Journal of general internal medicine
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Comparative Study
Delay of insulin addition to oral combination therapy despite inadequate glycemic control: delay of insulin therapy.
Patients and providers may be reluctant to escalate to insulin therapy despite inadequate glycemic control. ⋯ Despite inadequate glycemic control, a minority of patients added insulin or maximized oral agent doses, thus, incurring substantial glycemic burden on SU/MET. Additional studies are needed to examine the benefits of rapid titration to maximum doses and earlier initiation of insulin therapy.
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Comparative Study
Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.
The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. ⋯ Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.
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Homeless persons face many barriers to health care, have few resources, and experience high death rates. They live lives of disenfranchisement and neglect. Few studies have explored their experiences and attitudes toward death and dying. Unfortunately, studies done in other populations may not apply to homeless persons. Exploring these experiences and attitudes may provide insight into life, health care, and end-of-life (EOL) concerns of this population. ⋯ Findings from this study have implications for addressing social services, health promotion, prevention, and EOL care for homeless persons, as well as for others who are poor and disenfranchised.
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Comparative Study
Screening patients with a family history of colorectal cancer.
To compare screening practices and beliefs in patients with and without a clinically important family history. ⋯ More efforts are needed to translate information about family history of colorectal cancer into the care of patients.
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Although hospice care can alleviate suffering at the end of life for patients with cancer, it remains underutilized, particularly by African Americans and Hispanics. ⋯ Increasing hospice use may require interventions to improve the delivery of hospice care in minority communities.