Journal of general internal medicine
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The central venous pressure (CVP) is commonly estimated at the bedside by measuring the height of the jugular venous pressure (JVP) relative to the sternal angle. Determining the CVP from this measure requires that the distance from the sternal angle to the level of the mid-right atrium be known. Classical clinical teaching quotes this distance as 5 cm, invariable between patients, and invariable with changes in the elevation of the patient's head. The validity of these JVP characteristics has been questioned. ⋯ The distance from the sternal angle to the level of the mid-right atrium varies considerably between individuals and with patient position. When using the JVP to calculate the CVP, physicians need to consider specific patient factors and the patient's position.
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Greater participation in medical decision making is generally advocated for patients, and often advocated for those with diabetes. Although some studies suggest that diabetic patients prefer to participate less in decision making than do healthy patients, the empirical relationship between such participation and diabetic patients' satisfaction with their care is currently unknown. We sought to characterize the relationship between aspects of diabetic patients' participation in medical decision making and their satisfaction with care. ⋯ Clinicians may feel reassured that encouraging even initially reluctant patients with diabetes to participate in medical decision making may be associated with increased patient satisfaction. Greater patient participation has the potential to improve diabetic self-care because of the likely positive effect of patient satisfaction on adherence to treatment. Further research to assess the prospective effects of enhancing physician facilitation of patient participation is likely to yield important information for the effective treatment of chronically ill patients.
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To evaluate the adequacy of pharmacological thromboembolic prevention in the medical ward of a university hospital, we performed a retrospective study in 227 consecutive inpatients. The presence of risk factors, and type, length, and dose of pharmacological prevention were documented by chart review. ⋯ The high prevalence of over- and undertreatment is an indicator of less than optimal care. Quality of care interventions, such as the development of local guidelines, might improve the appropriateness of pharmacological thromboembolic prophylaxis in medical inpatients.
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To answer the question, "What do older disabled women report as the main symptoms causing their disability?" ⋯ Musculoskeletal pain was the most common cause of disability reported by older women, followed by weakness and balance difficulties. Greater attention to symptoms that interfere with daily activities of older persons may reduce the burden of disability.
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Adherence to complex antiretroviral therapy (ART) is critical for HIV treatment but difficult to achieve. The development of interventions to improve adherence requires detailed information regarding barriers to adherence. However, short follow-up and inadequate adherence measures have hampered such determinations. We sought to assess predictors of long-term (up to 1 year) adherence to newly initiated combination ART using an accurate, objective adherence measure. ⋯ Nearly all patients' adherence levels were suboptimal, demonstrating the critical need for programs to assist patients with medication taking. Interventions that assess and treat substance abuse and incorporate adherence aids may be particularly helpful and warrant further study.