Gastrostomy tubes are commonly used to provide nutrition and hydration

Question

Gastrostomy tubes are commonly used to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake. Among hospitalized patients aged 65 years or older in the United States, the number undergoing placement of a gastrostomy tube increased from 61000 in 1988 to 121000 in 1995. In 1990 and 1991, roughly one in every hundred hospitalized patients aged 85 years or older received a gastrostomy tube.

The short-term mortality rates following gastrostomy placement are high. In a cohort of more than 7000 American veterans who underwent placement of percutaneous endoscopic gastrostomy tubes between 1990 and 1992, median survival was 7.5 months and 1-year mortality was 59%. Among Medicare beneficiaries receiving gastrostomy tubes in 1991, 30-day and 1-year mortality was 24% and 63%, respectively. Because tube insertion itself is only rarely associated with fatal complications, the high short-term mortality clearly reflects a substantial underlying co-morbidity in this population. Most patients receiving gastrostomy tubes have advanced dementia, other types of severe neurological impairment, cancer, or advanced failure of other internal organs.

The growing use of tube feeding in a population with limited life expectancy inevitably raises the following question: Do physicians discuss the benefits and burdens of tube feeding adequately with patients or surrogate decision-makers before gastrostomy tubes are inserted? Assessing benefits and burdens is an integral part of informed decision-making and should precede any elective life-sustaining intervention. However, anecdotal observations and a recent interview study raise serious questions about the quality of the informed consent process preceding the insertion of gastrostomy tubes.

A small body of literature suggests that fully informed patients or their surrogates might in fact decline permanent tube feeding at a higher-than-expected rate. For example, in the study by Callahan et al, nearly half of the patients undergoing gastrostomy placement (or their surrogates) reported that no alternatives had been discussed before insertion of the tube. O' Brien and colleagues asked 379 mentally competent nursing home residents if they would want a gastrostomy tube if they became unable to eat because of permanent brain damage;  only  33% expressed a preference for tube feedings in this circumstance. In an interview study of 121 competent patients with amyotrophic lateral sclerosis, only 28% favored feeding by gastrostomy.    1 
 1. The passage is primarily concerned with

(A) the morbidity and mortality rates associated with the use of gastrostomy tubes
(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older
(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted
(D) the growing number of patients undergoing placement of a gastrostomy tube
(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube

2 
 2. According to the passage, the high mortality rate following gastrostomy found in research cited in paragraph two is not necessarily a direct result of the placement of a gastrostomy tube because

(A) tube insertion itself is only rarely associated with fatal complications
(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries
(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined
(D) all the patients in the studies mentioned suffered from life threatening diseases
(E) most of the patients in the studies mentioned suffered from life threatening diseases

3 
 3. It can be inferred from the passage that

(A) there are alternatives to the use of gastrostomy tubes to provide nutrition but not hydration for patients unwilling or unable to maintain an adequate oral intake.
(B) there are alternatives to the use of gastrostomy tubes to provide hydration but not nutrition for patients unwilling or unable to maintain an adequate oral intake.
(C) there are alternatives to the use of gastrostomy tubes to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake.
(D) the alternatives to gastrostomy tubes do not provide adequate nutrition and hydration
(E) the alternatives to gastrostomy tubes provide more adequate nutrition and hydration than the gastrostomy tubes

4 
 4. The author uses the word “only”  Highlighted ] most likely in order to

(A) highlight the oddity of the decision of the patients
(B) emphasize the relatively low percentage of patients that would opt for a gastrostomy tube if given the choice
(C) point out the limited value of inserting a gastrostomy tube
(D) distinguish the primary factor in the decision making process of brain damaged patients
(E) single out a unique merit of gastrostomy tubes for brain damaged patients

Source: Reading Comprehension Practice (Docs)

RohiniK · Answer

1. The passage is primarily concerned with

(A) the morbidity and mortality rates associated with the use of gastrostomy tubes
(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older
(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted
(D) the growing number of patients undergoing placement of a gastrostomy tube
(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube

My Para Summary is as below

Why GT (gastronomy tubes) are used and statistics with relation to the age
why mortality rate increases after GT insertions
informed consent is important
Given a choice most would reject the GT insertion

(A) the morbidity and mortality rates associated with the use of gastrostomy tubes -  this statistics pf mortality rate is discussed in para 2 
(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older -  discussed only in para 1 
(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted -  this is discussed in para 3 but para 4 suggests given a choice most patients will reject the GT procedure. First 2 paragraphs discuss what is GT and it's statistics to answer given a choice most patients will reject the GT procedure 
(D) the growing number of patients undergoing placement of a gastrostomy tube -  only in para 4 
(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube -  only few lines in the last paragraph

RohiniK · Answer

2. According to the passage, the high mortality rate following gastrostomy found in research cited in paragraph two is not necessarily a direct result of the placement of a gastrostomy tube because

(A) tube insertion itself is only rarely associated with fatal complications
(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries
(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined
(D) all the patients in the studies mentioned suffered from life threatening diseases
(E) most of the patients in the studies mentioned suffered from life threatening diseases

Last sentence of the second paragraph mentions the number of diseases that could be the cause of the mortality rate and GT tube insertions is rarely associated with any kind of complicates.

Choice A - is just mentions that GT tube insertions is rarely associated with any kind of complicates but it is not the cause of the deaths.

Between choice D and E, Choice D says All Patients whereas choice E says Most patients and is mentioned in the passage. 
So,  the correct answer is E

carlton17 · Answer

Passage summary: 
Para 1:
Gastrostomy tubes (GT) used for oral intake. Nos increased in US between 1988-1995.

Para 2:
High mortality rate. Possibly due to comorbidities.

Para 3:
Q - "  Do physicians discuss benefits?  " (also, this is the authors point of writing the passage).
Study - Doubts regarding informed consent process.

Para 4:
Literature - Suggests patients/surrogates might decline GT if fully informed. Examples given.

QUESTIONS:

1. The passage is primarily concerned with

(A) the morbidity and mortality rates associated with the use of gastrostomy tubes.
Easy to miss the fact that this answer choice only deals with the  rates  of morbidity and mortality. Discussed only in para 2 and no more. The concern is not the rate of morbidity and mortality. Rather, it is the fact that physicians are not discussing these rates with the patients/surrogates. Cannot be considered as the PRIMARY CONCERN of the passage. INCORRECT.

(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older.
Mentioned only once in the passage. Definitely not the PRIMARY CONCERN of the passage. INCORRECT.

(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted.  
Given in para 3; Up until now, the author has been citing data from studies. This is the first time the author gives his opinion and spaces it using a colon. CORRECT.

(D) the growing number of patients undergoing placement of a gastrostomy tube.
Mentioned in the passage only to aid the authors case, but not the PRIMARY CONCERN of the passage. INCORRECT.

(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube.
The complications are not the PRIMARY CONCERN. Rather, the lack of discussing them with the patients/surrogates is. INCORRECT.

PS. I had selected answer choice (A).

2. According to the passage, the high mortality rate following gastrostomy found in research cited in paragraph two is not necessarily a direct result of the placement of a gastrostomy tube because

Tricky question. The correct answer choice can be one that explicitly says that GTs did not result in a high mortality rate, or, it could be one that says that the high mortality rate was due to some other reason. Both sound legit. Both are mentioned in the passage.

(A) tube insertion itself is only rarely associated with fatal complications.
Sounds like a possible option. Will hold on to it.

(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries.
Does not support why high mortality rate is not necessarily a direct result of the placement of a GT. INCORRECT.

(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined.
Does not support why high mortality rate is not necessarily a direct result of the placement of a GT. INCORRECT.

(D) all the patients in the studies mentioned suffered from life threatening diseases.
Para 2 says "most patients", not "all patients". INCORRECT.

(E) most of the patients in the studies mentioned suffered from life threatening diseases.  
Possible correct answer.

Compare (A) and (E). To show that high mortality rate is not necessarily a direct result of the placement of a GT, it would be a stronger position to state that some other reason was causing the mortality as compared to simply state that the GT insertion itself only rarely caused fatal complications. If placement of a GT rarely causes mortality, and the patient has no comorbidity, and if the patient still dies, it would mean that the patient was one of the few that probably died due to the placement of a GT, right! Hence (E) is a better choice than (A).

PS. I selected answer choice (A). It's easier to comprehend the reasoning when the paragraph has been re-read.

3. It can be inferred from the passage that

(A) there are alternatives to the use of gastrostomy tubes to provide nutrition but not hydration for patients unwilling or unable to maintain an adequate oral intake.
Not mentioned in passage. INCORRECT.

(B) there are alternatives to the use of gastrostomy tubes to provide hydration but not nutrition for patients unwilling or unable to maintain an adequate oral intake.
Not mentioned in passage. INCORRECT.

(C) there are alternatives to the use of gastrostomy tubes to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake.  
Not directly mentioned. However, may be inferred. Not a big leap from what the author implies. Hold on to this answer choice.

(D) the alternatives to gastrostomy tubes do not provide adequate nutrition and hydration.
Not mentioned in passage. INCORRECT.

(E) the alternatives to gastrostomy tubes provide more adequate nutrition and hydration than the gastrostomy tubes.
Not mentioned in passage. INCORRECT.

Using method of elimination, CORRECT answer choice is (C).

4. The author uses the word “only”   most likely in order to

The author uses "only" here to show that less than majority (33%) would opt for GTs when the study represents a well informed group (mentally competent nursing home residents). This is also in acceptance with the main idea of the passage that the author is concerned with and the fact that, if given a choice, patients/surrogates would most probably not choose a GT when fully informed about its pros/cons.

(A) highlight the oddity of the decision of the patients.
The author is not referring to the oddity (33%). Rather, the author believes this figure is probably well represented since fully informed patients might decline GT. INCORRECT.

(B) emphasize the relatively low percentage of patients that would opt for a gastrostomy tube if given the choice.   
Bingo. The author does "emphasize the relatively low percentage" choosing GT if given a choice by using the word "only". CORRECT.

(C) point out the limited value of inserting a gastrostomy tube.
The author is not concerned about the "limited value" of a GT in this sentence. INCORRECT.

(D) distinguish the primary factor in the decision making process of brain damaged patients.
The author is not concerned about the "primary factor in the decision making process of brain damaged patients" of a GT in this sentence. The author is also not distinguishing this factor. INCORRECT.

(E) single out a unique merit of gastrostomy tubes for brain damaged patients.
The author does not use "only" as merit here. INCORRECT.

CHEERS!

100mitra · Answer

Paraphrasing:  
  Para 1:   Gastrostomy tubes usage and increasing requirements in 1990, and 1991
  Para 2:   short term mortality rate statistics of gastrostomy tube insertion in 1990 and 1992, associated with fatal complications related to dementia, nerve system, cancer or internal organ failure.
  Para 3:   Doubt raise on Physician in usage of gastrostomy tube with concern with and approval from patients 
  Para 4:   Small body of literature and survey suggests less than 33% favoured feeding by gastrostomy

1. The passage is primarily concerned with  
(A) the morbidity and mortality rates associated with the use of gastrostomy tubes
  Wrong:   passage does not discuss about rate associated with medical condition, and death rate due to usage of gastrostomy tubes, 
it gives statistics of gastrostomy usage in in 1990, and 1992, and survey conducted in favor for gastrostomy usage.

(B) the proliferation of the use of gastronomy tubes in patients aged 85 years or older 
  Wrong:    this is used only to show statistically increasing utilization of gastronomy tube

(C) whether physicians adequately discuss the benefits and burdens of tube feeding with patients or surrogate decision-makers before gastrostomy tubes are inserted
  Correct: 
Para 1: gives introduction to gastrostomy tube and it increasing utilization
Para 2: usage of gastrostomy tube in critical medical condition 
Para3: Raise doubt on physician and doctors, as mentioned in passage, 
“The growing use of tube feeding in a population with limited life expectancy inevitably raises the following question: Do physicians discuss the benefits and burdens of tube feeding adequately with patients or surrogate decision-makers before gastrostomy tubes are inserted?”
Para 4: survey conducted in which less patients favoured of gastrostomy tube  
 
(D) the growing number of patients undergoing placement of a gastrostomy tube 
  Wrong:    this is used only to show statistically increasing utilization of gastronomy tube

(E) the complications that often follow the insertion of a percutaneous endoscopic gastrostomy tube 
  Wrong:    Out of scope, complication details not mentioned in passage

2. According to the passage, 
the high mortality rate following gastrostomy found in research 
cited in paragraph two is not necessarily a direct result of the placement 
of a gastrostomy tube because

(A) tube insertion itself is only rarely associated with fatal complications
  Wrong:    Rarely associated with fatal complication! 
This sentence is to support statistics mentioned in passage, 
“In a cohort of more than 7000 American veterans 
who underwent placement of percutaneous endoscopic gastrostomy tubes between 1990 and 1992, 
median survival was 7.5 months and 1-year mortality was 59%. 
Among Medicare beneficiaries receiving gastrostomy tubes in 1991, 
30-day and 1-year mortality was 24% and 63%, respectively.”

(B) 30-day and 1-year mortality was 24% and 63% respectively in 1991 among Medicare beneficiaries
  Wrong:    This is only statistics, not a reason of justification for high mortality rate.

(C) only cases in which the percutaneous endoscopic gastrostomy tube was incorrectly place were examined
  Wrong:    “only cases - incorrectly place was examined” this detail is not mentioned in the passage

(D) all the patients in the studies mentioned suffered from life threatening diseases
  Wrong:    as mentioned in passage, 
“Most patients receiving gastrostomy tubes have advanced dementia, other types of severe neurological impairment, cancer, or advanced failure of other internal organs.”

(E) most of the patients in the studies mentioned suffered from life threatening diseases
  Correct: as mentioned in the passage, “Most patients receiving gastrostomy tubes have advanced dementia, other types of severe neurological impairment, cancer, or advanced failure of other internal organs.”

100mitra · Answer

3. It can be inferred from the passage that  
  Explanation:    for inference, supporting sentence in passage 
 Passage 1st line : “ Gastrostomy tubes are commonly used to provide nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake ”

1. A small body of literature suggests that fully informed patients or their surrogates might in fact 
 Decline permanent tube feeding  at a higher-than-expected rate: It means, alternative is available

2. O' Brien and colleagues asked 379 mentally competent nursing home residents 
if they would want a gastrostomy tube 
 if they became unable to eat  because of permanent brain damage; 
only 33% expressed a preference for tube feedings in this circumstance  It means other 66% needs alternative method

3.  In an interview study of 121 competent patients with amyotrophic lateral sclerosis, only 28% favoured feeding by gastrostomy:  it means remaining 72% favoured other feeding methods

(A) there are alternatives to the use of gastrostomy tubes to provide 
nutrition but not hydration for patients unwilling or unable to maintain an adequate oral intake.
  Wrong:   as per passage 1st line – Easy elimination

(B) there are alternatives to the use of gastrostomy tubes to provide 
hydration but not nutrition for patients unwilling or unable to maintain an adequate oral intake.
  Wrong:   as per passage 1st line – Easy elimination

(C) there are alternatives to the use of gastrostomy tubes to provide 
nutrition and hydration for patients unwilling or unable to maintain an adequate oral intake.
Correct: as per 1st line of passage and supporting 3 lines from the passage

(D) the alternatives to gastrostomy tubes do not provide 
adequate nutrition and hydration
  Wrong:   Out of scope, alternatives of gastrostomy tube providing adequate is not mentioned in the passage, only can be inferred based on supporting 3 sentences from passage, alternatives are available

(E) the alternatives to gastrostomy tubes provide 
more adequate nutrition and hydration than the gastrostomy tubes
  Wrong:   Out of scope, alternatives of gastrostomy tube providing adequate is not mentioned in the passage, only can be inferred based on supporting 3 sentences from passage, alternatives are available

4. The author uses the word  “only”  most likely in order to  
  Sentence:    O' Brien and colleagues asked 379 mentally competent nursing home residents 
if they would want a gastrostomy tube 
if they became unable to eat because of permanent brain damage; 
 only  33% expressed a preference for tube feedings in this circumstance

(A) highlight the oddity of the decision of the patients 
  Wrong:   Author does not differentiate category of patients based on oddity decision, 
in fact, “only” highlights specific group preference of tube and other not.

(B) emphasize the relatively low percentage of patients 
that would opt for a gastrostomy tube if given the choice 
- Correct, as per the sentence mentioned above

(C) point out the limited value of inserting a gastrostomy tube 
  Wrong:   It’s about preference on acceptance to use gastrostomy tube, not about the quantity of value utilization.

(D) distinguish the primary factor in the decision-making process of brain damaged patients 
  Wrong:   Irrelevant, as it turns away from intended meaning from preference of utilization to ability of decision making

(E) single out a unique merit of gastrostomy tubes for brain damaged patients 
  Wrong:   Out of scope, highlights about Unique merit about specific group of brain damaged patients

Sajjad1994 · Answer

Official Explanation

3. It can be inferred from the passage that

Explanation

The passage suggests that if patients were offered alternatives to gastrostomy tubes, some of them would choose them. We can infer from this that alternatives exist.

The best answer is C.

Gastrostomy tubes are commonly used to provide nutrition and hydration

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GMAT Reading Comprehension (RC) Questions

Gastrostomy tubes are commonly used to provide nutrition and hydration

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