Arch Intern Med
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In making decisions about life-sustaining medical interventions, respect for patient autonomy has been widely advocated, yet little is known about what variables may compete with a physician's ability to honor patient requests in clinical situations. We investigated physician attitudes and behaviors about end-of-life decisions by means of a questionnaire that posed five hypothetical scenarios in which an elderly, competent, terminally ill patient made a request that, if agreed to by the physician, could result in the patient's death. ⋯ Difficult clinical decisions regarding potentially life-prolonging measures are commonly heard in clinical practice. Physicians value the concept of patient autonomy but place it in the context of other ethical and legal concerns and do not always accept specific actions derived from this principle.
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Review Case Reports
Salmonella aortitis. A report of a successfully treated case with a comprehensive review of the literature.
A successfully treated case of Salmonella infection of the thoracic aorta is described. Salmonella enteritidis was isolated from blood cultures and from operative cultures of the aorta. ⋯ The pathogenesis, clinical and laboratory characteristics, and the treatment of aortitis due to Salmonella species are reviewed in 98 cases reported in the English-language literature since 1948. Early diagnosis and a combination of prompt surgical intervention and antibiotic therapy are essential for survival.
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Despite growing support for advance directives, there are few data validating their utility. We conducted this study to determine if the type of advance directive influences physicians' willingness to withhold specific therapies and if physicians are equally willing to withhold these therapies. ⋯ Detailed advance directives with a supportive proxy, coupled with physician-patient discussion, furnish the most reliable medical directives. Even with such directives, physicians are more likely to withhold life-saving therapies than simple tests, treatments, and pain medications.
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Comparative Study
Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation.
The purpose of this study was to determine the prevalence and determinants of acute renal failure in patients following cardiac arrest. ⋯ We conclude that acute renal failure occurs commonly in the postcardiac arrest period. Administration of the vasoconstrictor epinephrine, congestive heart failure, coronary artery disease, and preexisting renal insufficiency may be significant risk factors for the development of postcardiac arrest acute renal failure. The development of acute renal failure following cardiopulmonary resuscitation predicts a lesser likelihood of survival to discharge from the hospital.