The American journal of medicine
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Comparative Study
Functional disability, cognitive impairment, and depression after hospitalization for pneumonia.
The study objective was to examine whether hospitalization for pneumonia is associated with functional decline, cognitive impairment, and depression, and to compare this impairment with that seen after known disabling conditions, such as myocardial infarction or stroke. ⋯ Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.
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The study objective was to examine the association between pre-hospital serum vitamin D concentration and mortality after hospitalization. ⋯ Analysis of 23,603 hospitalized patients identified both 25(OH)D ≤15 ng/mL and 25(OH)D 15 to 30 ng/mL before hospital admission as associated with the odds of all-cause patient mortality at 30 days after hospitalization. In addition, pre-hospital serum 25(OH)D ≤15 ng/mL is significantly associated with the odds of community-acquired bloodstream infection.
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Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. ⋯ Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction.
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Patients with atrial fibrillation often have cardiovascular risk factors or known comorbid disease, yet the use of evidence-based primary and secondary prevention cardiac therapy among atrial fibrillation outpatients is unknown. ⋯ The majority of eligible atrial fibrillation outpatients did not receive all guideline-recommended therapies for cardiovascular comorbid conditions and risk factors. This represents a potential opportunity to improve atrial fibrillation patients' quality of care and outcomes.
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Historical Article
Crooked path made straight: the rise and fall of the southern governors' plan to educate black physicians.
In 1945, a wave of GI-Bill-supported African American students, qualified for admission to medical schools, returned from their service in World War II. The possibility that their acceptance would integrate all-white medical schools was a problem for the southern governors. The governors responded with a carefully considered plan to shunt these African American applicants to historically black medical colleges by joining in a Compact and attempting to purchase Meharry Medical College in Nashville, Tennessee. This untold story of American medicine and its connection to our present shortage of African American physicians in the South needs to be remembered and passed on to future generations.