Articles: mortality.
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The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. Using data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study, the authors assessed the 20-year mortality experience of smokeless tobacco users. Subjects aged 45 years or more at baseline (1971-1975) were categorized as either smokeless tobacco users (n = 1,068) or non-smokeless tobacco users (n = 5,737). ⋯ The lung cancer mortality rate among combined users (smokeless tobacco and cigarettes), based on the rates for exclusive smokeless tobacco users and exclusive smokers, was higher than expected, possibly because of heavier smoking among these subjects. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products.
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Semin Respir Crit Care Med · Oct 2002
Strategies for prevention of hospital-acquired pneumonia: oral and selective decontamination of the gastrointestinal tract.
The use of antimicrobial prophylaxis is the most extensively studied, though probably also the most controversial, method to prevent the development of ventilator-associated pneumonia (VAP). Selective decontamination of the digestive tract (SDD) includes the application of topical nonabsorbable antibiotics in the oropharynx, stomach, and intestines in combination with systemic antibiotics during the first days of ventilation. ⋯ Moreover, the significant reductions in incidences of VAP have, so far, not resulted in reductions of duration of ventilation and ICU-stay, and reductions in ICU-mortality were found only in meta-analysis. Selection of resistant bacteria is the most important drawback of antimicrobial prophylaxis, and the demonstrated benefits of antimicrobial prophylaxis should be carefully balanced with this potential risk.
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To describe the red blood cell transfusion practices of pediatric intensivists. ⋯ This survey documented a significant variation in transfusion practice patterns among pediatric critical care practitioners with respect to the threshold hemoglobin concentration for red blood cell transfusion. The volume of packed red blood cells given was not adjusted to the hemoglobin concentration.
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Semin Respir Crit Care Med · Oct 2002
Pneumonia complicating the acute respiratory distress syndrome.
Ventilator-associated pneumonia (VAP) complicating the course of acute respiratory distress syndrome (ARDS) is one of the most challenging diagnostic and treatment dilemmas in critical care medicine. The VAP incidence rate ranges from 37 to 60% in ARDS patients, significantly greater than for other causes of respiratory failure. Although the normal risk factors for VAP are the same in ARDS patients, multiple aspects of the underlying disease and its management increase the risk compared with non-ARDS patients. ⋯ The multilobar but predominantly lower lobe pattern of pneumonia in ARDS makes use of quantitative cultures of lower respiratory secretions (sampled by various techniques) very accurate to confirm the presence of pneumonia. VAP in ARDS patients is usually late-onset and therefore caused by highly antibiotic-resistant microorganisms. Somewhat surprisingly, the mortality of ARDS patients with VAP is not significantly greater than that of ARDS patients without VAP, although subsequent duration of mechanical ventilation is consistently prolonged in patients with VAP.
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Historical Article
Twentieth-century social and health-care influences on location of death in Canada.
Providing the right care, in the right place, to dying persons is hampered by a lack of understanding of where death and dying normally take place and ignorance about what influences location of death. This paper reports the findings of a multidisciplinary historical investigation of 20th-century influences on location of death in Canada. It builds on a study that found a hospitalization-of-death trend in Canada over much of the 20th century but a reduction in hospital deaths beginning in 1994. ⋯ A number of developments limited the availability of home care for chronically ill and terminally ill persons, including the increased participation of women in the workforce and the shift in nursing from private home duty to hospitals. Although some health and social support for home care has developed recently, this support clearly does not match that for hospital care. These findings indicate that location of death is an important focal point for studying and planning improvements in end-of-life care.