The American journal of medicine
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Randomized Controlled Trial Clinical Trial
A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy.
To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. ⋯ This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.
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Case Reports Comparative Study
Evaluation of a medical ethics consultation service: opinions of patients and health care providers.
To study the perceived effectiveness of bioethics consultation as evaluated by both professional staff and patients and their families. ⋯ Patients or family members and professional staff have different perceptions regarding the value of bioethics consultation. When asked for comments, patients/family members cite lack of communication with professional staff as their primary reason for responding negatively. Earlier mobilization of consultative staff, rigorous training of consultants in techniques of conflict resolution, and education of primary caregivers regarding recognition of communication problems may serve to narrow this perceptual divergence.
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We sought to describe sarcoidosis mortality in the United States from 1979 through 1991. ⋯ Reported mortality due to sarcoidosis varies by region, sex, and race. We cannot determine whether these differences are related to characteristics of the disease, or problems in death certification and coding.
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To determine the patterns of chronic outpatient management in urban patients with moderate and severe asthma, and to assess medical practice adherence to the Guidelines for the Diagnosis and Management of Asthma from the National Asthma Education Program (NAEP). ⋯ This is the first documentation of multiple problems in conforming with the standards of care delineated by the NAEP as they relate to the outpatient management of inner-city patients with moderate to severe asthma in the United States. In this population of patients with asthma, management was characterized by underutilization of anti-inflammatory therapy, inability to use inhalation devices properly, inadequate communication between patient and physician of an action plan to be utilized in the event of an acute exacerbation and inadequate physician intervention during the acute stages of the exacerbation. There was also overutilization of inhaled beta-agonists during exacerbations. It is imperative that these aspects of management, for which the NAEP has set standards of care, are addressed as part of the effort to reduce asthma morbidity in the urban United States.