Journal of general internal medicine
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Little is known about associations between psychiatric comorbidity and hospital mortality for acute medical conditions. This study examined if associations varied according to the method of identifying psychiatric comorbidity and agreement between the different methods. ⋯ The method used to identify psychiatric comorbidities in acute medical populations has a strong influence on the rates of identification and the associations between psychiatric illnesses with hospital mortality.
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Internists commonly perform invasive procedures, but serious deficiencies exist in procedure training during residency. ⋯ A comprehensive procedure service rotation of 2 weeks duration substantially improved residents' comfort and self-perceived knowledge in performing invasive procedures. These benefits persisted at least to the end of the academic year.
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Physician assisted death (PAD) was legalized through Oregon's Death with Dignity Act in 1994 and enacted in 1997. ⋯ Interventions that help patients maintain control, independence, and self-care in a home environment may be effective means of addressing serious requests for PAD.
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Multicenter Study
Acute myocardial infarction length of stay and hospital mortality are not associated with language preference.
Language barriers between patients and providers may influence the process and quality of care. ⋯ Language preference is not associated with AMI mortality, and the small increase in length of stay associated with non-English preference is accounted for by hospital level factors. Our results suggest that system level differences are important to consider in studies of the effect of language barriers in the health care setting.
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After acute myocardial infarction (AMI), treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) is widely recognized as crucial to reduce risk of a subsequent AMI. However, many patients fail to consistently remain on these treatments over time, and long-term adherence has not been well described. ⋯ Many patients initiating evidence-based secondary prevention therapies after an AMI fail to consistently remain on these treatments. Adherence is a priority area for development of better-quality measures and quality-improvement interventions. Barriers to beta-blocker adherence for low-income populations need particular attention.