ABSTRACT
The year 1996 marks the fifth anniversary of the federal Patient Self-Determination Act. The Patient Self-Determination Act required hospitals, nursing homes, and health plans to ask whether patients have advance directives and to incorporate them into the medical record. A "living will" is an advance directive by which a person tells caregivers the circumstances in which life-sustaining treatment is to be provided or forgone if the patient is unable to communicate. A "durable power of attorney for health care" enables one to designate a person to speak on his or her behalf if the author loses decision-making capacity. "Advance planning" is the process of reflection, discussion, and communication of treatment preferences for end-of-life care that precedes and may lead to an advance directive.
Subject(s)
Advance Care Planning , Advance Directives , Empirical Research , Communication , Comprehension , Humans , Physician-Patient Relations , Resuscitation Orders , Social Values , Terminal Care , Uncertainty , Withholding TreatmentSubject(s)
American Medical Association , Ethics, Medical , Managed Care Programs/standards , Physician-Patient Relations , Resource Allocation , United States Federal Trade Commission/standards , Conflict of Interest , Cost Control , Disclosure , Ethical Analysis , Federal Government , Government Regulation , Health Care Rationing , Managed Care Programs/legislation & jurisprudence , Patient Advocacy , Social Responsibility , United States , Withholding TreatmentABSTRACT
OBJECTIVE: To compare the gastrointestinal safety, ulcerogenic potential, and clinical efficacy over 5 years of nabumetone and naproxen therapy, in patients with rheumatoid arthritis (RA) or osteoarthritis (OA). METHODS: Fifty-two patients entered a randomized, double blind study. Patients were randomized to 3 months treatment with either nabumetone, 1000 mg nightly, or naproxen, 250 mg twice daily, followed by an endoscopist-blind 5-year followup study. After the double blind phase, 15 patients in the nabumetone group and 12 in the naproxen group continued in the longterm endoscopist-blind phase. Endoscopic evaluations for gastroduodenal damage and global assessments of arthritis activity and degree of pain for efficacy were measured. RESULTS: Over the 5-year period, endoscopically visible gastroduodenal ulceration was found in 8 of the naproxen treated patients compared with one of the nabumetone treated patients (p = 0.02). There was a significant difference in the time to develop an ulcer, with a greater risk of developing an ulcer sooner while taking naproxen (p < 0.01). Patients in both groups reported significant improvements in arthritis symptoms (p < 0.01). CONCLUSION: Nabumetone appears to have a significantly lower ulcerogenic potential than naproxen over a 5-year period, and there is a trend toward better tolerability as measured by withdrawals for adverse experiences.
