Patient preferences and physician practices for laboratory test results notification.

INTRODUCTION: This study assessed patient preferences and physician practices for laboratory test results notification in ambulatory care. METHODS: Patients aged 18 years or older (n=728) who were scheduled to see their primary care physician at 5 clinics were offered the opportunity to participate in an anonymous survey during their clinic visit. Their primary care physicians were also invited to participate in a separate online survey. Questions on both surveys included the current method of laboratory test results notification and satisfaction with the method. RESULTS: The majority of patients reported satisfaction with the current method of notification of normal results-the US mail-which was also the preferred method for notification of normal test results by both patients and physicians. Direct phone contact by the physician was the preferred method for notification of abnormal results by both patients (64%) and physicians (41%). Patients' preferred method of notification of normal results significantly agreed with the current method (P<.0001), whereas that of abnormal results did not (P=.52). CONCLUSIONS: Our findings indicate that patients and physicians both prefer the US mail for notification of normal laboratory test results and a direct phone call by the physician for notification of abnormal results.

End-of-Life Review.

CONTEXT: The term "End-of-Life Review" is often used by hospice workers in the context of spiritual apparitions or visitations prior to a patient's death. A review of the literature reveals no clear definition or categorization of this expression. OBJECTIVE: The aim of this study is to define the term "End-of-Life Review". DESIGN: The study was performed using the Delphi method. SETTING/PARTICIPANTS: A panel of interested parties was recruited from October 2006 to January 2007. INTERVENTION: Respondents were first asked to list their most common experiences associated with the term "End-of-Life Review," and then to rate each item as to how well it represented their understanding of this term. This process continued until subsequent rounds produce little change in the ranking of each item, suggesting a consensus. CONCLUSIONS: The term "End-of-Life Review" is a constellation of behaviors ranging from visitations from the departed to spiritual apparitions prior to death.

Medications for COPD: a review of effectiveness.

Chronic obstructive pulmonary disease (COPD) is a common problem among patients presenting to primary care. This condition has multiple individual and combined treatment regimens. The goals of treatment are to improve quality of life, exercise tolerance, sleep quality, and survival; and to reduce dyspnea, nocturnal symptoms, exacerbations, use of rescue medications, and hospitalizations. All patients benefit from bronchodilator medications as needed. Long-acting inhaled anticholinergics are probably more beneficial than short-acting formulations. Use of inhaled corticosteroids might benefit patients with mild COPD who have an inflammatory component or significant reversibility on spirometry. Patients with moderate to severe disease benefit from the use of long-acting inhaled anticholinergics, inhaled corticosteroids, and possibly a long-acting beta2 agonist or mucolytics. For rescue therapy, short-acting beta2 agonists or combination anticholinergics with a short-acting beta2 agonist should be used. Inhaled corticosteroids should be considered before initiating a long-acting beta2 agonist. Caution should be used if a long-acting beta2 agonist is discontinued before initiation of an inhaled corticosteroid because this may precipitate exacerbations. Evidence to support the use of mucolytics, oral theophylline, and oral corticosteroids is limited. Patients with severe hypoxemia (i.e., arterial oxygen pressure less than 55 mm Hg or oxygen saturation less than 88 percent) should be given continuous oxygen.