Abstract:
:In 1988, a new do-not-resuscitate policy aimed at assisting professional staff, nurses, patients, and families in end-of-life choices replaced the existing policy at The Cleveland Clinic Foundation. We conducted a retrospective chart review to examine the effects of the new policy on length of stay. Data were collected on demographics, clinical information, length of stay, and the frequency of do-not-resuscitate orders for expired Medicare patients in 1987 (n = 125) and 1989 (n = 135). Length of stay for patients who received a do-not-resuscitate order was significantly reduced in 1989 compared with 1987, partly because the orders were issued earlier in patients' stays in 1989. The number of days from writing the order until death did not change significantly from 1987 to 1989. We conclude that a well-defined do-not-resuscitate policy can reduce length of stay.
journal_name
Cleve Clin J Medjournal_title
Cleveland Clinic journal of medicineauthors
Kanoti GA,Gombeski WR Jr,Gulledge AD,Konrad D,Collins R,Medendorp SVdoi
10.3949/ccjm.59.6.591subject
Has Abstractpub_date
1992-11-01 00:00:00pages
591-4issue
6eissn
0891-1150issn
1939-2869journal_volume
59pub_type
杂志文章abstract::Of the imaging techniques currently available to evaluate women for breast disease, mammography remains the mainstay of breast cancer screening, but recent guidelines have included magnetic resonance imaging (MRI) for the screening of some women at high risk. Whole-breast ultrasonography for screening has not been est...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.74.12.897
更新日期:2007-12-01 00:00:00
abstract::Thrombotic thrombocytopenic purpura, Shiga toxin hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and antiphospholipid syndrome are thrombotic microangiopathies that present similarly but arise from different causes. Management depends on distinguishing them promptly and providing targeted therapy. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.84gr.17001
更新日期:2017-02-01 00:00:00
abstract::Vascular surgery is associated with a high risk of perioperative morbidity and mortality that is partly attributable to inflammatory stress induced by the surgical procedure. Preoperative initiation of a long-acting statin is a strategy intended to reduce the inflammatory stress response and the excess risk associated...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.76.s4.13
更新日期:2009-11-01 00:00:00
abstract::Transitions of care-when patients move from one health care facility to another or back home-that are poorly executed result in adverse effects for patients. Fortunately, programs can be implemented that enhance collaboration across care settings and improve outcomes including reducing hospital readmission rates. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.81a.13106
更新日期:2014-05-01 00:00:00
abstract::Fraud in scientific research is a widespread problem. It can involve falsifying data or documents, or knowingly failing to comply with regulations protecting research participants. Fraud can be committed by individuals, institutions, or corporations; in the context of research, fraud often is motivated by consideratio...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.74.suppl_2.s63
更新日期:2007-03-01 00:00:00
abstract::A surprising number of apparently healthy people harbor unsuspected pituitary tumors, which are being discovered incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) performed for other reasons. The majority can be safely observed; for others, medical therapy or surgical resection is necessary....
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.75.11.793
更新日期:2008-11-01 00:00:00
abstract::We reviewed the population of a surgical intensive care unit from July 1, 1987 to June 30, 1988, adjusting for severity of illness using the APACHE II system. Nineteen different departments admitted a total of 613 patients to the surgical intensive care unit. Predicted mortality was 22.9%; actual mortality was 15.7%. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.58.6.477
更新日期:1991-11-01 00:00:00
abstract::Heart failure is the most important public health problem in cardiovascular medicine, and is increasing in both prevalence and expense. Programs that use an interdisciplinary team to improve outpatient treatment and prevent hospitalizations will help improve care and control costs. But the most important long-term str...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.65.7.351
更新日期:1998-07-01 00:00:00
abstract::The metabolic syndrome--the cluster of obesity, impaired fasting glucose, elevated triglycerides, low high-density lipoprotein cholesterol, and hypertension--may not be a "real" syndrome in the strict sense. It can, however, still be a useful concept if it prompts a physician to look for and treat additional risk fact...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.74.3.199
更新日期:2007-03-01 00:00:00
abstract::To determine whether migraine exhibits a circadian rhythm or occurs randomly throughout the day, we analyzed the time of migraine onset in 15 migraine suffers (migraineurs) over 20 weeks. The patients suffered 211 migraine attacks over 20 weeks (range 3 to 30, median 13). Twelve of the 15 migraineurs had 50% or more o...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.59.3.326
更新日期:1992-05-01 00:00:00
abstract::Evidence of a neurophysiologic mechanism that involves hormones from adipocytes, pancreatic islet cells, and the gastrointestinal tract implicated in both obesity and diabetes has led to a search for drugs that not only either target obesity and diabetes or reduce hemoglobin A1c, but also have weight loss as a potenti...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.84.s1.04
更新日期:2017-07-01 00:00:00
abstract::Food allergies have increased in prevalence significantly in the past decade and so, apparently, has eosinophilic esophagitis. Although the cause of eosinophilic esophagitis is unknown, allergic responses including food allergies have been implicated. This article reviews both conditions, focusing on how to detect and...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.77a.09018
更新日期:2010-01-01 00:00:00
abstract::Patients with systemic lupus erythematosus (SLE, lupus) have a markedly better survival rate today than they did 50 years ago, but they face a greater risk of cancer, cardiovascular disease, and osteoporosis at early ages. With better understanding of the immunological mechanisms of the disease, new avenues of therapy...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.76a.gr005
更新日期:2009-02-01 00:00:00
abstract::The decline in testosterone with age has been associated with specific physical changes that affect quality of life and life expectancy, although a cause-and-effect relationship is yet to be established. While female menopause is rapid and well described, "male menopause" or androgen decline in older men is gradual an...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.79a.12010
更新日期:2012-11-01 00:00:00
abstract::Recent studies have significantly broadened understanding of immunoglobulin production and T-cell receptor formation at the gene level. A limited number of genes can be rearranged during the course of B-cell or T-cell development to yield unique DNA sequences that will code for specific antibodies and T-cell receptor ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.56.7.716
更新日期:1989-10-01 00:00:00
abstract::The neurohormone arginine vasopressin (AVP) is a promising target in the treatment of heart failure because AVP promotes congestion and hyponatremia, each of which is associated with poor outcomes. Diuretics are standard therapy for heart failure, but they have several limitations, including worsening renal function a...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.73.suppl_2.s24
更新日期:2006-06-01 00:00:00
abstract::Complications of chronic gastroesophageal reflux disease (GERD) run the gamut from erosive esophagitis to esophageal cancer, but all are linked to repeated exposure of the esophagus to caustic gastric and duodenal acid. Progression from one complication to another is not clearly established across the GERD continuum, ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.70.suppl_5.s33
更新日期:2003-11-01 00:00:00
abstract::Patients with pulmonary arterial hypertension (PAH) may present to internists, rheumatologists, cardiologists, or pulmonologists. This breadth of clinicians who encounter PAH patients, together with the complicated nature of PAH as a disease entity, argues for a shared-care approach to the management of these patients...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.70.suppl_1.s28
更新日期:2003-04-01 00:00:00
abstract::Informed consent in clinical research is a matter of both ethics and federal regulation. A research subject must enter a study voluntarily, be informed about risks and benefits, and understand the difference between experiment and treatment. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.71.11.907
更新日期:2004-11-01 00:00:00
abstract::Numerous immunomodulating agents are currently being studied in clinical trials for the treatment of COVID-19, including interferon therapies. Interferons are naturally occurring host antiviral proteins upstream of the inflammatory pathway that are released by host cells in response to the presence of viral pathogens....
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.87a.ccc066
更新日期:2020-12-03 00:00:00
abstract::An immunocompromised patient presented with chronic low back pain as the initial symptom and a subcutaneous abscess as the initial sign of disseminated aspergillosis. With the rising incidence of immunocompromised patients, cutaneous manifestation of aspergillosis may become more common. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.57.1.92
更新日期:1990-01-01 00:00:00
abstract::Elderly patients pose unique challenges perioperatively. They are more likely than younger surgical patients to be mentally and physically compromised at baseline, which increases the risk of delirium and postoperative cognitive dysfunction. Postoperative cognitive risk can be predicted, however, and effective strateg...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.76.s4.03
更新日期:2009-11-01 00:00:00
abstract::The history and physical examination, rather than routine laboratory, cardiovascular, and pulmonary testing, are the most important components of the preoperative evaluation. The history should include a complete review of systems (especially cardiovascular and pulmonary), medication history, allergies, surgical and a...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.71.1.63
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:There are now more than 31 million people 65 years of age or older in the United States, at least half of whom have systolic blood pressure 140 mm Hg or higher or diastolic blood pressure 90 mm Hg or higher or both. By the year 2050, 16 million Americans will be over age 85. OBJECTIVE:To review the current ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.62.1.29
更新日期:1995-01-01 00:00:00
abstract::The treatment of hepatitis C has evolved rapidly since the identification of the hepatitis C virus (HCV) in 1989. Since the first accepted therapy for HCV infection, recombinant interferon, received marketing approval a little more than a decade ago, it has come to be used in combination with ribavirin for improved ra...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.71.suppl_3.s3
更新日期:2004-05-01 00:00:00
abstract::The Women's Health Initiative found that the risks of hormone replacement therapy (HRT) exceeded its benefits in a large group of older postmenopausal women, but did not consider the efficacy of HRT in relieving vasomotor symptoms. Another recent study found that low-dose HRT was as effective as standard-dose HRT whil...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.69.9.670
更新日期:2002-09-01 00:00:00
abstract::One of the factors that contribute to the progressively declining course of heart failure could be sleep apnea. Whether treating sleep apnea improves the clinical outcomes of patients with heart failure needs to be tested in randomized clinical trials. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.72.10.929
更新日期:2005-10-01 00:00:00
abstract::Because type 2 diabetes mellitus is a progressive disease, most patients eventually need insulin. When and how to start insulin therapy are not one-size-fits-all decisions but rather must be individualized. This paper reviews the indications, goals, and options for insulin therapy in type 2 diabetes. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.82a.14069
更新日期:2015-08-01 00:00:00
abstract::Severe acute pancreatitis causes high rates of illness and death. Simple scoring predictors can help identify patients at risk so that treatment, primarily supportive, can begin promptly after presentation. Medical therapy is the mainstay, with supportive therapy consisting of controlled volume resuscitation and enter...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.80gr.13001
更新日期:2013-06-01 00:00:00
abstract::Evidence is mounting that obstructive sleep apnea causes or contributes to many chronic medical diseases, and that treatment with continuous positive airway pressure (CPAP) often improves concomitant diseases. The author reviews the association of obstructive sleep apnea with arterial hypertension, pulmonary hypertens...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.74.1.72
更新日期:2007-01-01 00:00:00