia at the time of hospital admission, the authors studied data for 13,979 patients admitted over a 46-month period. Of the 763 (4%) admitted with hyponatremia, 757 (99%) were matched by age, gender, and admitting date with normonatremic control patients. ⋯ This relationship with in- and outpatient mortality held when controlling for the diagnoses found more often in the hyponatremic patients. Hyponatremia appears to be an indicator of increased risk of death regardless of the disease with which it is associated.
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The authors evaluated the perceptions and adjustments of surviving spouses following patient deaths. Of 128 married patients dying in a university hospital in 1983, the surviving spouses of 105 (82%) were personally interviewed a year after the death. The physicians' perspectives were recorded through chart review. ⋯ Survivors of unexpected deaths were found to be at high risk for poor subsequent adjustment. Spouses with poorer adjustments consulted their own physicians more frequently, and used more alcohol and tranquilizers. The results identify areas where improvement is needed in communication with surviving spouses after patients' deaths.
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Comparative Study
Stress during internship: a prospective study of mood states.
Mood changes of interns during the internship year were studied using the Profile of Mood States (POMS), a standardized adjective checklist. All 35 interns in the University of California, Irvine-Long Beach Medical Program completed the POMS at internship orientation and at five other times during the year. Of the six mood factors measured by the POMS, four changed significantly during the testing period. ⋯ Vigor-activity scores were higher (p less than 0.01) at orientation than at the end of the year. Depression-dejection and confusion-bewilderment scores did not change significantly during the study period. Recognition of these mood changes is helpful for drawing the attention of house staff and faculty members to emotional stresses of training, and for identifying issues for discussion in intern support groups.
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Some of the physician's most difficult decisions involve whether to give cardiopulmonary resuscitation (CPR). Current research, hospital policies, and case law provide little guidance for these decisions, but medical ethics offers three useful principles. All three are based on patients' wishes. ⋯ Finally, if CPR will serve no therapeutic goals defined from the patient's wishes, it should not be given. Applying these principles requires a sympathetic, directed history which elicits the patient's wishes relevant to resuscitation. This article uses an actual case and a simple algorithm to show how these principles promote ethically sound resuscitation decisions.