Arch Intern Med
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Randomized Controlled Trial Clinical Trial
Improvements in advance care planning in the Veterans Affairs System: results of a multifaceted intervention.
Advance care planning (ACP) aims to guide health care in the event of decisional incapacity. Interventions to promote ACP have had limited effectiveness. We conducted an educational and motivational intervention in Department of Veterans Affairs outpatient clinics to increase ACP use and proxy and health care provider understanding of patients' preferences and values. ⋯ This intervention demonstrates mixed results and highlights the ongoing challenges of helping health care providers and potential proxy decision makers represent patient preferences and values.
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Although cocaine use and human immunodeficiency virus (HIV) infection have been linked with clinical cardiovascular disease, the effects of cocaine use and HIV infection, especially the combination of the 2, on subclinical disease have rarely been reported. The objective of this study was to evaluate whether cocaine use alone, HIV infection alone, or a combination of the 2 is associated with coronary calcification, a marker of subclinical atherosclerosis. ⋯ These results suggest that HIV infection alone, cocaine use alone, or the 2 combined may contribute to early subclinical atherosclerotic cardiovascular disease.
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Many physicians receive financial incentives to limit their ordering of expensive tests and procedures. While Medicare mandates disclosure of incentives, it is not clear how to inform patients without undermining trust. ⋯ The public wants information about physician financial incentives. Specific communication styles enhance how this information is conveyed to patients, increasing trust and supporting the physician-patient relationship.
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Comparative Study
Use of clinical prediction rules in detecting osteoporosis in a population-based sample of postmenopausal women.
Osteoporosis clinical prediction rules attempt to identify the postmenopausal women in whom, on the basis of individual risk factors, bone densitometry will detect low bone mass. We assessed and compared the diagnostic properties of the following 3 osteoporosis clinical prediction rules: the Simple Calculated Osteoporosis Risk Estimation, Osteoporosis Risk Assessment Instrument, and National Osteoporosis Foundation practice guidelines. ⋯ Our results suggest that these clinical prediction rules do not perform well as a general screening method to identify postmenopausal women who are more likely to have osteoporosis; however, the Osteoporosis Risk Assessment Instrument and Simple Calculated Osteoporosis Risk Estimation may be useful in identifying some women who need not undergo testing, especially younger postmenopausal women.