JAMA : the journal of the American Medical Association
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To determine whether African-American children with asthma use more emergency department (ED) and inpatient medical services and fewer preventive services than white children with similar insurance coverage and family income. ⋯ Higher use of ED and inpatient services for asthma among African-American children using Medicaid (compared with white children) cannot be fully explained by poverty or inadequate health insurance. Furthermore, these children appear to make disproportionately few office visits for asthma, suggesting suboptimal use of preventive services for asthma. In contrast, the comparable use of well-child visits in the two groups suggests the problem may not be in access to care in general, but there may be specific problems in the successful management of chronic diseases such as asthma among African-American children.
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The field of advance directives has come a long way. It has further to go, and like other new interventions in medicine, it will continue to evolve. ⋯ An immediate agenda for action might look something like the following: (1) encouraging ambulatory care physicians to cosign advance care documents, (2) providing validated worksheets by institutions for ready office and ward use, (3) educating physicians in how to conduct advance planning, and (4) including advance planning discussions in reimbursement systems. Additional moves should include adjustment of medical law to reflect two categories of incompetence and further research on advance care planning to ensure continuing improvement.
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To present the current state of systemic radiopharmaceutical therapy for the palliation of pain in individuals with metastatic cancer and to evaluate the palliative effect and degree of hemotoxicity of strontium chloride 89 (89Sr) in patients with painful osteoblastic metastases primarily from prostate and breast cancer. ⋯ As many as 80% of selected patients with painful osteoblastic bony metastases from prostate or breast cancer may experience some pain relief following 89Sr administration. In addition, as many as 10% or more may become pain free. Duration of clinical response may average 3 to 6 months in some cases. Hemotoxicity is mild. A decrease in treatment costs with administration of 89Sr to patients with painful osteoblastic bony metastases from prostate cancer may occur. These observations reflect the preliminary nature of knowledge in this field and point to the need for larger clinical trials of the use of 89Sr palliation.