Arch Intern Med
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Comparative Study
Colorectal cancer detection in the practice setting. Impact of fecal blood testing.
To assess the contribution of fecal blood testing to cancer detection in a clinical practice setting, we studied records from 160 patients with both a new tissue diagnosis of colorectal adenocarcinoma and a preceding stool blood test (HemoQuant, Mayo Medical Laboratories, Rochester, Minn) determination. In this group, 71% had suggestive colorectal symptoms (particularly stool changes, overt bleeding, and abdominal pain) or anemia at presentation, and 29% were asymptomatic. ⋯ Fecal blood levels were higher with advanced, larger, and more proximal tumors and with stools collected before purgation. We conclude that, in the practice setting, fecal blood level elevation alone is an uncommon but important manner of colorectal cancer presentation, most cancers present with symptoms, and fecal blood levels are often normal in both symptomatic and asymptomatic patients.
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We reviewed the records of 274 consecutive deaths at the Milton S. Hershey Medical Center, Hershey, Pa, occurring through May 1988 to examine the approach of physicians, patients, and families in making the decision to invoke the "do-not-resuscitate" order. Of these 274 patients who died, 171 (62%) had do-not-resuscitate orders. ⋯ In turn, 36 (75%) of these patients participated in the do-not-resuscitate decision. Nursing activities were quantified for the 24 hours preceding and the 24 hours following the do-not-resuscitate order. No difference could be found comparing these two periods whether the comparison was made on the general hospital ward or in the intensive care unit.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Hypoglycemic coma in anorexia nervosa. Case report and review of the literature.
Clinically significant hypoglycemia is an unusual complication of anorexia nervosa. We describe a 44-year-old woman with a 5-year history of anorexia nervosa who presented with hypoglycemic coma and eventually experienced sudden death. ⋯ Nine previously reported cases of severe hypoglycemia in anorexia nervosa are reviewed (six of the patients involved also died). The presence of severe hypoglycemia in anorexia nervosa implies a grave prognosis and mandates aggressive medical and nutritional therapy to improve the chance of survival.
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A survey of alcohol and other drug-use patterns of 300 second- and third-year students at a mid-Atlantic private medical school was undertaken in 1987. Two hundred sixty-three (88%) of the medical students surveyed completed the anonymous questionnaire. Tobacco use decreased from 11% before to 4% during medical school. ⋯ Frequent use of cocaine (greater than 10 times) during medical school, reported by 5% of the students, was directly related to excessive alcohol intake, tobacco dependence, frequent use of marijuana before and during medical school, and medical and behavioral problems related to alcohol and other drug use. Less than 25% of medical schools have a formal policy aimed at identifying impaired students, and only 12% have formal treatment protocols for helping impaired students. We propose that all medical schools initiate programs to diagnose alcohol and other drug-abuse problems in medical student candidates and in the students themselves, and that intervention for any alcohol or other drug problem be encouraged and supported by formal medical school policies designed to help the impaired student.
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Central to the nature of the physician-patient relationship is how fully patients are informed about their disease and prognosis and how active a role they take in deciding treatment; the "autonomy" and "paternalistic" models represent current poles of physician behavior. While informed consent has become ubiquitous in medical practice, it is not clear to what extent the value of patient autonomy has entered into everyday medical decisions. ⋯ We found that most patients wanted guidance from their physicians and most physicians did not view the patient as autonomous. The more traditional parentalistic model continues to influence the physician-patient relationship, at least for this technical endeavor.