Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: development of a scale.

Objective: Patients with sickle cell disease (SCD) often perceive negative provider attitudes, which may affect the quality of patient-provider communication and care during vaso-occlusive crises (VOCs). This study investigated the validity and reliability of a scale to measure provider attitudes toward patients with acute VOC.

Methods: Using a cohort of adults with VOC (September 2006 to June 2007), we administered a 10-item provider questionnaire within 72 h of patient encounters.

Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study.

Background: The use of peritoneal dialysis (PD) has declined in the United States over the past decade and technique failure is also reportedly higher in PD compared to hemodialysis (HD), but there are little data in the United States addressing the factors and outcomes associated with switching modalities from PD to HD.

Methods: In a prospective cohort study of 262 PD patients enrolled from 28 peritoneal dialysis clinics in 13 U.S.

Clinical information technologies and inpatient outcomes: a multiple hospital study.

Background: Despite speculation that clinical information technologies will improve clinical and financial outcomes, few studies have examined this relationship in a large number of hospitals.

Methods: We conducted a cross-sectional study of urban hospitals in Texas using the Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on physician interactions with the information system. After adjustment for potential confounders, we examined whether greater automation of hospital information was associated with reduced rates of inpatient mortality, complications, costs, and length of stay for 167 233 patients older than 50 years admitted to responding hospitals between December 1, 2005, and May 30, 2006.

Age and comorbidities are effect modifiers of gender disparities in renal transplantation.

Women have less access to kidney transplantation than men, but the contributions of age and comorbidity to this disparity are largely unknown. We conducted a national cohort study of 563,197 patients with first-onset ESRD between 2000 and 2005. We used multivariate generalized linear models to evaluate both access to transplantation (ATT), defined as either registration for the deceased-donor waiting list or receiving a live-donor transplant, and survival benefit from transplantation, defined as the relative rate of survival after transplantation compared with the rate of survival on dialysis.

Improving the diversity climate in academic medicine: faculty perceptions as a catalyst for institutional change.

Purpose: To assess perceptions of underrepresented minority (URM) and majority faculty physicians regarding an institution's diversity climate, and to identify potential improvement strategies.

Method: The authors conducted a cross-sectional survey of tenure-track physicians at the Johns Hopkins University School of Medicine from June 1, 2004 to September 30, 2005; they measured faculty perceptions of bias in department/division operational activities, professional satisfaction, career networking, mentorship, and intentions to stay in academia, and they examined associations between race/ethnicity and faculty perceptions using multivariate logistic regression.

Results: Among 703 eligible faculty, 352 (50.

Patient awareness of chronic kidney disease: trends and predictors.

Background: The impact of recent guidelines for early detection and prevention of chronic kidney disease (CKD) on patient awareness of disease and factors that might be associated with awareness have not been well described.

Methods: Awareness rates were assessed in 2992 adults (age, > or =20 years) with CKD stages 1 to 4 from a nationally representative, cross-sectional survey (National Health and Nutrition Examination Survey 1999-2004). Awareness of CKD was defined by an answer of yes to "Have you ever been told you have weak or failing kidneys?" Potential predictors of awareness included demographics, access to care, and clinical and lifestyle factors, which were assessed by standardized interviewer-administered questionnaires and physical examinations.

Longitudinal study of depressive symptoms and health-related quality of life during pregnancy and after delivery: the Health Status in Pregnancy (HIP) study.

Objective: Depressive symptoms are known to affect functioning in early pregnancy. We estimated the effect of a change in depressive symptoms status on health-related quality of life (HRQoL) throughout pregnancy and after delivery.

Methods: Longitudinal study of 200 women.

MYH9 is associated with nondiabetic end-stage renal disease in African Americans.

As end-stage renal disease (ESRD) has a four times higher incidence in African Americans compared to European Americans, we hypothesized that susceptibility alleles for ESRD have a higher frequency in the West African than the European gene pool. We carried out a genome-wide admixture scan in 1,372 ESRD cases and 806 controls and found a highly significant association between excess African ancestry and nondiabetic ESRD (lod score = 5.70) but not diabetic ESRD (lod = 0.

Hospital characteristics associated with highly automated and usable clinical information systems in Texas, United States.

Background: A hospital's clinical information system may require a specific environment in which to flourish. This environment is not yet well defined. We examined whether specific hospital characteristics are associated with highly automated and usable clinical information systems.

The association of sudden cardiac death with inflammation and other traditional risk factors.

Despite the frequency of cardiovascular death in dialysis patients, few studies have prospectively measured sudden cardiac death in these individuals. Here, we sought to determine the frequency of sudden cardiac death and its association with inflammation and other risk factors among the CHOICE (Choices for Healthy Outcomes In Caring for ESRD) cohort of 1,041 incident dialysis patients. Sudden cardiac death was defined as that occurring outside of the hospital with an underlying cardiac cause from death certificate data.

Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries.

Purpose: This study attempts to determine the associations between postdischarge environmental (PDE) and socioeconomic (SES) factors and early readmission to hospitals.

Design And Methods: This study was a cohort study using the 2001 Medicare Current Beneficiary Survey and Medicare claims for the period from 2001 to 2002. The participants were community-dwelling Medicare beneficiaries admitted to hospitals, discharged home, and surviving at least 1 year after discharge (n = 1,351).

Lipoprotein(a) level as a predictor of cardiovascular disease and small apoliprotein(a) isoforms in dialysis patients: assay-related differences are important.

Background: Lipoprotein(a) assays sensitive to apolipoprotein(a) size may underestimate associations of lipoprotein(a) with cardiovascular disease (CVD) and low molecular weight (LMW) apolipoprotein(a) isoforms. This study among 629 dialysis patients compares the value of two lipoprotein(a) assays in predicting CVD events and small isoforms.

Methods: Lipoprotein(a) level was measured by an apolipoprotein(a) size-insensitive ELISA and apolipoprotein(a) size-sensitive immunoturbidometric (IT) assay; and apolipoprotein(a) size by Western blot.

Accuracy of patients' reports of comorbid disease and their association with mortality in ESRD.

Background: Patient awareness of chronic diseases is low. Unawareness may represent poor understanding of chronic illness and may be associated with poor outcomes in patients with end-stage renal disease (ESRD).

Study Design: Concurrent prospective national cohort study.

Phosphate levels and blood pressure in incident hemodialysis patients: a longitudinal study.

An elevated serum phosphate level in hemodialysis patients has been associated with mineral deposition in blood vessels. We studied a possible physiologic consequence of hyperphosphatemia by examining the relation between serum phosphate levels and blood pressure in 707 incident hemodialysis patients from 75 clinics who were enrolled in a prospective cohort study. We conducted cross-sectional and longitudinal multiple linear regression analyses, adjusting for demographics, medical history, and laboratory factors.

Serum phosphate levels and risk of infection in incident dialysis patients.

Background And Objectives: Hyperphosphatemia is highly prevalent in dialysis patients and may be associated with immune dysfunction. The association of serum phosphate level with infection remains largely unexamined.

Design, Setting, Participants, & Measurements: In an incident cohort of 1010 dialysis patients enrolled from 1995 to 1998 and treated in 80 US clinics, the association of phosphate level (low <3.

Let's get serious about racial and ethnic disparities.

Racial and ethnic disparities in health and health care have been documented for over two decades in kidney disease, in a variety of other conditions, across settings, and for different medical and surgical interventions. We now have government reports that track progress on reducing racial disparities, but the pace of progress has been disheartening. The reasons for some of these disparities are known and include biologic, socioeconomic, cultural, and environmental factors as well as system, patient, and provider factors that affect access and quality of medical services.

The association of state and national legislation with living kidney donation rates in the United States: a national study.

The effect of state legislation and federal policies supporting living donors on living kidney donation rates in the United States is unknown. We studied living kidney donation rates from 1988 to 2006, and we assessed changes in donation before and after the enactment of state legislation and the launch of federal initiatives supporting donors. During the study, 27 states enacted legislation.

Impact of activated vitamin D and race on survival among hemodialysis patients.

Contrary to most examples of disparities in health outcomes, black patients have improved survival compared with white patients after initiating hemodialysis. Understanding potential explanations for this observation may have important clinical implications for minorities in general. This study tested the hypothesis that greater use of activated vitamin D therapy accounts for the survival advantage observed in black and Hispanic patients on hemodialysis.

Do hospitals provide lower-quality care to minorities than to whites?

Using three years of state inpatient discharge data from thirteen states, we computed, for each hospital, race/ethnicity-specific quality measures using the Agency for Healthcare Research and Quality inpatient quality indicators and patient safety indicators. We found that risk-adjusted quality indicators for blacks, Hispanics, and Asians were not statistically worse than corresponding quality indicators for whites in the same hospital. We conclude that when whites and minorities are admitted to the hospital for the same reason or receive the same hospital procedure, they receive the same quality of care.

Race, medical researcher distrust, perceived harm, and willingness to participate in cardiovascular prevention trials.

Minority underrepresentation exists in medical research including cardiovascular clinical trials, but the hypothesis that this relates to distrust in medical researchers is unproven. Therefore, we examined whether African American persons differ from white persons in perceptions of the risks/benefits of trial participation and distrust toward medical researchers, and whether these factors influence willingness to participate (WTP) in a clinical drug trial. Participants were self-administered a survey regarding WTP in a cardiovascular drug trial given to 1440 randomly selected patients from 13 Maryland outpatient cardiology and general medicine clinics.

Third-generation parathyroid hormone assays and all-cause mortality in incident dialysis patients: the CHOICE study.

Background: There has been controversy about the utility of new third-generation parathyroid hormone (PTH) assays measuring only 1-84 PTH, with few large studies comparing second- and third-generation PTH measurements in patients with ESRD.

Methods: We measured 1-84 PTH ('biointact' or 'whole' PTH) and total PTH ('intact' PTH) in a national cohort of 515 incident dialysis patients from banked frozen EDTA plasma (median follow-up, 35 months) and examined the accuracy of estimating 1-84 PTH from total PTH and the associations of these levels with patient characteristics and mortality.

Results: The 1-84 PTH and total PTH levels were closely correlated.