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BACKGROUND Previous studies suggest that patients who are more involved in their medical care have better outcomes.
OBJECTIVES We sought to compare health care processes and outcomes for patients with HIV based on their preferred level of involvement
in health decisions.
DESIGN Cross-sectional analysis of audio computer-assisted interviews with patients at an urban HIV clinic.
PATIENTS One thousand and twenty-seven patients awaiting an appointment with their primary care provider.
MEASURES Patients were asked how they preferred to be involved in decisions (doctor makes most or all decisions, doctor and patient
share decisions, patient makes all decisions). We also asked patients to rate the quality of communication with their HIV
provider, and their self-reported receipt of and adherence to HAART.
RESULTS Overall, 23% patients preferred that their doctor make all or most decisions, 63% preferred to share decisions with their
doctor, and 13% preferred to make all final decisions alone. Compared to patients who prefer to share decisions with their
HIV provider, patients who prefer that their provider make all/most decisions were significantly less likely to adhere to
HAART (OR [odds ratio] 0.57, 95% CI 0.38–0.86) and patients who preferred to make decisions alone were significantly less
likely to receive HAART or to have undetectable HIV RNA in unadjusted analyses (OR 0.52, 95% CI 0.31–0.87 for receipt of HAART;
OR 0.64, 95% CI 0.44–0.95 for undetectable HIV RNA). After controlling for potentially confounding patient characteristics
and differences in patient ratings of communication quality, patients who preferred that their provider make all/most decisions
remained significantly less likely to adhere to HAART (OR 0.58, 95% CI 0.38–0.89); however, the associations with receipt
of HAART and undetectable HIV RNA were no longer significant (OR 0.60, 95% CI 0.34–1.05 for receipt of HAART; OR 0.80, 95%
C.I 0.53–1.20 for undetectable HIV RNA).
CONCLUSIONS Although previous research suggests that more patient involvement in health care decisions is better, this benefit may be
reduced when the patient wants to make decisions alone. Future research should explore the extent to which this preference
is modifiable so as to improve outcomes. 相似文献
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Sharon Stein Merkin MHS PhD Arun Karlamangla Eileen Crimmins Susan L. Charette Mark Hayward Jung Ki Kim Brandon Koretz Teresa Seeman 《International journal of public health》2009,54(3):166-174
Objectives: To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3
race/ethnic groups.
Methods: We analyzed data for a nationally representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white,
black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey
from 1999–2002.
Results: Participants with < high school education were 2.5 times less likely than participants with ≥ high school education to have
been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3–0.5,
and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends
associated with education after adjusting for age, gender, race and comorbidities.
Conclusions: Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic
group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent
steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low
education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent
cardiovascular disease.
Submitted: 31 March 2007; revised: 27 March 2008, 09 September 2008; accepted: 29 September 2008 相似文献
96.
Christophe Garweg MD PhD Jonathan P. Piccini MD MHS Laurence M. Epstein MD Camille Frazier-Mills MD MHS Larry A. Chinitz MD Clemens Steinwender MD Kurt Stromberg MS Todd Sheldon MS Dedra H. Fagan PhD Mikhael F. El-Chami MD 《Journal of cardiovascular electrophysiology》2023,34(1):197-206
Introduction
Micra atrioventricular (AV) provides leadless atrioventricular synchronous pacing by sensing atrial contraction (A4 signal). Real-world operation and reliability of AV synchrony (AVS) assessment using device data have not been described. The purposes of this study were to (1) assess the correlation between AVS and atrial mechanical sensed-ventricular pacing (AM-VP) percentages in patients with permanent high-degree AV block and (2) report on the real-world effectiveness of Micra AV.Methods
The correlation between ECG-determined AVS in-clinic and device-collected %AM-VP was assessed using data from 40 patients with high-degree AV block enrolled in the Micra Atrial tRacking using a Ventricular AccELerometer (MARVEL) 2 study. A retrospective analysis to assess continuously-sampled %AM-VP since last session, device programming, and electrical parameters was performed using Micra AV transmissions from the Medtronic CareLink database. Patients with transmissions ≥180 days postimplant were included.Results
Among the 40 MARVEL 2 AV block patients with a median %VP of 99.7%, AVS was highly correlated with AM-VP (median AVS 87.1%, median AM-VP 79.1%; R2 = 0.764, p < .001). The CareLink cohort included 4384 patients programmed to VDD mode. The mean A4 amplitude was 2.3 ± 1.8 m/s2 at implant and 2.3 ± 1.6 m/s2 at 28 weeks. In patients with %VP >90% (n = 1662), the median %AM-VP was 74.7%. For the full cohort, median %VP was 65.6% and median projected battery longevity was 10.5 years.Conclusion
In patients with a high pacing burden, %AM-VP provides a reasonable estimation of AVS. The first large real-world analysis of Micra AV patients with >90% VP showed stable atrial sensing over time with a median %AM-VP, a correlate of AVS, of 74.7%. 相似文献97.
Langer I Guller U Koechli OR Berclaz G Singer G Schaer G Fehr MK Hess T Oertli D Bronz L Schnarwyler B Wight E Uehlinger U Infanger E Burger D Zuber M;Swiss Multicenter Sentinel Lymph Node Study Group in Breast Cancer 《Annals of surgical oncology》2007,14(6):1896-1903
Background The sentinel lymph node (SLN) status has proven to accurately reflect the remaining axillary lymph nodes and represents the
most important prognostic factor. It is unknown whether an association exists between the SLN status and the presence of bone
marrow (BM) micrometastases. The objective of the present investigation was to evaluate whether or not such an association
exists.
Methods In the present investigation 410 patients with early stage breast cancer (pT1 and pT2 ≤3cm, cN0) were prospectively enrolled
between 1/2000 and 12/2003. All patients underwent SLN biopsy and bone marrow aspiration. The histological examination of
the SLN consisted of step sectioning, H&E, and immunohistochemistry (Lu-5, CK 22) staining. Cancer cells in the BM were stained
with monoclonal antibodies A45-B/B3 against cytokeratin and counted by an automated computerized digital microscope.
Results BM micrometastases were detected in 28.8% (118/410) of all patients. The SLN contained metastases in 32.4% (133/410). Overall
51.2% of the patients (210/410) were SLN negative/BM negative and 12.4% (51/410) SLN positive/BM positive. Of all patients,
16.4% (67/410) were SLN negative/BM positive and 20.0% (82/410) SLN positive/BM negative. There was a statistically significant
association between the SLN and BM status, both in unadjusted (Fisher’s exact test: P = .004) and multiple logistic regression analysis (P = .007).
Conclusions In the present investigation a significant association was found between a positive SLN status and the presence of BM micrometastases.
Nonetheless, the percentage of non-concordance (SLN negative/BM positive and SLN positive/BM negative) was considerable. The
prognostic impact of BM micrometastases in our patient sample remains to be evaluated.
Presented at the 2006 Annual Meeting of the Society of Surgical Oncology in San Diego/USA. 相似文献
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Dorthe Nielsen RN MHS PhD Lotte Huniche MA PhD Kim Brixen MD PhD Opinder Sahota MD PhD Tahir Masud MD PhD 《Scandinavian journal of caring sciences》2013,27(3):516-524
The aim of this qualitative study was to increase understanding of the importance of osteoporosis information and knowledge for patients’ ways of handling osteoporosis in their everyday lives. Interviews were performed with 14 patients recruited from two English university hospitals and 12 patients from a Danish university hospital. Critical psychology was used as a theoretical framework for the data analysis, which aimed at shedding light on patients’ ways of conducting everyday life with osteoporosis. The themes that emerged from the analysis showed that life conditions influenced the way in which risk, pain and osteoporosis were handled. Everyday life was also influenced by patients’ attitude to treatment. The patients who were experiencing emotional difficulties in handling osteoporosis were not those suffering from severe osteoporosis and fractures. Approaches to living with knowledge of future fracture risk varied according to the individual patient’s resourcefulness and experiences. 相似文献
100.