Journal of general internal medicine
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Posttraumatic stress and complicated grief in family members of patients in the intensive care unit.
Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a patient's ICU stay. ⋯ Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief.
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To determine which easily available clinical factors are associated with mortality in patients with stable COPD and if health-related quality of life (HRQoL) provides additional information. ⋯ Among patients with stable COPD, FEV(1%) was the main predictor of respiratory mortality and dyspnea of all-cause mortality. In general, HRQoL was not related to mortality when dyspnea was taken into account, and CRQ and SGRQ behaved in similar ways regarding mortality.
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Modifiable risk factors such as diet and physical activity contribute to racial disparities among patients with diabetes. Despite this, little is known about how frequently physicians provide counseling or referral to address these risk factors, or whether such rates differ by patient race. ⋯ Rates of lifestyle modification counseling/referral were similarly low among African-Americans and whites in this national study. Our results highlight a need for interventions to enhance physician counseling for patients with diabetes, particularly those at high-risk for diabetes-associated morbidity and mortality, such as racial/ethnic minorities.
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Multicenter Study
Communication and decision making about life-sustaining treatment: examining the experiences of resident physicians and seriously-ill hospitalized patients.
Despite evidence-based recommendations for communication and decision making about life-sustaining treatment, resident physicians' actual practice may vary. Few prior studies have examined these conversations qualitatively to uncover why ineffective communication styles may persist. ⋯ Residents' communication practices may stem from their attempt to balance an informed choice model of decision making with their interest in providing appropriate care for the patient. Physicians' beliefs about mandatory autonomy may be an impediment to improving communication about patients' choices for life-sustaining treatment. Redefining the role of the physician will be necessary if a shared decision making model is to be adopted.
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Practice Guideline
Self-neglect in older adults: a primer for clinicians.
Self-neglect in older adults is an increasingly prevalent, poorly understood problem, crossing both the medical and social arenas, with public health implications. Although lacking a standardized definition, self-neglect is characterized by profound inattention to health and hygiene. In light of the aging demographic, physicians of all specialties will increasingly encounter self-neglectors. ⋯ The individual's capacity is often questioned, and interventions are case-based. More research is needed in basic epidemiology and risk factors of the problem, so that targeted interventions may be designed and tested. The debate of whether self-neglect is a medical versus societal problem remains unresolved, yet as health sequelae are part of the syndrome, physicians should be part of the solution.