Journal of general internal medicine
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An estimated 20-50% of patients do not take medications as recommended. Accepting a doctor's recommendation is the first step in medication adherence, yet little is known about patients' beliefs and preferences about how medications are prescribed. ⋯ Patients' beliefs and preferences about medication prescribing may affect medication adherence. Additional empiric studies that explore whether doctors' relationships with pharmaceutical representatives impact medication adherence by affecting trust are indicated. In addition, it would be worthwhile to explore whether discussions between patients and doctors regarding equipoise (no clear scientific evidence for 1 treatment choice over another) affect medication adherence.
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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.