Access to state-of-the-art healthcare: a missing dynamic in consumer selection of a retirement community.

The top ten retirement destinations in the United States are compared to the State of Michigan with regard to the quality of medical care that can be readily obtained in the event of a medical emergency. Access to care during the following three medical emergencies was analyzed: cardiac arrest, thromboembolic (ischemic) stroke, and severe traumatic injury. In all instances, successful treatment is dependent on timely access to care. The authors report that, when combined with the health status of baby boomers and their migratory trends on retirement, access to tertiary medical care for the treatment of cardiac arrest, certified primary stroke centers, and level I trauma centers is the missing dynamic in the choice of retirement community among today's prospective retirees. They recommend that physicians encourage this patient population to consider such factors when choosing a retirement community.

Re-treatment of chronic idiopathic thrombocytopenic purpura with rituximab: literature review.

The aim of this literature review was to identify from published reports, the characteristics and response to rituximab of nine patients with chronic idiopathic thrombocytopenic purpura who had been re-treated after responding to an initial course of therapy. The female/male ratio of re-treated patients was eight, suggesting selection or their suitability for treatment because the female/male ratio of 95 initially treated patients in all published reports between December 1998 and June 2003 was 2. Almost three times as many females responded to the first course of rituximab. All second responses, where recorded, were complete despite two previous partial responses and one minor response. The duration of the second response was at least as durable and more so than the first. Of the nine re-treated patients, the two failures had not undergone splenectomy, yet had achieved a complete response to the first course. All four patients who had previously responded to intravenous immunoglobulin responded to both the initial and subsequent course of rituximab. The influence of prior splenectomy, response to intravenous immunoglobulin, and distinctive patterns of time course until platelet response suggest that there might be different mechanisms of response to rituximab.