Access and outcomes among minority transplant patients, 1999-2008, with a focus on determinants of kidney graft survival.

Coincident with an increasing national interest in equitable health care, a number of studies have described disparities in access to solid organ transplantation for minority patients. In contrast, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations. In this paper, we review trends in access to solid organ transplantation and posttransplant outcomes by organ type, race and ethnicity. In addition, we present an analysis of categories of factors that contribute to the racial/ethnic variation seen in kidney transplant outcomes. Disparities in minority access to transplantation among wait-listed candidates are improving, but persist for those awaiting kidney, simultaneous kidney and pancreas and intestine transplantation. In general, graft and patient survival among recipients of solid organ transplants is highest for Asians and Hispanic/Latinos, intermediate for whites and lowest for African Americans. Although much of the difference in outcomes between racial/ethnic groups can be accounted for by adjusting for patient characteristics, important observed differences remain. Age and duration of pretransplant dialysis exposure emerge as the most important determinants of survival in an investigation of the relative impact of center-related versus patient-related variables on kidney graft outcomes.

A replicated five cluster MMPI typology of morbidly obese female candidates for gastric bypass.

This study clusters empirically into subgroups the preoperative MMPI profiles of morbidly obese females seeking a gastric bypass, assesses the replicability of clusters across different subject populations and tests the hypotheses that cluster inclusion bears a significant relationship to weight loss and post-operative follow-up behavior. One hundred seventy women participated: 85 were patients at The University of Texas Health Science Center at San Antonio, Texas (UTHSCSA), and 85 were from the Cherryhill Medical Surgical Center (CMSC), Albion, Michigan. A hierarchical cluster analytic technique was applied using the cosine measure and average linkage within groups method. Purification of the two samples resulted in seven groups with 59 cases in the UTHSCSA sample and six groups with 62 cases in the CMSC sample. Five groups containing 94 subjects (55 percent) replicated across the two samples (UTHSCSA = 44; CMSC = 50). Discriminant analysis yielded four statistically significant functions. The chi 2 test was employed to discern significant differences based on group inclusion. Demographic differences between the two geographic samples are discussed. One year follow-up studies found that personality type bears a significant relationship to indexed weight loss, follow-up appointment frequency, and follow-up duration for the San Antonio sample.

Patients who leave the hospital against medical advice: the role of the psychiatric consultant.

Previous studies have identified characteristics of patients who threaten to leave non-psychiatric units against medical advice, but few have described the role of the psychiatric consultant in the patient's decision. This study compared the medical records of 31 patients who threatened to leave the hospital against medical advice (AMA) and who were seen in consultation with the records of AMA-discharged patients who were not seen by a psychiatric consultant. Most patients who received consultations remained hospitalized or were discharged in regular fashion. Those seen soon after admission were most likely to stay. Patients were more likely to remain hospitalized if the consultant's recommendations had a practical, rather than a psychological, orientation.