"Misfearing"--culture, identity, and our perceptions of health risks.

Despite knowing that heart disease kills more women each year than all cancers combined, most women fear breast cancer far more - and their health-related behavior reflects this difference. If our sense of risk is less about fact than about feeling, how do we adjust it?

Increasing value and reducing waste: addressing inaccessible research.

The methods and results of health research are documented in study protocols, full study reports (detailing all analyses), journal reports, and participant-level datasets. However, protocols, full study reports, and participant-level datasets are rarely available, and journal reports are available for only half of all studies and are plagued by selective reporting of methods and results. Furthermore, information provided in study protocols and reports varies in quality and is often incomplete.

Time to brain imaging in acute stroke is improving: secondary analysis of the INSTINCT trial.

Background And Purpose: Patients with acute ischemic stroke benefit from rapid evaluation and treatment, and timely brain imaging is a necessary component. We determined the effect of a targeted behavioral intervention on door-to-imaging time (DIT) among patients with ischemic stroke treated with tissue-type plasminogen activator. Second, we examined the variation in DIT accounted for by patient-level and hospital-level factors.

When health insurance is not a factor: national comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments.

Objectives: We examined the proportion of homeless veterans among users of Veterans Affairs (VA) emergency departments (EDs) and compared sociodemographic and clinical characteristics of homeless and nonhomeless VA emergency department users nationally.

Methods: We used national VA administrative data from fiscal year 2010 for a cross-sectional study comparing homeless (n = 64,091) and nonhomeless (n = 866,621) ED users on sociodemographics, medical and psychiatric diagnoses, and other clinical characteristics.

Results: Homeless veterans had 4 times the odds of using EDs than nonhomeless veterans.

Navigating the boundaries of emergency department care: addressing the medical and social needs of patients who are homeless.

Objectives: We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless.

Methods: We conducted semistructured interviews with emergency medicine residents from 2 residency programs, 1 in New York City and 1 in a medium-sized northeastern city, from February to September 2012. A team of researchers reviewed transcripts independently and coded text segments using a grounded theory approach.

Barriers to evaluation for early intervention services: parent and early intervention employee perspectives.

Objective: To explore barriers to early intervention (EI) evaluation among referred infants and toddlers.

Methods: We conducted semistructured interviews with parents of children referred for EI services and with EI staff. We purposively sampled families according to whether they received an EI evaluation.

The effect of resilience on posttraumatic stress disorder in trauma-exposed inner-city primary care patients.

Posttraumatic stress disorder (PTSD) has previously been associated with increased risk for a variety of chronic medical conditions and it is often underdiagnosed in minority civilian populations. The current study examined the effects of resilience on the likelihood of having a diagnosis of PTSD in an inner-city sample of primary care patients (n=767). We measured resilience with the Connor-Davidson Resilience Scale, trauma with the Childhood Trauma Questionnaire and Trauma Events Inventory, and assessed for PTSD with the modified PTSD symptom scale.

Adapting an in-person patient-caregiver communication intervention to a tailored web-based format.

Background: Interventions that target cancer patients and their caregivers have been shown to improve patient-caregiver communication, support, and emotional well-being.

Objective: To adapt an in-person communication intervention for cancer patients and caregivers to a web-based format, and to examine the usability and acceptability of the web-based program among representative users.

Methods: A tailored, interactive web-based communication program for cancer patients and their family caregivers was developed based on an existing in-person, nurse-delivered intervention.

Trust in the internet as a health resource among older adults: analysis of data from a nationally representative survey.

Background: Distrust in the Internet as a source of health information remains common among older adults. The influence of this distrust on Internet use for health-related purposes, however, is unclear.

Objective: The objective of our study was to explore how older adults' trust in the Internet influences their online health-related activities, and to identify potential targets for improving health-related Internet resources for older adults.

Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials.

Background: Due to a shortage of studies focusing on older adults, clinicians and policy makers frequently rely on clinical trials of the general population to provide supportive evidence for treating complex, older patients.

Objectives: To examine the inclusion and analysis of complex, older adults in randomized controlled trials.

Review Methods: A PubMed search identified phase III or IV randomized controlled trials published in 2007 in JAMA, NEJM, Lancet, Circulation, and BMJ.

Moving beyond the impasse: discussing death and dying with African American patients.

This article offers a historical and cultural lens through which physicians can gain a better understanding of patient-provider conflict in end-of-life discussions with African American patients and their families. Just as a practitioner would not prescribe a medication to treat a symptom without first determining its underlying cause, it is unwise, and usually ineffective, to try to discuss end-of life care with patients without first understanding the context that shapes their perspectives on death and dying. The first section of this article provides a historical and sociological context to understand the source of the patient-provider conflicting perspectives.

Multicenter validation of the Philadelphia EMS admission rule (PEAR) to predict hospital admission in adult patients using out-of-hospital data.

Objectives: The objective was to validate a previously derived prediction rule for hospital admission using routinely collected out-of-hospital information.

Methods: The authors performed a multicenter retrospective cohort study of 1,500 randomly selected, adult patients transported to six separate emergency departments (EDs; three community and three academic hospitals in three separate health systems) by a city-run emergency medical services (EMS) system over a 1-year period. Patients younger than 18 years or who bypassed the ED to be evaluated by trauma, obstetric, or psychiatric teams were excluded.