Arch Intern Med
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Several interventions have been shown to be of benefit to patients with stroke (hereafter referred to as stroke patients) in clinical trials, but the net effect of these interventions in the general stroke population has not been established. The purpose of this study was to evaluate temporal trends in the characteristics, treatments, and outcomes of acute stroke patients in the province of Ontario. ⋯ Improvements in the outcomes of stroke patients have occurred in Ontario during the 1990s, despite an increasing proportion of elderly stroke patients with multiple comorbidities. Increasing use of secondary prevention medications may explain this trend.
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Case Reports
Sedative use in the last week of life and the implications for end-of-life decision making.
The use of sedation at the end of life has aroused ethical controversy, attracting accusations of hastening death by gradually increasing sedative doses. The doctrine of double effect has been introduced as an ethical defense. This study aimed to determine how sedative doses change at the end of life and how often the doctrine of double effect might be relevant. ⋯ Sedative dose increases in the last hours of life were not associated with shortened survival overall, suggesting that the doctrine of double effect rarely has to be invoked to excuse sedative prescribing in end-stage care.