Journal of general internal medicine
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Multicenter Study
Lack of adherence with preoperative B-blocker recommendations in a multicenter study.
Clinical guidelines support the use of preoperative B-blocker in select patients. Patient safety groups have sought to measure the level of adherence to these recommendations. ⋯ Preoperative B-blocker was significantly underutilized when compared with the current guideline recommendations. Target heart rate goals were not achieved in clinical practice, and few hospitalized patients had preoperative B-blockade initiated. The lack of adherence to preoperative B-blocker recommendations in practice may be impacted by ongoing clinical questions regarding the appropriate selection of candidates for this therapy. Further efforts toward achieving guideline recommendations for preoperative B-blocker use should be focused on the subset of patients that are uniformly agreed upon to be at high risk for cardiac events.
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Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low rates of referral to addiction treatment programs. ⋯ Outpatient/day hospital-based integrated treatment is a viable option for medically ill substance-abusing adults who would otherwise be hospitalized and is associated with higher than expected completion rates and low rate of complications. Co-locating the unit at a hospital and integrating extensive social supports appear to be key components to this model.
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During clinical training, house officers frequently encounter intense experiences that may affect their personal growth. The purpose of this study was to explore processes related to personal growth during internship. ⋯ Efforts to support personal growth during residency training include fostering supportive relationships, encouraging reflection, and recognizing interns' core values especially in association with powerful triggers.
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Little is known about the relation between perceptions of health care discrimination and use of health services. ⋯ Persons who report discrimination may be less likely to receive some preventive health services. However, perceived discrimination is unlikely to account for a large portion of observed disparities in receipt of preventive care.
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Comparative Study
Attitudes of urban American Indians and Alaska Natives regarding participation in research.
To determine what factors influence participation in health research among American Indians and Alaska Natives. ⋯ Close attention to study type, institutional sponsorship, community involvement, potential risks and benefits, and topic are essential to conceptualizing, designing, and implementing successful health research with American Indian and Alaska Native populations.