Journal of general internal medicine
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Comparative Study
Race/ethnicity and risk of AIDS and death among HIV-infected patients with access to care.
Prior studies evaluating racial/ethnic differences in responses to antiretroviral therapy (ART) among HIV-infected patients have not adequately accounted for many potential confounders, and few have included Hispanic patients. ⋯ In the setting of similar access to care, we did not observe a disparity for the risk of clinical events for racial/ethnic minorities, despite lower ART adherence.
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Comparative Study
Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue.
Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient safety. ⋯ Among patients receiving MMT and medical care at different sites, documentation of opioid dependence and MMT in the medical record occurs for the majority, but is missing in a substantial number of patients. Most of these patients are prescribed medications that potentially interact with methadone. This study highlights opportunities for improved coordination between medical care and MMT.
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Comparative Study
Predictors of outcome after exacerbation of chronic obstructive pulmonary disease.
The outcome after hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD) is unfavorable and uncertainty exists about factors predicting short and long-term prognosis. ⋯ In this study, MRC scale and BMI predicted outcome after COPD hospitalization. Pending further validation, this predictive model may contribute to identify patients with poor outcome even when spirometric data are unavailable.
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Comparative Study
The association of patient age with cardiovascular disease risk factor treatment and control in diabetes.
While inadequate treatment intensification may contribute to sub-optimal CVD risk factor control in older patients with diabetes, the relationship between patient age and treatment intensification is largely unexplored. ⋯ Both treatment intensification rates and control of BP, A1c and LDL cholesterol control varied somewhat by age, suggesting room for further improvement in treatment intensification and control.
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Comparative Study
Alternative approaches to ambulatory training: internal medicine residents' and program directors' perspectives.
Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. ⋯ Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.