Nursing homes are less well studied than hospices or hospitals as a setting for terminal care. This study examines patient characteristics, symptoms, direct causes and underlying diseases of terminally ill nursing home patients in the Netherlands. We conclude that the terminal phase of the mainly noncancer patients is difficult to predict and, once diagnosed, little time is left to provide good palliative care. A better identification of the symptom burden might improve the prognostication of life expectancy in the elderly.
The purposes of this study were to assess whether in-hospital mortality rates differed across lower- and higher-volume hospitals by expected surgical risk and if high-risk patients were more likely to undergo coronary artery bypass grafting at low-volume centers. Using data on 27 355 patients at 68 California hospitals, Nallamothu and colleagues discovered that differences in adjusted in-hospital mortality between low- and high-volume centers rose as the expected risk of in-hospital death increased. The authors also found that the likelihood of patients having surgery at a low-volume center also rose significantly with expected surgical risk. Thus, high-risk patients were more likely to undergo coronary artery bypass grafting at low-volume facilities where their risk of dying is higher.
This study documents emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing the integration of complementary and alternative medical therapies and health care providers into conventional medical settings. This study analyzes the extent to which institutions have developed consensus approaches concerning legal issues in developing models of integrative care and whether current approaches allow or impede the delivery of consistent clinical care and research.
Wang and colleagues performed a cross-sectional study to investigate whether cardiac valvular calcification is a marker of atherosclerosis in patients with end-stage renal disease. They found that valvular calcification was strongly associated with inflammation, increasing carotid intima-media thickness, and calcification, giving important evidence that valvular calcification is also a marker of atherosclerosis and arterial calcification in patients with end-stage renal disease.
Dramatic increases in the use of herbal and other natural products were reported during the last decade. Data obtained from a nationwide random digit dialing survey were examined to determine which dietary supplements American adults use, whether the prevalence has continued to increase in recent years, and whether the popularity of individual supplements has changed. The weekly prevalence of dietary supplement use increased from 14% in 1998-1999 to 19% in 2002. However, the increase was entirely accounted for by the use of lutein, a new addition to multivitamin products; the overall 2002 prevalence excluding lutein was 14%. Thus, although the sharp increase in supplement use in the 1990s appears to have slowed, the addition of supplements such as lutein and lycopene to mainstream multivitamins has become an important source of exposure.
Use of herbal products according to year of interview and age of subject.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2005;165(3):254. doi:10.1001/archinte.165.3.254