J Natl Med Assoc
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This historical cohort study assessed the impact of race on critical factors in the diagnosis and drug treatment of cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS) patients over a 7-year period. The study subjects included 194 adult patients with a history of AIDS who were treated for CMV retinitis between September 1987 and September 1994. Abstracted inpatient hospital medical records and a statewide automated AIDS database were the primary sources of data. ⋯ Patients diagnosed with early disease were more likely to be white, whereas patients diagnosed with severe disease were more likely to be black. There was no difference in the type of CMV retinitis treatment or patient survival time after diagnosis, nor time to treatment once diagnosed by race. These results suggest that differences in survival may not be the result of discrimination against black patients and may be due more likely to practices associated with accessing medical treatment.
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Hereditary angioedema is a rare disorder characterized by a localized subepithelial edema and swelling of the gastrointestinal and upper respiratory tract. The disorder is estimated to occur in 1 in 50,000 to 150,000 individuals. However, the prevalence of the disorder among the African-American population is uncertain. This is a case report of hereditary angioedema occurring in an African-American woman whose symptoms persisted for more than a decade prior to diagnosis.
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Under the auspices of the Buffalo General Hospital and the faculty of medicine of the State University of New York at Buffalo, a comprehensive delivery system for primary care has been established in a local inner-city neighborhood. At the Deaconess Family Medicine Center, located within an inner-city location of Buffalo, New York, several divisions have been integrated to provide comprehensive patient-oriented primary care. These divisions include a primary care clinic, an urgent care clinic, a substance abuse clinic, and a community pediatrics clinic. ⋯ The horizontal integration of these four divisions is in turn vertically integrated with the tertiary care teaching hospital inpatient and obstetrical services, providing a continuum of patient care. The horizontal integration serves as an entry point for patients to enter the hospital's health-care system, while the vertical integration capability serves to capture any specialized referrals or inpatient needs. This article discusses the structure of the center, with special reference to service integration, service delivery, and patient capture; medical education; and the place of integrated units in the strategic plan of a tertiary care hospital.
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Comparative Study Clinical Trial
A review of racial differences in geriatric depression: implications for care and clinical research.
How racial differences influence depressed elders' seeking and obtaining treatment for depression is poorly understood. Studies in other medical illnesses show older African Americans use fewer health-care services for heart disease, stroke, and renal dialysis. This article reviews the racial composition of Duke University's Clinical Research Center (CRC) for the Study of Depression in the Elderly. ⋯ Active efforts to improve minority recruitment increased this percentage to 15% by the end of the project's second year. Likely explanations for low minority participation rates include 1) elders may recognize depressive symptoms, but do not seek or cannot obtain medical treatment, and 2) depressive symptoms may be attributed to a crisis of the spirit (so help is sought through prayer and the church), the "slowing down" process of aging, or part of life's burden to be endured. Future attempts at both treatment and clinical research recruitment efforts are needed to address these possibilities.
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A retrospective analysis was conducted to determine the effects of metformin on glycosylated hemoglobin (HbA1c), body weight, and adverse events in an African-American population. Thirty-six patients who were receiving combination therapy with metformin and either a sulfonylurea or insulin were identified from a hospital pharmacy database. ⋯ The effect of combination therapy on weight was variable; however, twice as many patients lost weight compared with those who gained weight. Metformin appeared to be well-tolerated, with gastrointestinal symptoms being the most commonly reported adverse events.