Journal of general internal medicine
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Randomized Controlled Trial Comparative Study
Placebo adherence and its association with morbidity and mortality in the studies of left ventricular dysfunction.
A provocative finding from several double-blind clinical trials has been the association between greater adherence to placebo study medication and better health outcomes. We used data from the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial (SOLVD-TT) and the SOLVD Prevention Trial (SOLVD-PT) to examine whether such associations could be validated and to examine several sources of bias and potential confounding. ⋯ In these two trials, better adherence to placebo was associated with markedly superior health outcomes, including total in-study mortality and incident cardiovascular events. No important confounders were identified. These data suggest there may exist strong but unrecognized determinants of health outcomes for which placebo adherence is a marker.
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Multicenter Study Comparative Study
Hablamos Juntos (Together We Speak): interpreters, provider communication, and satisfaction with care.
The Hablamos Juntos-Together We Speak (HJ)--national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. ⋯ Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations.
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Learning in a clinical environment differs from formal educational settings and provides specific challenges for clinicians who are teachers. Instruments that reflect these challenges are needed to identify the strengths and weaknesses of clinical teachers. ⋯ No instrument covered all relevant aspects of clinical teaching comprehensively. Validation of the instruments was often limited to assessment of internal consistency and reliability. Available instruments for assessing clinical teachers should be used carefully, especially for consequential decisions. There is a need for more valid comprehensive instruments.
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Comparative Study
Massachusetts health reform and disparities in coverage, access and health status.
Massachusetts health reform has achieved near-universal insurance coverage, yet little is known about the effects of this legislation on disparities. ⋯ Achieving equity in health and health care may require additional focused intervention beyond health reform.