J Natl Med Assoc
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A useful framework for initiating organ donation discussions in the primary care setting may help increase willingness to donate and thereby increase the frequency of organ transplantation. Given the lower willingness to donate among African Americans and that a higher proportion of African Americans die while waiting for an organ transplant, this is an important group to consider in such an approach. We examined the association among completion of a living will and willingness to donate and the influence of race in this relationship. ⋯ The public is generally supportive of organ donation although African Americans remain less willing to donate after controlling for confounding variables. Physicians interested in increasing donation rates should consider incorporating organ donation into discussions of advance care planning and end-of-life care.
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Hispanic patients comprise the largest minority population in the United States. The federal government mandates that healthcare providers be able to communicate with those patients who have limited English ability. The primary purpose of this study was to assess the English-language proficiency of self-declared English-speaking Hispanic patients in the emergency department (ED). The secondary purpose was to determine concordance between patients' tested English proficiency and perceived proficiency by nurses and physicians. We hypothesized that many patients who state that they are able to speak English do not in fact possess sufficient ability to communicate in English. ⋯ This study demonstrated that a significant number of patients who report English proficiency have an inadequate level of English health literacy and therefore English-language ability. Furthermore, there was a discrepancy between level of English competency found in the study and in the perceived English competency of the patients in the judgment of the physicians and nurses in the ED. This study demonstrated that that there was significant lack of English-language ability of self-declared Hispanic patients, suggesting that a more liberal use of interpreters may be indicated.
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Inhaled corticosteroids (ICSs) are the most effective medications available for patients with persistent asthma of all severities and currently are recommended as the preferred asthma controller therapy by the National Heart, Lung and Blood Institute. Nevertheless, lingering concerns about potential adverse systemic effects of ICSs contribute to their underuse. This review discusses the safety of ICSs with respect to potential systemic effects of most concern to physicians and patients. ⋯ ICSs have minimal systemic effects in most patients when taken at recommended doses. The benefits of ICS therapy clearly outweigh the risks of uncontrolled asthma, and ICSs should be prescribed routinely as first-line therapy for children and adults with persistent disease.