Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/mortality , Antiretroviral Therapy, Highly Active/methods , Intensive Care Units , APACHE , Acquired Immunodeficiency Syndrome/diagnosis , Anti-HIV Agents/therapeutic use , Critical Care/methods , Critical Illness , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/mortality , Hospital Mortality/trends , Humans , Male , Prognosis , Risk Assessment , Survival Analysis , Treatment OutcomeSubject(s)
Heat Stress Disorders , Weather , Aged , Chicago/epidemiology , Health Education/organization & administration , Heat Stress Disorders/etiology , Heat Stress Disorders/mortality , Heat Stress Disorders/prevention & control , Humans , International Cooperation , Paris/epidemiology , Risk Factors , Social Isolation , Urban HealthSubject(s)
Infectious Disease Transmission, Professional-to-Patient , Intensive Care Units , Nursing Staff, Hospital , Physicians , Cross Infection/prevention & control , Cross Infection/transmission , Hand Disinfection , Humans , Infection Control/methods , Infection Control/standards , Risk , WorkloadSubject(s)
Biomedical Technology , Critical Care/trends , Computers , Humans , Television , Time FactorsABSTRACT
STUDY OBJECTIVES: To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA). DESIGNS: Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998). SETTING: Inner-city, public hospital ICU. PATIENTS: Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results. MEASUREMENTS AND RESULTS: In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups. CONCLUSIONS: At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.
Subject(s)
Asthma/chemically induced , Heroin/adverse effects , Urban Population , Adolescent , Adult , Asthma/epidemiology , Case-Control Studies , Chicago/epidemiology , Cocaine-Related Disorders/epidemiology , Cross-Sectional Studies , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/epidemiology , Female , Heroin/administration & dosage , Heroin Dependence/epidemiology , Humans , Intensive Care Units , Male , Middle Aged , Patient Admission , Retrospective Studies , Substance Abuse Detection , Urban Population/statistics & numerical dataABSTRACT
Low levels of high-density lipoprotein cholesterol (HDL-C) are currently considered to be a major risk factor for the development of coronary artery disease (CAD). Deficiencies in the HDL metabolic pathway promote atherosclerosis and contribute to CAD. Low HDL-C levels are included in the Framingham 10-year risk assessment for CAD although they are not yet targeted for therapy. Recent clinical trials have shown benefits from raising HDL-C, particularly in patients with lower baseline levels. The statin class of drugs, used primarily to lower the level of low-density lipoprotein-cholesterol, may be able to raise the HDL-C level as well. Statins could potentially affect HDL-C by different modes of action, most importantly by altering reverse cholesterol transport. Among the currently available statins, simvastatin has demonstrated the most consistent ability to raise HDL-C level, but further large-scale studies at an early stage will be needed to prove the antiatherogenic effects of this class of drugs.
Subject(s)
Anticholesteremic Agents/pharmacology , Cholesterol, HDL/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Anticholesteremic Agents/therapeutic use , Cardiovascular Diseases/prevention & control , Cholesterol/metabolism , Cholesterol, HDL/physiology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
...allowing physicians to withhold life support and resuscitation because they feel it is futile, no matter how beneficent their intentions, would be an unwarranted step backwards toward the type of paternalism modern American society has turned away from. If we agree that all professional ethics must, in some way, be responsive to the society that profession serves, then in these most critical situations, the final decision must rest with the patient.
Subject(s)
Decision Making , Medical Futility , Patients , Physicians , Resuscitation Orders , Resuscitation , Withholding Treatment , Altruism , Beneficence , Critical Illness , Economics , Euthanasia, Passive , Family , Health Care Rationing , Hospitals , Humans , Informed Consent , Jurisprudence , Life Support Care , Mental Competency , Mortality , Paternalism , Patient Selection , Physician's Role , Physician-Patient Relations , Prognosis , Resource Allocation , Social Values , Third-Party Consent , TrustSubject(s)
Critical Illness , Decision Making , Euthanasia, Passive , Terminally Ill , Withholding Treatment , Advance Directives , Ethics Committees , Ethics Committees, Clinical , Family , Freedom , Humans , Informed Consent , Intensive Care Units , Jurisprudence , Mental Competency , Nutritional Support , Patients , Persistent Vegetative State , Personal Autonomy , Resuscitation Orders , Right to Die , Third-Party Consent , Treatment Refusal , United StatesABSTRACT
KIE: A case study is presented in which the 7-year-old son of an uninsured, unemployed single parent dies of leukemia before sufficient funds can be raised from the public for a bone marrow transplant. The state legislature had voted to reallocate Medicaid funding from organ transplants to medical services for low-income children and pregnant women. Three commentaries consider the moral justification for the legislature's decision and the priorities that should be set by policy makers for the allocation of health care resources.^ieng
