The Relationship Between Time Spent Communicating and Communication Outcomes on a Hospital Medicine Service

BACKGROUND  

Quality care depends on effective communication between caregivers, but it is unknown whether time spent communicating is associated with communication outcomes.     

Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs

Background  

Differential diagnosis (DDX) generators are computer programs that generate a DDX based on various clinical data.     

Diabetes Control Among Hispanics in the Action to Control Cardiovascular Risk in Diabetes Trial

BACKGROUND

Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care.

OBJECTIVE

To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

DESIGN

Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0?%, and standard, targeting glycated hemoglobin between 7.0?% and 7.9?%.

PARTICIPANTS

Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States.

MAIN MEASURE

Glycated hemoglobin

RESULTS

Compared to Puerto Ricans, Mexicans were more likely (HR?=?1.38, CI:0.90?C2.10) and Dominicans as likely (HR?=?1.01, CI:0.66?C1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR?=?1.57, CI:0.99?C2.51 in the intensive arm, HR?=?1.51, CI:0.95?C2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR?=?0.47, CI:0.31?C0.71), and Dominicans (OR?=?0.41, CI:0.26?C0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR?=?0.66, CI:0.43?C1.02).

CONCLUSIONS

Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies.     

Implementing bathhouse-based voluntary counselling and testing has no adverse effect on bathhouse patronage among men who have sex with men

Implementing HIV voluntary counselling and testing (VCT) in bathhouses is a proven public health strategy for reaching high-risk men who have sex with men (MSM) and efficiently identifying new HIV cases. However, some bathhouse managers are concerned that VCT programmes could adversely affect business. This study examined whether offering VCT on the premises of a bathhouse changed patterns of patron visits. A collaborating bathhouse provided electronic anonymized patron data from their entire population of attendees. VCT was offered on premises with varying frequencies over the course of three years. Club entrances and exits were modelled as a function of intensity of VCT programming. Club entrances did not differ as a function of how many days per week testing was being offered in a given month. Additionally, club entrances did not decrease, nor did club exits increase, during specific half-hour time periods when testing was offered. Implementing bathhouse-based VCT did not have any demonstrable impact on patronage. Public health officials can leverage these results to help alleviate club managers' concerns about patron reactions to providing testing on site, and to support expanding sexual health programmes for MSM in these venues.     

An Expanded Self‐Medication Hypothesis Based on Cognitive‐Behavioral Determinants for Heroin Abusers in Taiwan: A Cross‐Sectional Study

Background: This study proposed and examined an expanded self‐medication hypothesis (eSMH) model based on cognitive behavioral determinants, including the direct effects of negative emotional states, positive outcome expectancies and refusal self‐efficacy on heroin use, and the mediating roles of positive outcome expectancies and refusal self‐efficacy between negative emotional states and heroin use. Methods: A total of 360 male heroin abusers were recruited from a drug abuse treatment center in Taiwan. Participants were asked to complete a set of questionnaires on frequency of heroin use, anxious/depressive mood, positive outcome expectancies, and refusal self‐efficacy. Structural equation modeling was used to examine the eSMH model. Results: Results showed that the eSMH model displayed proper goodness‐of‐fit. Positive outcome expectancies and negative emotional status were significant predictors of heroin use, whereas refusal self‐efficacy was not a significant predictor. Additionally, positive self‐efficacy was a mediator between negative emotional status and heroin use. Conclusion: Results support a reduced eSMH model and suggest a significant role of positive self‐efficacy in the relationship between negative affective states and heroin use. This relationship should be examined in the longitudinal study, and should be given clinical consideration in treatment of individuals struggling with heroin abuse and negative affective states. (Am J Addict 2012;21:S43–S48)     

Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: Results from the HERCULES trial

Background : Atherosclerotic renal artery stenosis (ARAS) causes hypertension (HTN) and threatens renal function (RF). The HERCULES Trial is a prospective, multicenter trial of renal stenting in patients with uncontrolled HTN and ARAS evaluating the safety and effectiveness of the RX Herculink Elite Renal Stent System (Abbott Vascular, Santa Clara, CA). Results : Mean systolic blood pressure (SBP) at baseline was 162 mm Hg. Nearly 70% of patients were receiving three or more antihypertensive medications (mean 3.4 medications per patient). Baseline serum creatinine was 1.2 ± 0.4 and 61.5% of subjects had estimated glomerular filtration <60. The restenosis rate was 10.5% at 9 months. The study device, procedure, and clinical success rates were 96.0, 99.2, and 98.0%, respectively. Freedom from major adverse events was 94.8%. At 9 months, the mean SBP significantly decreased (mean 145, paired t test P < 0.0001) after stenting with no change in medications. There was no correlation between SBP reduction and baseline BNP or BNP reduction. 相似文献   

Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions

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