Journal of general internal medicine
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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.
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Greater participation in medical decision making is generally advocated for patients, and often advocated for those with diabetes. Although some studies suggest that diabetic patients prefer to participate less in decision making than do healthy patients, the empirical relationship between such participation and diabetic patients' satisfaction with their care is currently unknown. We sought to characterize the relationship between aspects of diabetic patients' participation in medical decision making and their satisfaction with care. ⋯ Clinicians may feel reassured that encouraging even initially reluctant patients with diabetes to participate in medical decision making may be associated with increased patient satisfaction. Greater patient participation has the potential to improve diabetic self-care because of the likely positive effect of patient satisfaction on adherence to treatment. Further research to assess the prospective effects of enhancing physician facilitation of patient participation is likely to yield important information for the effective treatment of chronically ill patients.
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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 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.