Journal of general internal medicine
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The emotional investment required to construct a caring doctor-patient relationship can be justified on humane grounds. Can it also be justified as a direct physiologic intervention? Two lines of evidence point in this direction. People in an empathic relationship exhibit a correlation of indicators of autonomic activity. ⋯ Furthermore, the experience of feeling cared about in a relationship reduces the secretion of stress hormones and shifts the neuroendocrine system toward homeostasis. Because the social engagement of emotions is simultaneously the social engagement of the physiologic substrate of those emotions, the process has been labeled sociophysiology. This process can influence the health of both parties in the doctor-patient relationship, and may be relevant to third parties.
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To identify the life events that older persons experience as most stressful, to evaluate older persons' perceptions of the consequences of these stressful events for their lives, and to evaluate the relationship of demographic factors and measures of health and functional status to these perceptions. ⋯ Older persons experience a wide array of stressful life events, with only a small minority reporting personal illnesses as the most stressful. Similar stressful events can have either negative or positive consequences for older persons' lives. This variation in response to stressful events among older persons may indicate different degrees of resilience, a potentially important factor underlying successful aging that deserves further investigation.
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Comparative Study
Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes.
To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes. ⋯ Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.
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The central venous pressure (CVP) is commonly estimated at the bedside by measuring the height of the jugular venous pressure (JVP) relative to the sternal angle. Determining the CVP from this measure requires that the distance from the sternal angle to the level of the mid-right atrium be known. Classical clinical teaching quotes this distance as 5 cm, invariable between patients, and invariable with changes in the elevation of the patient's head. The validity of these JVP characteristics has been questioned. ⋯ The distance from the sternal angle to the level of the mid-right atrium varies considerably between individuals and with patient position. When using the JVP to calculate the CVP, physicians need to consider specific patient factors and the patient's position.