The Western journal of medicine
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Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. ⋯ Although the inhaled route of administration has the benefit of allowing patients to self-titrate the dose, the smoking of crude plant material is problematic. The NIH panel recommended that a high priority be given to the development of a controlled inhaled form of THC. The presence of a naturally occurring cannabinoid-receptor system in the brain suggests that research on selective analogues of THC may be useful to enhance its therapeutic effects and minimize adverse effects.
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To assess the effects of implementing a standardized order form on the prescribing and monitoring of gentamicin sulfate at a nonteaching Veterans Affairs Medical Center, we prospectively evaluated the prescribing and monitoring of gentamicin for 14 months after the use of such a form was implemented. The data collected included dosing, initial serum gentamicin concentrations, and serum creatinine measurements. These data were compared with similar data obtained during a period of 6 months before the order form was used. ⋯ The timely measurement of serum gentamicin concentrations and serum creatinine levels was improved in the group for whom the order form was used. The order form was completed satisfactorily in 44 patients (94%). We conclude that implementing a standardized order form improved the use of gentamicin.
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To determine the quality of care provided to non-English-speaking patients with non-insulin-dependent (type 2) diabetes mellitus compared with English-speaking patients, we did a retrospective cohort study of 622 patients with type 2 diabetes, of whom 93 were non-English-speaking and 529 were English-speaking. They were patients at primary and specialty care clinics at a university and a county hospital, and the study was based on clinical and administrative database records with a 12-month follow-up. Professional interpreters were provided to all non-English-speaking patients. ⋯ Outcome variables also did not differ, including standardized glycohemoglobin and other laboratory results, complication rates, use of health services, and total charges. At these institutions, the quality of diabetes care for non-English-speaking patients appear to be as good as, if not better than, for English-speaking patients. Physicians may be achieving these results through more frequent visits and laboratory testing.