Journal of general internal medicine
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Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown. ⋯ Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.
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Randomized Controlled Trial Multicenter Study
Early response to preventive strategies in the Diabetes Prevention Program.
Recommendations for diabetes prevention in patients with prediabetes include lifestyle modification and metformin. However, the significance of early weight loss and glucose measurements when monitoring response to these proven interventions is unknown. ⋯ Weight and glucose at 6 and 12 months strongly predict lower subsequent diabetes risk with a lifestyle intervention; lower FG predicts lower risk even with substantial weight loss. Early reduction in glycemia is a stronger predictor of future diabetes risk than weight loss for metformin. We offer the first evidence to guide clinicians in making interval management decisions for high-risk patients undertaking measures to prevent diabetes.
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Randomized Controlled Trial Multicenter Study
Weight loss success in metabolic syndrome by telephone interventions: results from the SHINE Study.
The Diabetes Prevention Program (DPP) intensive lifestyle intervention resulted in significant weight loss, reducing the development of diabetes, but needs to be adapted to primary care provider (PCP) practices. ⋯ PCP staff delivery of the DPP lifestyle intervention by telephone can be effective in achieving weight loss in obese people with metabolic syndrome. Greater weight loss may be attained with a group telephone intervention.
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Multicenter Study
"I wish we could normalize driving health:" a qualitative study of clinician discussions with older drivers.
Driving for older adults is a matter of balancing independence, safety and mobility, and prematurely relinquishing the car keys can impact morbidity and mortality. Discussions about "when to hang up the keys" are difficult for clinicians, drivers, and family members, and therefore are often avoided or delayed. "Advance Driving Directives" (ADDs) may facilitate conversations between health care providers and older drivers focused on prevention and advance planning for driving cessation. ⋯ Clinicians and older drivers often wait to discuss driving until there are specific "red flags", but both groups support a new framework in which physicians routinely and regularly bring up driving with patients earlier in order to facilitate planning for the future.
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Review Case Reports
Reconsidering against medical advice discharges: embracing patient-centeredness to promote high quality care and a renewed research agenda.
Hospital discharges against medical advice (AMA) are common, costly, stigmatizing to patients, and are associated with excess morbidity and mortality. Achieving better quality care for patients discharged AMA has been limited both by the sparse research illuminating how best to care for this challenging patient population, as well as a lack of standards regarding this clinical practice. ⋯ This paper will recommend future directions to answer remaining questions for the field, and offer guidance for providing ethically sound and high quality care for the affected population. Applying the widely accepted principles of patient-centered care and shared decision making to AMA discharges offers the opportunity to improve quality of care and promote ethical health care practice.