Other Medicine and Health Sciences Commons^™

Uncertainty And Competing Priorities In Shared Clinical Decision-Making, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews observes that a connecting thread among the articles published therein is an element of uncertainty among patients and clinicians. Competing priorities for the patient also may be present. Several approaches to overcoming these prevalent conflicts to delivery of better health care have been proposed, the most important of which may be clinicians embracing a will to practice shared decision-making.

Clinical And Laboratory Features That Distinguish Dengue From Other Febrile Illnesses In Endemic Populations, James Potts, Alan Rothman

Alan Rothman

OBJECTIVE: Clinicians in resource-poor countries need to identify patients with dengue using readily-available data. The objective of this systematic review was to identify clinical and laboratory features that differentiate dengue fever (DF) and/or dengue haemorrhagic fever (DHF) from other febrile illnesses (OFI) in dengue-endemic populations. METHOD: Systematic review of the literature from 1990 to 30 October 2007 including English publications comparing dengue and OFI. RESULTS: Among 49 studies reviewed, 34 did not meet our criteria for inclusion. Of the 15 studies included, 10 were prospective cohort studies and five were case-control studies. Seven studies assessed all ages, four assessed children …

Integrating An Automated Diabetes Management System Into The Family Management Of Children With Type 1 Diabetes., Tammy R. Toscos, Stephen W. Ponder, Barbara J. Anderson, Mayer B. Davidson, Martin L. Lee, Elaine Montemayor-Gonzalez, Patricia Reyes, Eric Link, Kevin L. Mcmahon

Tammy R Toscos

OBJECTIVE: The study objective was to evaluate how the use of a pervasive blood glucose monitoring (BGM) technology relates to glycemic control, report of self-care behavior, and emotional response to BGM of children with type 1 diabetes and their parents. RESEARCH DESIGN AND METHODS: Forty-eight children aged less than 12 years (mean 8.8 years) with type 1 diabetes were randomly assigned to one of two study groups, a control group (conventional care without technology) or an experimental group (conventional care with technology), and followed for 12 months. Families in the experimental group were given the Automated Diabetes Management System (ADMS), …

Unexplained Variation Across Us Nursing Homes In Antipsychotic Prescribing Rates., Yong Chen, Becky Briesacher, Terry Field, Jennifer Tjia, Denys Lau, Jerry Gurwitz

Jennifer Tjia

BACKGROUND: Serious safety concerns related to the use of antipsychotics have not decreased the prescribing of these agents to nursing home (NH) residents. We assessed the extent to which resident clinical characteristics and institutional prescribing practice were associated with antipsychotic prescribing.

METHODS: Antipsychotic prescribing was assessed for a nationwide, cross-sectional population of 16 586 newly admitted NH residents in 2006. We computed facility-level antipsychotic rates based on the previous year's (2005) prescribing patterns. Poisson regressions with generalized estimating equations were used to identify the likelihood of resident-level antipsychotic medication use in 2006, given 2005 facility-level prescribing pattern and NH resident …

Perceived Accessibility As A Predictor Of Youth Smoking, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

PURPOSE: Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. METHODS: This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the …

Perceived Accessibility Of Cigarettes Among Youth: A Prospective Cohort Study, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

BACKGROUND: The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study. METHODS: Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed …

Disparities And Survival Among Breast Cancer Patients, Terry Field, Diana Buist, Chyke Doubeni, Shelley Enger, Hassan Fouayzi, Gene Hart, Eli Korner, Lois Lamerato, Donald Bachman, Jennifer Ellis, Lisa Herrinton, Mark Hornbrook, Richard Krajenta, Liyan Liu, Janice Yao

Chyke A. Doubeni

BACKGROUND: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.

PURPOSE: To determine whether this survival disparity persists in an insured population with access to medical care.

METHODS: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, …

Thirty-Year Trends (1975-2005) In The Magnitude And Hospital Death Rates Associated With Complete Heart Block In Patients With Acute Myocardial Infarction: A Population-Based Perspective, Hoa Nguyen, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Juan Zevallos, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: The contemporary magnitude and prognostic implications of complete heart block (CHB) in patients with acute myocardial infarction (AMI) are unknown. As part of a community-based study of patients hospitalized with AMI in the Worcester, MA, metropolitan area, changes over time in the incidence rates of CHB complicating AMI and the prognostic impact of CHB on short-term survival were examined.

METHODS: The study population consisted of 13,663 residents of the Worcester metropolitan area who were hospitalized with AMI at all greater Worcester medical centers during 15 annual periods between 1975 and 2005.

RESULTS: The average age of the hospitalized study …

Coming Of Age And Taking Stock: The State Of Academic Health Policy Research Centres In Canada, Michele L. Mekel, Samuel E.D Shortt

Michele L Mekel

This descriptive study takes stock of Canada's health services and health policy research capacity by profiling the organizational models, operational challenges, and success strategies utilized by Canadian academic health policy research centres. While each such centre is unique, the results point to some common themes, including symbiotic relationships between centres and their ministries of health, pervasive infrastructure funding challenges and the importance of having a supportive academic home.