10), have a stage IV decubitus ulcer (adjusted risk ratio, 2.28), or have had a late enrollment in hospice (adjusted risk ratio, 1.17).

CONCLUSIONS

Burdensome transitions are common, vary according to state, and are associated with markers of poor quality in end-of-life care. (Funded by the National Institute on Aging.)”
“Purpose: To evaluate

the outcomes of carotid artery stenting (CAS) and open surgical repair (OR) for treatment of radiation-induced carotid stenosis (RIGS).

Methods: We retrospectively reviewed 60 patients treated for 73 RICSs from a group GDC-0973 ic50 of 5,824 patients who had carotid interventions between 1992 and 2009. Thirty-three patients (37 arteries) were treated with CAS and 27 patients (36 arteries) with OR. CAS was performed using embolic protection as part of a prospective institutional registry since 2003. End-points included mortality, LY3009104 stroke, myocardial infarction (MI), cranial nerve injury (CNI), wound complication, restenosis,

and reintervention.

Results: Demographics and cardiovascular risk factors were similar in both groups, with the exception of higher rates (P < .05) of hyperlipidemia (81% vs 56%) and coronary artery disease (63% vs 33%) in OR patients. There were more patients with tracheostomy (31% vs 4%) and time interval from irradiation to intervention was longer in the CAS group. There were no early deaths. At 30 days, OR was associated with one (3%) stroke, two (5.5%) MIs, six (17%) CNIs, and three (8%) wound complications. OR patients with prior radical neck dissections had more wound complications (14% vs 5%) and CNIs (28% vs 9%) compared with those without neck Pifithrin �� dissections. In the CAS group, there were two (6%) strokes and no Mls, CNIs, or wound

complications. Mean length of hospital stay was longer after OR than CAS (4.1 +/- 3.7 days vs 2.4 +/- 2.1 days; P = .02). Median follow-up was 58 months. At 7 years, OR was associated with higher patient survival (75% +/- 15% vs 29% 13%, P = .008) and freedom from neurological events (100% vs 57% +/- 9.5%, P = .058), but similar freedom from restenosis (80% +/- 10% vs 72% +/- 9%) and reinterventions (87% +/- 10% vs 86% +/- 9%) compared with CAS.

Conclusion: Carotid artery stenting for radiation-induced stenosis has the advantages of no CNI or wound complications with similar early stroke rate compared with open carotid repair. However, the lower freedom from neurological events may offset the early benefits of carotid stenting in patients who are considered good candidates for open surgery. (J Vasc Surg 2011;53:629-36.)”
“A 45-year-old overweight woman with a history of depression sees her physician with a recurrence of acute bronchitis. She began smoking at 15 years of age and now smokes 10 to 15 cigarettes per day. She smokes her first cigarette immediately on awakening. She has made multiple attempts to quit, once briefly using a nicotine patch, but she had a relapse because of strong urges to smoke and weight gain.