Medical care
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Multicenter Study Clinical Trial
Immunologic function and virologic suppression among children with perinatally acquired HIV Infection on highly active antiretroviral therapy.
The goal of highly active antiretroviral therapy (HAART) has been to stabilize and reconstitute immune function and suppress viral replication to the greatest degree possible. Suppression of HIV viral replication has been associated with improved long-term and short-term prognosis. Limited data are available on the level of virologic suppression and immune function of pediatric patients followed in clinical settings in the HAART era. ⋯ In this multisite, pediatric cohort, the rate of near-complete virologic suppression (<50 or <400 cpm) was low. However, the majority of patients have near-normal CD4 counts and viral loads <15,000 cpm. Follow up will be critical to assess the implications of ongoing low-level viral replication with near-normal CD4 values.
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Multicenter Study
Hospital and outpatient health services utilization among HIV-infected children in care 2000-2001.
The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization. ⋯ Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children.
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We applied constructs from the transtheoretical model (TTM) of behavior change to identify modifiable determinants of patient participation in medical decision-making. ⋯ To move people from precontemplation towards action in participating in medical decision-making, interventions focusing on increasing the pros and decreasing the cons of participation may be needed. The challenge is to balance advocacy for an active patient role with individual patients' preference for participation.
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Multicenter Study
Primary care provider attitudes are associated with smoking cessation counseling and referral.
Most primary care providers (PCPs) endorse the importance of smoking cessation, but counseling rates are low. We evaluated the consistency of PCP's attitudes toward smoking cessation counseling and corresponding smoking-cessation behaviors. ⋯ PCPs, regardless of intervention participation, had attitudes consistent with their reported smoking-cessation behaviors and more favorable attitudes were associated with higher rates of patient-reported smoking cessation behavior. Findings suggest that PCPs who endorse smoking-cessation counseling and referral may provide more treatment recommendations and have higher patient quit rates.
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Comparative Study
Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans.
Stroke affects more than 500,000 older persons each year in the United States, but no studies have compared older stroke patients in Medicare health maintenance organizations (HMOs) and fee-for-service (FFS) after recent changes in FFS reimbursement. ⋯ Traditional measures of quality such as 30-day rehospitalization may not be valid when comparing HMO and FFS patients if differences might reflect an alternative service mix. Utilization of post-acute care for FFS patients appears similar to HMO patients except for discharge to rehabilitation facilities.