Arch Intern Med
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Adherence with clinical practice guidelines is highly variable. Reasons for their inconsistent performance have not been well studied. ⋯ Nonadherence to a pneumonia guideline was associated with a variety of patient, system, and physician factors. Guideline implementation strategies should take into account the heterogeneous forces that can influence physician decision making.
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Comparative Study
Attitudes and practices concerning the end of life: a comparison between physicians from the United States and from The Netherlands.
This study compares attitudes and practices concerning the end-of-life decisions between physicians in the United States and in the Netherlands, using the same set of questions. ⋯ In this study of American and Dutch physicians, 2 important differences emerge: different attitudes toward the patient who is concerned over being a burden, and different frequency of euthanasia and PAS in the two countries.
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Review Practice Guideline Guideline
Guidelines for nonemergency use of parenteral phenytoin products: proceedings of an expert panel consensus process. Panel on Nonemergency Use of Parenteral Phenytoin Products.
This document summarizes the proceedings of an expert panel consensus process addressing the nonemergency use of parenteral phenytoin products for management of seizures in pediatric and adult patients. The algorithm and consensus statements developed by the expert panel emphasize strategies for lowering the probability of adverse events associated with the use of parenteral phenytoin products. ⋯ Key factors covered in the algorithm include a list of patient characteristics and considerations necessary to prevent parenteral phenytoin adverse effects during selection of administration route and recommendations for monitoring of parenteral phenytoin therapy once it has been initiated. Situations requiring rapid attainment of high phenytoin concentrations, such as in the management of acute seizures, are not addressed in these guidelines.
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Comparative Study
Cranial computed tomography before lumbar puncture: a prospective clinical evaluation.
To prospectively identify which patients can safely undergo lumbar puncture (LP) without screening cranial computed tomography (CT). ⋯ Because of the low prevalence of lesions that contraindicate LP, screening cranial CT solely to establish the safety of performing an LP typically provides limited additional information. Physicians can use their overall clinical impression and 3 clinical predictors to identify patients with the greatest risk of having intracranial lesions that may contraindicate LP.
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Partial thromboplastin time: prediction of adverse events and poor prognosis by low abnormal values.
Clinical observations suggest an increased incidence of bleeding and thrombosis in association with a shortened partial thromboplastin time (PTT). ⋯ Abnormally fast PTTs, particularly if confirmed on repeated testing, indicate a significant risk of subsequent death, thrombosis, bleeding, and overall morbidity. Careful examination of patients with low PTTs may reduce such associated morbidity and mortality.