Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study
Clinic-based versus outsourced implementation of a diabetes health literacy intervention.
We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. ⋯ An outsourced diabetes education and counseling approach for community health centers appears more feasible than clinic-based models. Patients receiving the carve-out strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach. Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed.
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Observational Study
The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease.
The prevalence and consequences of financial barriers to health care among patients with multiple chronic diseases are poorly understood. ⋯ In diabetic adults with CHD, financial barriers to health care were associated with impaired access to medical care, inferior quality of care and greater vascular morbidity. Eliminating financial barriers and adherence to guideline-based recommendations may improve the health of individuals with multiple chronic diseases.
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The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel. ⋯ The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.
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Review Meta Analysis
SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials.
Hot flashes are the most commonly reported vasomotor symptom during the peri- and early post-menopausal period. ⋯ SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects.
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Multicenter Study
Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity.
Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. ⋯ African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.