Journal of general internal medicine
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Use of bariatric surgery for severe obesity has increased dramatically. ⋯ Contemporary bariatric surgery appears to result in sustained weight reduction with acceptable costs but rigorous, longer-term (≥5 year) data are needed and a paucity of RCT data on mortality and obesity related comorbidity is evident. Procedure-specific variations in efficacy and risks exist and require further study to clarify the specific indications for and advantages of different procedures.
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Randomized Controlled Trial Comparative Study
The patient-doctor relationship and online social networks: results of a national survey.
The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient-doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described. ⋯ Personal OSN use among physicians and physicians-in-training mirrors that of the general population. Patient-doctor interactions take place within OSNs, and are more typically initiated by patients than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic.
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As the country turns toward implementation of the Patient Protection and Affordable Care Act, realizing the potential of reform will require significant transformation of the American system of health care delivery. To that end, the new law seeks to strengthen the nation's primary care foundation through enhanced reimbursement rates for providers and the use of innovative delivery models such as patient-centered medical homes. ⋯ If successfully implemented, the Affordable Care Act has the potential to realign incentives within the health system and create opportunities for providers to be rewarded for delivering high value, patient-centered primary care. Such a transformation could lead to better outcomes for patients, increase job satisfaction among physicians and encourage more sustainable levels of health spending for the nation.
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Comparative Study
Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic.
Despite high rates of post-deployment psychosocial problems in Iraq and Afghanistan veterans, mental health and social services are under-utilized. ⋯ Among Iraq and Afghanistan veterans new to primary care, an integrated primary care visit further improved the likelihood of an initial mental health and social services evaluation over background increases, but did not improve retention in specialty mental health services.
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Comparative Study
Racial disparity in blood pressure: is vitamin D a factor?
Higher prevalence of hypertension among African Americans is a key cause of racial disparity in cardiovascular morbidity and mortality. Explanations for the difference in prevalence are incomplete. Emerging data suggest that low vitamin D levels may contribute. ⋯ In cross-sectional analyses, 25(OH)D explains one quarter of the Black-White disparity in SBP. Randomized controlled trials are required to determine whether vitamin D supplementation could reduce racial disparity in BP.