Annals of internal medicine
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To determine whether gastric intramural pH (pHi), an indirect measure of gastric mucosal ischemia, can be used to predict the success of weaning from mechanical ventilation. Gastric mucosal ischemia (and, therefore, acidosis) may develop in patients during unsuccessful attempts to wean them from mechanical ventilation because blood flow from nonvital areas (for example, splanchnic bed) is diverted to meet the increased demands of respiratory muscles. ⋯ Gastrointestinal acidosis may be an early sign of weaning failure. Measurement of pHi, which is simple and rapid, may be of practical value in predicting the likelihood of weaning success or failure during weaning trials.
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Comparative Study
Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research.
To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease. ⋯ Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.
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To understand better the decline in medical student interest in internal medicine. ⋯ Students, particularly female students, expressed a strong interest in establishing better relationships with patients. Lack of respect by medical attendings and negative teaching methods were important sources of dissatisfaction among both men and women. Attention to these relationship issues, in addition to housestaff stress and expected future income, may improve the attractiveness of internal medicine.
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To determine whether plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and lipopolysaccharide are detectable in patients when they first present with the sepsis syndrome and to determine whether levels correlate with patient survival. ⋯ Patients with the sepsis syndrome have detectable levels of circulating TNF-alpha, IL-1, IL-6, and lipopolysaccharide independent of culture-documented infection. Lipopolysaccharide and cytokines may play a pathogenic role in sepsis, and the combination of several elevated factors may be important in determining patient survival.
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Data on body weight and weight change collected from nationally representative samples of U. S. adults are reviewed. The body mass index (weight [kg]/height [m2]) has a low correlation with height and is used to compare body weights between persons of differing heights. ⋯ Longitudinal body weight measurements taken 10 years apart show that adults younger than 55 years tend to gain weight, whereas those 55 years and older tend to lose weight. The youngest adults gain the most weight, and the oldest adults lose the most weight. In all age groups, women have substantially greater variation in their 10-year weight change than do men.