Journal of general internal medicine
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After acute myocardial infarction (AMI), treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) is widely recognized as crucial to reduce risk of a subsequent AMI. However, many patients fail to consistently remain on these treatments over time, and long-term adherence has not been well described. ⋯ Many patients initiating evidence-based secondary prevention therapies after an AMI fail to consistently remain on these treatments. Adherence is a priority area for development of better-quality measures and quality-improvement interventions. Barriers to beta-blocker adherence for low-income populations need particular attention.
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Physician assisted death (PAD) was legalized through Oregon's Death with Dignity Act in 1994 and enacted in 1997. ⋯ Interventions that help patients maintain control, independence, and self-care in a home environment may be effective means of addressing serious requests for PAD.
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Multicenter Study
Acute myocardial infarction length of stay and hospital mortality are not associated with language preference.
Language barriers between patients and providers may influence the process and quality of care. ⋯ Language preference is not associated with AMI mortality, and the small increase in length of stay associated with non-English preference is accounted for by hospital level factors. Our results suggest that system level differences are important to consider in studies of the effect of language barriers in the health care setting.
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Clinical decision support systems can improve medical diagnosis and reduce diagnostic errors. Older systems, however, were cumbersome to use and had limited success in identifying the correct diagnosis in complicated cases. ⋯ The Isabel clinical decision support system quickly suggested the correct diagnosis in almost all of these complex cases, particularly with key finding entry. The system performed well in this experimental setting and merits evaluation in more natural settings and clinical practice.
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To evaluate the impact of regulatory scenarios on the financial viability of medical device companies. ⋯ The environment in which the medical device industry operates is financially attractive. Furthermore, when compared with the alternative of applying the same evidence standards for pharmaceuticals to medical devices, the CSP policy offers improved financial incentives for medical device companies.