Arch Intern Med
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The knowledge, attitudes, and behavior of elderly persons regarding living wills were explored in a rural county in eastern North Carolina. A questionnaire was administered to 75 ambulatory elderly persons by personal interview at community dining sites. Fifty-two percent (39) of these subjects said they were familiar with living wills and 64% (48 persons) correctly summarized what the North Carolina living will says. ⋯ However, this elderly population did not make use of living wills as a means of indicating their wishes. Recommendations are made to improve physician-patient and patient-proxy communication regarding preferences for medical care at the end of life and living wills. Alternatives to the living will should also be explored.
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As part of a trial of ethics education in a university-based, categorical, internal medicine training program, we surveyed all medical house officers at our institution regarding their knowledge of medical ethics, their attitudes and beliefs about selected issues in medical ethics, and their confidence in dealing with ethical problems. In a multivariate linear regression model, house officer knowledge scores were negatively correlated with postgraduate year, and positively correlated with age and with reporting a Jewish religious identity. ⋯ Attitudes and beliefs were largely uncorrelated with training or demographic characteristics. These results have implications for ethics education of both medical students and residents.
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We describe cases of severe odynophagia, extensive oral ulcerations, and bowel perforation in patients with human immunodeficiency virus infection that were caused by lymphomatoid granulomatosis. Such presentations in human immunodeficiency virus-infected individuals are usually ascribed to other causes and may be incorrectly treated on an empiric basis. ⋯ We review our limited treatment experience with zidovudine, interferon alfa, and H2 blockers in our patients. Based on the markedly increased frequency in which lymphomatoid granulomatosis is being diagnosed at our institution in the post-human immunodeficiency virus era, we postulated an association between these two entities.
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An 18-year-old woman who underwent an elective second-trimester abortion developed Streptococcus agalactiae (group B streptococcus) endocarditis characterized by a large, pedunculated vegetation involving a previously normal tricuspid valve. Polyarthritic symptoms, as well as multiple pulmonary emboli, were experienced, and cure followed a course of treatment using intravenous penicillin G potassium combined with gentamicin sulfate. Endocarditis caused by this pathogen usually occurs among individuals compromised by underlying chronic disorders and, today, is a rare sequela of pregnancy and abortion. When planning therapy, consideration should be given to the possibility of tolerance among clinical isolates and the need for operative intervention in selected patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Absence of drug interaction between heparin and nitroglycerin. Randomized placebo-controlled crossover study.
The purpose of this randomized crossover study was to determine whether nitroglycerin interacts with heparin in terms of its anticoagulative properties as determined by activated partial thromboplastin time and thrombin time. Eight healthy adults were given either a 60-minute intravenous infusion of 5 mg of nitroglycerin or a 0.9% sodium chloride solution subsequent to the administration of an intravenous injection of 5000 U of heparin. No nitroglycerin-related drug interference with heparin was observed as measured by the activated partial thromboplastin time and the thrombin time.