Evaluation of mupA Evigene in comparison to disk diffusion for detection of high-level mupirocin resistance in clinical isolates of Staphylococcus aureus.

High-level mupirocin resistance (H-Mu(r)) in S. aureus is associated with the mupA gene. The mupA Evigene test rapidly identifies this gene. This study assessed the performance of mupA Evigene compared to that of susceptibility disk testing. mupA Evigene detected H-Mu(r) in 6/179 S. aureus isolates, and the results were concordant with those of susceptibility disk testing.

Understanding why rheumatoid arthritis patient treatment preferences differ by race.

OBJECTIVE: Rheumatoid arthritis (RA) patient preferences may account for some of the variability in treatment between racial groups. How and why treatment preferences differ by race is not well understood. We sought to determine whether African American and white RA patients differ in how they evaluate the specific risks and benefits related to medications. METHODS: A total of 136 RA patients completed a conjoint analysis interactive computer survey to determine how they valued the specific risks and benefits related to treatment characteristics. The importance that respondents assigned to each characteristic and the ratio of the importance that patients attached to overall benefit versus overall risk were calculated. Subjects having a risk ratio <1 were classified as being risk averse. RESULTS: The mean age of the study sample was 55 years (range 22-84). Forty-nine percent were African American and 51% were white. African American subjects assigned the greatest importance to the theoretical risk of cancer, whereas white subjects were most concerned with the likelihood of remission and halting radiographic progression. Fifty-two percent of African American subjects were found to be risk averse compared with 12% of the white subjects (P < 0.0001). Race remained strongly associated with risk aversion (adjusted odds ratio [95% confidence interval] 8.4 [3.1, -23.1]) after adjusting for relevant covariates. CONCLUSION: African American patients attach greater importance to the risks of toxicity and less importance to the likelihood of benefit than their white counterparts. Effective risk communication and improved understanding of expected benefits may help decrease unwanted variability in health care.

Racial disparities in treatment preferences for rheumatoid arthritis.

BACKGROUND: Data suggest that differences in patient preferences may account for racial disparities in the use of medical interventions. Racial disparities have also been noted in outcomes and the delivery of healthcare services in chronic disease. Whether treatment preferences in chronic disease differ by race is not known. METHODS: We elicited treatment preferences for aggressive therapy in patients with rheumatoid arthritis who identified themselves as being black or white. RESULTS: One hundred fifty consecutive eligible patients were invited to participate. Of these, 136 subjects completed the interview. In unadjusted analysis, 51% of white participants preferred aggressive therapy compared with 16% of blacks (P < 0.0001). Subjects who were married and reported having at least some college education had stronger preferences for aggressive therapy compared with their respective counterparts. After adjusting for covariates, race remained the strongest predictor of aggressive therapy examined in this study [adjusted odds ratio (95% confidence interval) = 11.2 (1.9-64.9)]. CONCLUSIONS: In this study, fewer black patients preferred aggressive treatment compared with white patients with similar disease severity. These results have important clinical implications because use of aggressive treatment improves both short- and long-term outcomes in rheumatoid arthritis. Efforts to improve patient education and physician communication should be made to ensure that all patients have an accurate understanding of the benefits, as well as risks, associated with the best available treatment options.