Archives of internal medicine最新文献

{"title":"The effect of values affirmation on race-discordant patient-provider communication.","authors":"Edward P Havranek,&nbsp;Rebecca Hanratty,&nbsp;Channing Tate,&nbsp;L Miriam Dickinson,&nbsp;John F Steiner,&nbsp;Geoffrey Cohen,&nbsp;Irene A Blair","doi":"10.1001/2013.jamainternmed.258","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.258","url":null,"abstract":"<p><strong>Background: </strong>Communication between African American patients and white health care providers has been shown to be of poorer quality when compared with race-concordant patient-provider communication. Fear on the part of patients that providers stereotype them negatively might be one cause of this poorer communication. This stereotype threat may be lessened by a values-affirmation intervention.</p><p><strong>Methods: </strong>In a blinded experiment, we randomized 99 African American patients with hypertension to perform a values-affirmation exercise or a control exercise before a visit with their primary care provider. We compared patient-provider communication for the 2 groups using audio recordings of the visit analyzed with the Roter Interaction Analysis System. We also evaluated visit satisfaction, trust, stress, and mood after the visit by means of a questionnaire.</p><p><strong>Results: </strong>Patients in the intervention group requested and provided more information about their medical condition (mean [SE] number of utterances, 66.3 [6.8] in the values-affirmation group vs 48.1 [5.9] in the control group [P = .03]). Patient-provider communication in the intervention group was characterized as being more interested, friendly, responsive, interactive, and respectful (P = .02) and less depressed and distressed (P = .03). Patient questionnaires did not detect differences in visit satisfaction, trust, stress, or mood. Mean visit duration did not differ significantly between the groups (19.2 minutes in the control group vs 20.5 minutes in the intervention group [P = .29]).</p><p><strong>Conclusions: </strong>A values-affirmation exercise improves aspects of patient-provider communication in race-discordant primary care visits. The clinical impact of the intervention must be defined before widespread implementation can be recommended.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 21","pages":"1662-7"},"PeriodicalIF":0.0,"publicationDate":"2012-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31026783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The skinny on obesity and end-stage renal disease.","authors":"Kirsten L Johansen","doi":"10.1001/2013.jamainternmed.917","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.917","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 21","pages":"1651-2"},"PeriodicalIF":0.0,"publicationDate":"2012-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31010031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing radiology use on an inpatient medical service: choosing wisely.","authors":"Naama Neeman,&nbsp;Katie Quinn,&nbsp;Krishan Soni,&nbsp;Michelle Mourad,&nbsp;Niraj L Sehgal","doi":"10.1001/archinternmed.2012.4293","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4293","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1606-8"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30863795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-eluting stents should not be used in ST-elevated myocardial infarction with cardiogenic shock.","authors":"Sébastien Champion,&nbsp;Bernard Alex Gaüzère,&nbsp;Yannick Lefor","doi":"10.1001/archinternmed.2012.4418","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4418","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1613-4"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31045750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing high-value, cost-conscious diabetes mellitus care through the use of low-cost medications and less-intensive glycemic control target.","authors":"Timothy J Wilt,&nbsp;Amir Qaseem","doi":"10.1001/2013.jamainternmed.203","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.203","url":null,"abstract":"","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1610-1"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30960763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PLAN score: a bedside prediction rule for death and severe disability following acute ischemic stroke.","authors":"Martin J O'Donnell,&nbsp;Jiming Fang,&nbsp;Cami D'Uva,&nbsp;Gustavo Saposnik,&nbsp;Linda Gould,&nbsp;Emer McGrath,&nbsp;Moira K Kapral","doi":"10.1001/2013.jamainternmed.30","DOIUrl":"https://doi.org/10.1001/2013.jamainternmed.30","url":null,"abstract":"<p><strong>Background: </strong>We sought to develop and validate a simple clinical prediction rule for death and severe disability after acute ischemic stroke that can be used by general clinicians at the time of hospital admission.</p><p><strong>Methods: </strong>We analyzed data from a registry of 9847 patients (4943 in the derivation cohort and 4904 in the validation cohort) hospitalized with acute ischemic stroke and included in the Registry of the Canadian Stroke Network (July 1, 2003, to March 31, 2008; 11 regional stroke centers in Ontario, Canada). Outcome measures were 30-day and 1-year mortality and a modified Rankin score of 5 to 6 at discharge.</p><p><strong>Results: </strong>Overall 30-day mortality was 11.5% (derivation cohort) and 13.5% (validation cohort). In the final multivariate model, we included 9 clinical variables that could be categorized as preadmission comorbidities (5 points for preadmission dependence [1.5], cancer [1.5], congestive heart failure [1.0], and atrial fibrillation [1.0]), level of consciousness (5 points for reduced level of consciousness), age (10 points, 1 point/decade), and neurologic focal deficit (5 points for significant/total weakness of the leg [2], weakness of the arm [2], and aphasia or neglect [1]). Maximum score is 25. In the validation cohort, the PLAN score (derived from preadmission comorbidities, level of consciousness, age, and neurologic deficit) predicted 30-day mortality (C statistic, 0.87), death or severe dependence at discharge (0.88), and 1-year mortality (0.84). The PLAN score also predicted favorable outcome (modified Rankin score, 0-2) at discharge (C statistic, 0.80).</p><p><strong>Conclusions: </strong>The PLAN clinical prediction rule identifies patients who will have a poor outcome after hospitalization for acute ischemic stroke. The score comprises clinical data available at the time of admission and may be determined by nonspecialist clinicians. Additional studies to independently validate the PLAN rule in different populations and settings are required.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1548-56"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/2013.jamainternmed.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31045744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an acute coronary syndrome: systematic review and meta-analysis of randomized controlled trials.","authors":"András Komócsi,&nbsp;András Vorobcsuk,&nbsp;Dániel Kehl,&nbsp;Dániel Aradi","doi":"10.1001/archinternmed.2012.4026","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4026","url":null,"abstract":"<p><strong>Background: </strong>Despite receipt of dual antiplatelet therapy, patients after an acute coronary syndrome (ACS) remain at significant risk for thrombotic events. The role of orally activated Xa antagonist (anti-Xa) and direct thrombin inhibitors is debated in this setting. Our study objective was to evaluate the efficacy and safety of new-generation oral anticoagulant agents compared with placebo in patients receiving antiplatelet therapy after an ACS.</p><p><strong>Methods: </strong>Electronic databases were searched to identify prospective randomized placebo-controlled clinical trials that evaluated the effects of anti-Xa or direct thrombin inhibitors in patients receiving antiplatelet therapy after an ACS. Efficacy measures included stent thrombosis, overall mortality, and a composite end point of major ischemic events, while thrombolysis in myocardial infarction-defined major bleeding events were used as a safety end point. The net clinical benefit was calculated as the sum of composite ischemic events and major bleeding events.</p><p><strong>Results: </strong>For the period January 1, 2000, through December 31, 2011, we identified 7 prospective randomized placebo-controlled clinical trials that met the study criteria, involving 31 286 patients. Based on the pooled results, the use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an ACS was associated with a dramatic increase in major bleeding events (odds ratio, 3.03; 95% CI, 2.20-4.16; P < .001). Significant but moderate reductions in the risk for stent thrombosis or composite ischemic events were observed, without a significant effect on overall mortality. For the net clinical benefit, treatment with new-generation oral anticoagulant agents provided no advantage over placebo (odds ratio, 0.98; 95% CI, 0.90-1.06; P = .57).</p><p><strong>Conclusion: </strong>The use of anti-Xa or direct thrombin inhibitors is associated with a dramatic increase in major bleeding events, which might offset all ischemic benefits in patients receiving antiplatelet therapy after an ACS.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1537-45"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30929205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life.","authors":"Katherine Aragon,&nbsp;Kenneth Covinsky,&nbsp;Yinghui Miao,&nbsp;W John Boscardin,&nbsp;Lynn Flint,&nbsp;Alexander K Smith","doi":"10.1001/archinternmed.2012.4451","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4451","url":null,"abstract":"<p><strong>Background: </strong>In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care. We sought to examine patterns of Medicare posthospitalization SNF use in the last 6 months of life.</p><p><strong>Methods: </strong>We used data from the Health and Retirement Study, a longitudinal survey of older adults, linked to Medicare claims (January 1994 through December 2007). We determined the number of individuals 65 years or older at death who had used the SNF benefit in the last 6 months of life. We report demographic, social, and clinical correlates of SNF use. We examined the relationship between place of death and hospice use for those residing in nursing homes and the community before the last 6 months of life.</p><p><strong>Results: </strong>The mean age at death among 5163 individuals was 82.8 years; 54.5% of the cohort were female, and 23.2% had resided in a nursing home. In total, 30.5% had used the SNF benefit in the last 6 months of life, and 9.2% had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon (P < .01 for all). Of community dwellers who had used the SNF benefit, 42.5% died in a nursing home, 10.7% died at home, 38.8% died in the hospital, and 8.0% died elsewhere. In contrast, of community dwellers who did not use the SNF benefit, 5.3% died in a nursing home, 40.6% died at home, 44.3% died in the hospital, and 9.8% died elsewhere.</p><p><strong>Conclusions: </strong>Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare posthospitalization benefit, and 1 in 11 elders will die while enrolled in the SNF benefit. Palliative care services should be incorporated into SNF-level care.</p>","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1573-9"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30945161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in use of high-cost diabetes mellitus medications in the VA healthcare system.","authors":"Walid Gellad,&nbsp;Maria Mor,&nbsp;Xinhua Zhao,&nbsp;Julie Donohue,&nbsp;Chester Good","doi":"10.1001/archinternmed.2012.4482","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.4482","url":null,"abstract":"1. Iglehart JK. Health insurers and medical-imaging policy—a work in progress. N Engl J Med. 2009;360(10):1030-1037. 2. Redberg RF. Cancer risks and radiation exposure from computed tomographic scans: how can we be sure that the benefits outweigh the risks? Arch Intern Med. 2009;169(22):2049-2050. 3. Stern RG. Diagnostic imaging: powerful, indispensable, and out of control. Am J Med. 2012;125(2):113-114. 4. Brook RH. Do physicians need a “shopping cart” for health care services? JAMA. 2012;307(8):791-792. 5. Cooke M. Cost consciousness in patient care—what is medical education’s responsibility? N Engl J Med. 2010;362(14):1253-1255. 6. Weinberger SE. Educating trainees about appropriate and cost-conscious diagnostic testing. Acad Med. 2011;86(11):1352. 7. American Board of Internal Medicine. Choosing Wisely Initiative. http://www .abimfoundation.org/Initiatives/Choosing-Wisely.aspx. Accessed July 22, 2012. 8. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. 9. McMahon LF Jr, Chopra V. Health care cost and value: the way forward. JAMA. 2012;307(7):671-672.","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1608-9"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.4482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30959060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the 2008 US Preventive Services Task Force recommendation to discontinue prostate cancer screening among male Medicare beneficiaries.","authors":"Joseph S Ross,&nbsp;Rong Wang,&nbsp;Jessica B Long,&nbsp;Cary P Gross,&nbsp;Xiaomei Ma","doi":"10.1001/archinternmed.2012.3726","DOIUrl":"https://doi.org/10.1001/archinternmed.2012.3726","url":null,"abstract":"For clinical evidence to have an impact on the health of populations, guideline recommendations must be rapidly and widely disseminated and physicians and other health care professionals must act responsively. Recommendations to discontinue care may be even more challenging. Recently, the US Preventive Services Task Force (USPSTF) recommended that no man receives prostate-specific antigen (PSA)-based screening for prostate cancer.1 While the impact of this recommendation will not be immediately understood in practice, the impact of the USPSTF’s August 2008 recommendation to discontinue PSA-based prostate cancer screening for men 75 years and older may inform expectations.2","PeriodicalId":8290,"journal":{"name":"Archives of internal medicine","volume":"172 20","pages":"1601-3"},"PeriodicalIF":0.0,"publicationDate":"2012-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archinternmed.2012.3726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30912731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}