Medical care
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Comparative Study
Racial variations in postoperative outcomes of carotid endarterectomy: evidence from the Veterans Affairs National Surgical Quality Improvement Program.
Black patients and Hispanic patients receive carotid endarterectomy (CEA) at lower rates than white patients. It is unclear whether worse surgical outcomes are influencing clinical decision-making regarding use of the operation among minority group patients. ⋯ Rates of major postoperative complications after CEA are low within the VA and similar across racial/ethnic groups with the possible exception of Hispanic men with TIA. Further investigation of this elevated complication rate among Hispanic men with TIA may be warranted.
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Availability of options other than aggressive medical treatment for persons with life-limiting illnesses has provided hospitals an opportunity to adopt formalized end-of-life care services. ⋯ Given the attention paid by both the general public and health professionals to pain relief and providing appropriate care to dying persons, such services are slow to be institutionalized in the hospital setting. The authors' findings suggest strategies for research and policy.
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Patients communicate their desires and expectations largely by making requests. However, the antecedents and consequences of request fulfillment have received limited attention. ⋯ Request fulfillment affects patient and physician satisfaction and perceptions of health outcomes. New approaches that efficiently recognize and respond to patient requests are needed.
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Editorial Comment
In-hospital end-of-life services: is the cup 2/3 empty or 1/3 full?