Journal of general internal medicine
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All employees hired over a six-month period at a large hospital underwent pre-employment urinary toxicology screening. Results of the screening were kept confidential. After a year of employment, the personnel folders of all employees studied were reviewed. ⋯ There was a strongly significant difference between clerical and professional employees on each of these variables. This study did not find a relation between drug use and job performance. The widespread use of drug screening prior to employment makes further studies of this issue important.
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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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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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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.