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Original Research: Robin L. Kruse, David R. Mehr, Jenny T. van der Steen, Marcel E. Ooms, Richard W. Madsen, Ashley K. Sherman, Ralph B. D’Agostino, Gerrit van der Wal, and Miel W. Ribbe Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis Ann Fam Med 2005; 3: 422-429 [Abstract] [Full text] [PDF]

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Electronic letters published:

Aggressive Care for Demented Nursing Home Residents With Pneumonia May Not Be Effective

James P. Richardson, M.D., M.P.H.   (6 October 2005)

Treating Terminally Ill Patients

Edward T. Bope   (6 October 2005)

Aggressive Care for Demented Nursing Home Residents With Pneumonia May Not Be Effective 6 October 2005
James P. Richardson, M.D., M.P.H., Baltimore, Maryland, USA Chief, Division of Geriatric Medicine, Union Memorial Hospital, Baltimore, Maryland Send response to journal: Re: Aggressive Care for Demented Nursing Home Residents With Pneumonia May Not Be Effective	This study is a worthy attempt to study the outcomes of various treatments for pneumonia in nursing home residents in two countries with very different approaches. Not surprisingly, the health of the resident prior to onset of pneumonia is more predictive than the specific treatment in frail demented patients. This information may help guide physicians and families facing the difficult decision of whether to hospitalize acutely ill nursing home residents. Competing interests:   None declared
Treating Terminally Ill Patients 6 October 2005
Edward T. Bope, Columbus, Ohio Riverside Methodist hospital Send response to journal: Re: Treating Terminally Ill Patients	At the core this article raises the social question of how to manage life threatening infection in terminally ill patients. Some will question my use of the term "terminally ill" but these patients were institutionalized and to a large degree demented with no hope for recovery. The Dutch were more likely to withhold antibiotics and less likely to hospitalize or use IM anitibiotics. In my opinion families, guardians and physicians should become uncomfortable with attempting to halt death in bedridden, demented patients. The 90% mortality in the Dutch study of demented patients not receiving antibiotics could be seen as a blessing rather than a fault. Competing interests:   None declared