Journal of general internal medicine
-
Patients are often advised to initiate a physical activity program by walking for transportation or leisure. This study explored whether neighborhood factors beyond the individual might affect compliance. ⋯ Neighborhood physical and social environmental factors are significantly associated with walking at recommended levels. Being aware of the ways that the environment could affect a patient's compliance with PA recommendations may help physicians tailor recommendations to circumstances.
-
Comparative Study
"Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry.
Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. ⋯ Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.
-
Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. ⋯ One quarter of women with HCV in this cohort were not aware of their diagnosis. Among those aware of their HCV, 1 in 4 received liver biopsy and treatment for HCV. Both provider and patient education interventions regarding HCV testing and HCV treatment options and guidelines are needed to enhance HCV awareness and participation in HCV evaluation and treatment.
-
Secondary erythrocytosis of cyanotic congenital heart disease (CCHD) is pathologically different from primary erythrocytosis of polycythemia vera (PV). An association between elevated hematocrit and thrombosis has been established in PV patients, and treatment guidelines recommend maintaining hematocrit <45%. Although an association between elevated hematocrit and thrombosis has not been established in CCHD and secondary erythrocytosis, the current clinical practice is to phlebotomize these patients to hematocrit <65%. ⋯ Other factors, including dehydration and iron deficiency, may precipitate hyperviscosity symptoms. The treatment is volume replacement and low-dose iron therapy, not phlebotomy. Repeated phlebotomy causes iron deficiency with microcytic erythrocytes, which increases the whole blood viscosity and, therefore, can potentially accentuate rather than decrease the risk for a cerebrovascular accident.
-
To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. ⋯ The association between CIC and HbA1c <7% is heterogeneous and depends on the domain of complexity. The varying associations of CIC categories with optimal glycemic control suggest the need for appropriate risk adjustment when using HbA1c <7% as a valid performance measure for diabetes quality of care.