Abstract:
BACKGROUND:The decision to place a percutaneous feeding tube (PFT) in patients who are at the end of life is multidimensional and often complicated. We assessed the effect of physician education and counseling for patients and their surrogates on inpatient nonsurgical (endoscopic and radiologic) PFT placement rates, indications, complications, and mortality. METHODS:In a pre-paid group practice, a geriatrician initiated a program of physician education and patient/surrogate counseling on the ethical and nutritional aspects of long-term enteral feeding. We compared rates of nonsurgical PFT placement (excluding those for cancer therapy or gastric decompression), indications, complications, and short- and long-term mortality in adult inpatients before (2004) and after (2005) the program. RESULTS:In 2004 and 2005, 115 and 60 inpatients underwent PFT placement, respectively. The annual number of hospital admissions was similar, but the rate of PFT placement declined (0.80% vs. 0.44%, P < 0.0001). The indications were cerebrovascular accident (42 [37%] versus 22 [37%]), dementia (15 [13%] versus 3 [5%]), other neurological disease (28 [24%] versus 16 [26%]), and miscellaneous disease (30 [26%] versus 19 [32%]); P > 0.05. Severe infectious complications occurred in 4 (3%) versus 0 (0%) patients, P > 0.05. Mortality (2004 versus 2005) at 30 days (23 [20%] versus 11 [18%]), 1 year (62 [54%] versus 29 [48%]) and 2 years (72 [63%] versus 31 [52%]) was similar, P > 0.05. CONCLUSION:A pilot program of educating referring physicians and counseling patients and their surrogates reduced the rate of inpatient PFT placement by nearly 50%. Indications, severe complications and short- and long-term mortality remained unchanged.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Swaminath A,Longstreth GF,Runnman EM,Yang SJdoi
10.1097/SMJ.0b013e3181c9800fsubject
Has Abstractpub_date
2010-02-01 00:00:00pages
126-30issue
2eissn
0038-4348issn
1541-8243journal_volume
103pub_type
杂志文章abstract::From January 1986 to December 1987, 32 patients with recurrent colorectal cancer had second-look radioimmunoguided surgery (RIGS system). All patients had pathologic confirmation of recurrence. The RIGS system identified 81% of recurrences, and in six patients recurrent tumor was identified only by RIGS. All patients ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1989-10-01 00:00:00
abstract::The importance of considering organic diseases when evaluating catatonic patients is illustrated by two cases of akinetic parkinsonism in which the patients became catatonic, with waxy flexibility. The catatonic syndrome occurs in association with a variety of lesions that may affect any level of the central nervous s...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198606000-00008
更新日期:1986-06-01 00:00:00
abstract::Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.SMJ.0000146587.06656.98
更新日期:2005-01-01 00:00:00
abstract::Chest pain is a frequent patient complaint that requires a careful history and physical examination to determine its cause. Cardiac and esophageal causes of chest pain are common, but musculoskeletal disorders such as Tietze's syndrome, chest wall pain syndromes, fibrositis, inflammatory arthritic conditions, cervical...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198801000-00014
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Cancer of the esophagus remains a highly lethal disease, but new treatment approaches that build onto traditional surgical and radiotherapeutic methods are making an impact on organ preservation while offering hope for improved survival. METHODS:Reviewed here are recent data from trials on the use of new ra...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:10.1097/00007611-199911000-00003
更新日期:1999-11-01 00:00:00
abstract::Several recent cases illustrate the medical-ethical-legal consequences associated with lack of awareness in caring for and treating the dying patient. We question whether solutions advanced by others are feasible or desirable for use in medical education, and suggest looking to the familiar principles of clinical medi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197904000-00011
更新日期:1979-04-01 00:00:00
abstract::An example of a blind-ending branch of a bifid ureter in a woman presenting with a urinary tract infection is reported. Definition, diagnosis, and treatment of this anomaly are discussed. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197907000-00031
更新日期:1979-07-01 00:00:00
abstract::Slipped capital femoral epiphysis has been described in several syndromes associated with short stature and endocrine disturbances. I have presented a case of slipped capital femoral epiphysis in conjunction with Russell-Silver syndrome. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198907000-00026
更新日期:1989-07-01 00:00:00
abstract:BACKGROUND:Among patients with pulmonary disease due to Mycobacterium avium complex (MAC) seen recently at our center, a substantial number have had extensive calcified mediastinal, hilar, and peribronchial lymphadenopathy, a finding historically inconsistent with pulmonary MAC disease. METHOD:We retrospectively studi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199906000-00005
更新日期:1999-06-01 00:00:00
abstract::Potentially serious iatrogenic hand injuries occurred in three patients in a general medicine practice. All resulted from technologic advances in patient care. Each resulted in substantial economic and emotional costs. One patient sustained a serious residual disability. Such injuries have rarely been reported in the ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198612000-00011
更新日期:1986-12-01 00:00:00
abstract::This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and tr...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.SMJ.0000140834.30654.0F
更新日期:2005-03-01 00:00:00
abstract::Allergic rhinitis affects approximately 40% of children and generally presents in children from 10-19 years of age; however, the condition has been seen in children as young as 6 months. Antihistamines are commonly prescribed in infants and children for the relief of allergic symptoms. A 23-month-old male with a histo...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181b9ae49
更新日期:2010-05-01 00:00:00
abstract::Insomnia disorder is present in as much as 30% of the general adult population. Given the significant adverse effects of pharmacotherapy, cognitive behavioral therapy (CBT) has been found to be an effective alternative in individuals with insomnia. CBT for insomnia (CBTi) encompasses sleep hygiene, stimulus control, s...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.14423/SMJ.0000000000000769
更新日期:2018-02-01 00:00:00
abstract::Elderly patients with community-acquired pneumonia may not have a systemic inflammatory response characterized by fever and leukocytosis. We compared lack of fever and leukocytosis with mortality in elderly patients with community-acquired pneumonia. Patients with fever and leukocytosis (group A, 47 patients) were com...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199703000-00006
更新日期:1997-03-01 00:00:00
abstract::We have used the island gluteus maximus musculocutaneous flap to cover sacral pressure sores. In this report, we describe the surgical anatomy, cadaveric dissections (n = 25), and postoperative follow-up (one to 40 months) in 13 clinical cases. Our results compare favorably with those of other previously reported seri...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:1985-10-01 00:00:00
abstract::Stercoraceous perforation of the colon is most often unsuspected and is usually diagnosed at operation or autopsy. Abdominal radiographs show large fecal masses in the rectum and sigmoid colon, and occasionally lying free in the peritoneal cavity. Free intraperitoneal air is present. We have reported a single case, wi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197910000-00037
更新日期:1979-10-01 00:00:00
abstract::Anticonvulsant hypersensitivity syndrome (AHS) is a potentially life-threatening adverse drug reaction presenting with fever, skin eruptions, and internal organ involvement. We describe a case of AHS with fulminant hepatitis that occurred two weeks after introduction of lamotrigine in a 40-year-old female patient with...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/SMJ.0b013e3181878b95
更新日期:2009-01-01 00:00:00
abstract::Most patients with intestinal obstruction have had previous surgery. Rarely, the development of adhesions and resulting small bowel obstruction is attributed to previous intra-abdominal trauma. We present the case of a young man, without a history of surgery, who had been a restrained driver in a motor vehicle crash. ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2001-05-01 00:00:00
abstract::Each year an estimated 1.3 million Americans suffer eye injuries. There is little information in the literature regarding the prevalence, demographic characteristics, and prognosis of these patients. The Eye Injury Registry of Alabama (EIRA) serves as the first and only statewide system of its kind for the collection ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198707000-00004
更新日期:1987-07-01 00:00:00
abstract::This is a case which highlights unique diagnostic challenges in the evaluation of a previously healthy patient presenting with a myelopathy initially most concerning for malignancy. However, timely recognition and nonoperative therapy of unexpected spinal sarcoidosis with corticosteroidal therapy was crucial in averti...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181e90745
更新日期:2010-09-01 00:00:00
abstract::This review assessed the overall effectiveness of repeated treatments with botulinum toxin type A (BoNTA) across different conditions, as documented in the published literature. Forty-four original research articles reporting on 16 different conditions were identified that included data on the duration or efficacy of ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.smj.0000220888.88722.ab
更新日期:2006-08-01 00:00:00
abstract::A 37-year-old black man with presumed Pneumocystis carinii pneumonia who was treated with systemic IV pentamidine had fatal pancreatitis and massive hepatomegaly. Fatal pancreatitis can occur with no hemorrhagic changes seen at autopsy. Awareness of the relationship between pentamidine and pancreatitis should be empha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract::Massive ovarian edema is a rare tumor-like condition of the ovary characterized by marked enlargement of one or both ovaries due to marked accumulation of edema fluid in the ovarian stroma. This paper reviews the literature on massive ovarian edema and presents a case associated with androgenic manifestations. ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199511000-00015
更新日期:1995-11-01 00:00:00
abstract::A 42-year-old man had nausea, vomiting, periumbilical pain, tenesmus, and diarrhea shortly after eating seafood. Stool microscopy showed "beaver bodies," or Psorospermium haeckelii, a nonpathogenic algal organism often confused with enteric pathogens and commonly found in the excrement of persons consuming crayfish. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2001-02-01 00:00:00
abstract::An 8 year-old girl had a large congenital nevus involving the posterior thigh, leg, and foot. The nevus on non-weight-bearing areas was resected, and the areas were resurfaced with artificial skin and ultra-thin split-thickness grafts. A good result was ultimately achieved. Our management of this case and the relative...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2001-03-01 00:00:00
abstract::Gastrocolic fistulas are rare, and are usually seen as complications of peptic ulcer or malignancy of the stomach and large intestine. We have described a case resulting from chronic relapsing pancreatitis. The patient was successfully treated with excision of the fistula and closure of the gastric and colonic wall. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198910000-00030
更新日期:1989-10-01 00:00:00
abstract:BACKGROUND:Patient comfort is an important part of laceration repair. METHODS:The study was a randomized single-blind cross-over trial in which each participant received 250 ml warmed and 250 ml room temperature saline irrigation in simple linear wounds after a local anesthetic was instilled. The solutions and the ord...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.SMJ.0000056657.63336.6C
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:The US Bureau of Primary Health Care has promoted collaboration between federally funded community health centers and neighborhood religious congregations, yet little is known about how such organizations currently interact in underserved neighborhoods. METHODS:Semistructured interviews were conducted with l...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000168338.87518.cc
更新日期:2005-12-01 00:00:00
abstract::We present the case of a 17-year-old girl who came to our center with a red irritated eye from exposure to tarantula hairs. An ophthalmology literature search revealed six reported cases. There have been no reports of these cases in the general medical and pediatric literature. Due to the increasing popularity of tara...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199806000-00011
更新日期:1998-06-01 00:00:00
abstract::We have described a 38-year-old white American woman who had a 7-year history of pain in the left anterior chest, neck, right wrist, and buttocks. The pain fluctuated in severity and appeared to coincide with worsening of her skin condition, palmoplantar pustulosis (PPP). She manifested the typical skeletal features o...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199304000-00021
更新日期:1993-04-01 00:00:00