Journal of general internal medicine
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This research addresses two issues concerning the role of primary care physicians in suicide prevention: 1) Are there signals in a patient's medical record that identify patients at increased risk of suicide? 2) Is the pattern of utilization of suicides immediately prior to suicide different from those of other patients? To address these issues, medical records data for suicides and for symptomatically depressed and non-depressed enrollees of an HMO were compared. Suicidal ideation and behavior, selected psychiatric diagnoses, and interpersonal problems were associated with suicide. ⋯ Less than 20% of the suicides visited a primary care physician in the month prior to death. Only 39% of suicides received specialty mental health treatment in the 18 months prior to death.
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Hypothermia in colder climates in the United States occurs predominately as a result of exposure of alcoholics to cold outdoor temperatures. Among 24 cases of accidental hypothermia occurring at a university medical center in the deep South, differences in clinical presentation were identified. In contrast to experience in colder climates, 17/22 cases (76%) developed at home. ⋯ Social isolation was not a strong predictor, with 6/17 of the elderly (35%) living alone. Death occurred in 9/24 patients (37%), but survival could not be predicted from admission temperature, hypotension, anemia, or serum glucose. Since extreme cold temperatures are infrequent in the deep South, identified differences in demographics may be due to inadequate housing or lack of preparation for cold weather dangers.
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Randomized Controlled Trial Clinical Trial
Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes.
To maximize disease control, patients must participate effectively in their medical care. The authors developed an intervention designed to increase the involvement of patients in medical decision making. In a 20-minute session just before the regular visit to a physician, a clinic assistant reviewed the medical record of each experimental patient with him/her, guided by a diabetes algorithm. ⋯ Analysis of audiotapes of the visits to the physician showed the experimental patients were twice as effective as controls in eliciting information from the physician. Experimental patients reported significantly fewer function limitations. The authors conclude that the intervention is feasible and that it changes patient behavior, improves blood sugar control, and decreases functional limitations.
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Patients' perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of "patient request fulfillment" to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. ⋯ Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes.
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The occurrence of fever and the clinical profile of febrile patients on the medical service of a teaching hospital were studied prospectively. Thirty-six per cent of 972 patients developed fever (temperature exceeding 38 degrees C). Their 13% mortality rate and 13.2-day average hospital stay exceeded the 3% mortality and seven-day hospitalization for afebrile patients (p less than 0.0001 for both). ⋯ Patients with bacterial infections had higher temperatures on the first febrile day (mean 38.9 degrees C) and were more likely to have had prior infections than those with other causes of fever (mean 38.3 degrees C, p less than 0.001). Older patients (greater than 75 years) had a lower febrile response to bacterial infections than younger patients. Fever in hospitalized medical patients is a common and important concomitant of increased mortality and length of hospitalization.