JAMA internal medicine
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JAMA internal medicine · Jul 2013
Differences in human immunodeficiency virus care and treatment among subpopulations in the United States.
Early diagnosis of human immunodeficiency virus (HIV) infection, prompt linkage to and sustained care, and antiretroviral therapy are associated with reduced individual morbidity, mortality, and transmission of the virus. However, levels of these indicators may differ among population groups with HIV. Disparities in care and treatment may contribute to the higher incidence rates among groups with higher prevalence of HIV. ⋯ Significant age disparities exist at each step of the continuum of care. Additional efforts are needed to ensure that all persons with HIV receive a diagnosis and optimal care to reduce morbidity, mortality, disparities in care and treatment, and ultimately HIV transmission. Ensuring that people stay in care and receive treatment will increase the proportion of HIV-infected individuals who achieve and maintain a suppressed viral load.
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The current view in intensive care medicine is that very sick patients need very intensive treatment. However, in this group of highly vulnerable patients, more intensive treatment may promote the chances of unwanted adverse effects and hence, iatrogenic damage. ⋯ We illustrate our case by describing the intensity of the most relevant treatment options for patients with septic shock, including mechanical ventilation, fluid management, blood pressure-targeted therapy, corticosteroids, patient monitoring, sedation, and nutrition. We conclude that treatment of critically ill patients while keeping in mind the "less is more" paradigm might not only benefit the patient but could also have a notable impact on the ever-increasing intensive care-related health care costs.
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JAMA internal medicine · Jul 2013
Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women.
Red meat consumption has been consistently associated with an increased risk of type 2 diabetes mellitus (T2DM). However, whether changes in red meat intake are related to subsequent T2DM risk remains unknown. ⋯ Increasing red meat consumption over time is associated with an elevated subsequent risk of T2DM, and the association is partly mediated by body weight. Our results add further evidence that limiting red meat consumption over time confers benefits for T2DM prevention.
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JAMA internal medicine · Jul 2013
Mortality for publicly reported conditions and overall hospital mortality rates.
Federal efforts about public reporting and quality improvement programs for hospitals have focused primarily on a small number of medical conditions. Whether performance on these conditions accurately predicts the quality of broader hospital care is unknown. ⋯ Hospital performance on publicly reported conditions can potentially be used as a signal of overall hospital mortality rates.