Arch Intern Med
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The reasons for racial differences in health care are not well known, but the characteristics of hospitals where people receive care may be an important factor in the quality of care that patients receive. Therefore, we sought to determine the proportion and volume of elderly black vs white patients treated at hospitals and examine the characteristics and performances of hospitals that care for disproportionately high volumes of black patients. ⋯ Hospital care for black patients in the United States is remarkably concentrated in a small percentage of hospitals, although the hospitals that care for a high proportion of black patients have only marginally worse quality of care than those that care for a low proportion of black patients. The level of concentration of black patients provides a fresh opportunity to improve care for black patients by targeting efforts toward a small group of hospitals.
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Cross-sectional studies find an elevated prevalence of depression among subjects with diabetes mellitus (DM). The causal mechanisms and temporal sequence of this association have not been clearly delineated. This study investigated the prospective relationship between DM and depressive symptoms. ⋯ Among well-functioning older adults, DM is associated with increased risk of depressive symptoms.
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Widely used models for teaching and assessing communication skills highlight the importance of greeting patients appropriately, but there is little evidence regarding what constitutes an appropriate greeting. ⋯ Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names.
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Randomized Controlled Trial
Simultaneous vs sequential counseling for multiple behavior change.
Many patients in primary care settings present with multiple behavioral risk factors for cardiovascular disease. Research has provided little information on the most effective ways to approach multiple behavior change counseling in clinical settings. ⋯ Long-term multiple behavior change is difficult in primary care. This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach.
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Some, but not all, reports suggest that patients with Gaucher disease are at increased risk of developing malignancies, particularly hematopoietic tumors. The aim of this study was to assess the pattern of Gaucher disease and subsequent malignancies among male veterans admitted to US Veterans Affairs hospitals. ⋯ We found 2- to 3-fold risks of non-Hodgkin lymphoma, malignant melanoma, and pancreatic cancer in patients with Gaucher disease, but no significant association between Gaucher disease and cancer in general or with other specific malignancies such as multiple myeloma.