Arch Intern Med
-
Antiendotoxin monoclonal antibodies are under investigation as adjunctive therapy for severe sepsis. One of these antibodies (the human IgM monoclonal antibody HA-1A) was marketed in Europe during 1992 for treatment of patients with severe sepsis, especially those with shock, and probable gram-negative bacilli (GNB) bacteremia, after a placebo-controlled trial showed improved outcome in such patients. This cohort study was designed to assess characteristics and determinants of outcome of patients through a nationwide registry of all adult patients hospitalized in intensive care units of French hospitals and treated with HA-1A. ⋯ This cohort study did not confirm decreased mortality in patients with GNB bacteremia, as reported in the first placebo-controlled HA-1A trial, and it further suggests excess mortality in the subgroup of patients with non-GNB infection. In clinical trials of patients with severe sepsis, controlling for both the severity of acute illness score and the number of organ system failures, as well as for the severity of underlying disease and the source of infection, should be considered, especially when subgroups are analyzed.
-
The attitudes of hospitalized patients and their attending physicians about advance directives have not been well studied. We compared these attitudes and explored relationships between them and the frequency of actual directives and directive discussions during hospitalization. ⋯ Most medical inpatients in a community hospital want to, are able to, and meet their own physicians' indications to discuss advance directives. Hospitalization presents an unrealized opportunity for physicians and patients to initiate these discussions.
-
Review Historical Article
Cardiopulmonary resuscitation. Historical perspectives, physiology, and future directions.
To review the historical evolution and rationale for the development of new techniques of cardiopulmonary resuscitation (CPR). ⋯ Improved methods of CPR are now available. Selective use of CPR in the hospital and community training in the use of these new adjunctive techniques should have the greatest impact on improved survival after sudden cardiac arrest.