摘要:

ObjectiveTo review the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on the elderly.Data SourcesA computer‐assisted search of the English‐language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.Study SelectionStudies on the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy were screened for review. Studies on left ventricular hypertrophy in the elderly and recent studies were emphasized.Data ExtractionPertinent data were extracted from the reviewed articles. Emphasis was on studies involving the elderly. Relevant articles were reviewed in depth.Data SynthesisAvailable data about the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on studies involving the elderly were summarized.ConclusionsLeft ventricular hypertrophy caused by hypertension or other cardiovascular disease is not only a marker for but also a contributor to cardiovascular morbidity and mortality in elderly and young patients. The question of whether regression of left ventricular mass in patients with hypertension will decrease cardiovascular morbidity and mortality needs to be answered by prospective studies using different types of antihypertensive drugs. Future studies on the efficacy of antihypertensive drugs and on stratification of therapy should include echocardiographic estimates of left ventricular mass in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01834.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01835.x

年代:1992

数据来源: WILEY

摘要:

The increased attention in US medicine to medical ethics reflects in large part the “new” demography of a growing elderly population and the conflict of whether decisions regarding medical care should be based on cost‐effectiveness or “human‐effectiveness.” Currently, about 40 percent of the nation's elderly end up in nursing homes where they confront ethical and legal dilemmas that would not arise in their own homes. In the nursing home, difficult medical‐ethical decisions generally rely on two approaches: the often used but frequently invalid concept of informed consent and little used ethics committees.At The Jewish Home and Hospital for Aged in New York City we have developed a program of “ethics rounds” as an alternative to ethics committees. We conduct the rounds in the open style of a forum or clinical conference rather than with the aura of a decision‐making group. We encourage the participation of patients and family and seek to educate the staff, any one of whom may choose to attend. The rounds consist of a multidisciplinary case presentation, an interview of patient and/or family, a discussion by the staff, and an overview by an ethicist.Staff response to the educational and interdisciplinary aspects of the rounds has been

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01836.x

年代:1992

数据来源: WILEY

摘要:

Little is known about protocols for routine laboratory testing in nursing homes. To determine what laboratory protocols are employed by community nursing homes, directors of nursing service in the 73 long‐term‐care facilities in Portland, Oregon were surveyed. One‐hundred percent responded, and 56% reported having laboratory testing protocols. Ninety percent of protocols employed screening tests, and 88% employed monitoring tests, but content varied widely.Although physicians are ultimately responsible for ordering laboratory tests, protocols were derived from various sources including nursing staff, pharmacy and laboratory consultants, and Department of Health and Human Service guidelines. It is recommended that physicians take a leadership role in helping nursing homes develop clinically useful, cost‐effective testing str

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01837.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01838.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01841.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01843.x

年代:1992

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01844.x

年代:1992

数据来源: WILEY