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Objectives: To describe physicians' end-of-life practices, perceptions regarding end-of-life care and characterize differences based upon physician specialty and demographic characteristics. To illuminate physicians' perceptions about differences among their African-American and Caucasian patients' preferences for end-of-life care.Design and Methods: Twenty-four African-American and 16 Caucasian physicians (N=40) participated in an in-person interview including 23 primary care physicians, 7 cardiologists, and 10 oncologists. Twenty-four practices were in urban areas and 16 were in rural counties.Results: Physicians perceived racial differences in preferences for end-of-life care between their Caucasian and African-American patients. Whereas oncologists and primary care physicians overwhelmingly reported having working relationships with hospice, only 57% of cardiologists reported having those contacts. African-American physicians were more likely than Caucasian physicians to perceive racial differences in their patients preferences for pain medication.Significance Of Results: Demographic factors such as race of physician and patient may impact the provider's perspective on end-of-life care including processes of care and communication with patients. [ABSTRACT FROM AUTHOR]

Heart failure is a high prevalence, high burden disease with an unpredictable trajectory. Given that approximately 50% of persons with the diagnosis die within 5 years, the implications for communication about advance planning and end of life, although simultaneously providing hope and treatment, are extremely challenging. This article reports on a feasibility trial of a modest continuing education seminar to increase awareness and communication skills of inpatient nurses. Curriculum design details, including objectives and methods, are described. Needs assessment and evaluation data are reported. At the 2-month posttest, a summary communications skill score showed significant improvement. Data also illustrated that the challenge of facing issues about dying are complicated by a work force of relatively young staff and low exposure to few actual deaths during relatively short lengths of stay. [ABSTRACT FROM AUTHOR]

Objective: Effective communication is recognized as an essential process to providing quality care, including palliative and end-of-life care. Discussion of prognosis and support needs of patients with heart failure is particularly challenging given the nature of the condition and care across several settings. The objective was to design, implement, and evaluate an interdisciplinary workshop aimed at improving attitudes and skills related to communication with patients and family, health team communication and documentation, and assessment of physical and emotional symptoms.Methods: A pretest, delayed posttest evaluation design was used to evaluate two 4-h workshops offered to nurses, social workers, and other nonphysician clinicians.Results: Although baseline reports of skills were high for the participants, significant improvement was noted for objectives emphasized in the workshop.Significance Of Results: This project demonstrated the feasibility of designing, marketing a brief workshop, and positively impacting communication and documentation skills. [ABSTRACT FROM AUTHOR]

The distribution of Campylobacter pyloridis in the stomach and duodenal bulb of two series of patients (n = 53) with dyspeptic symptoms was studied. In all patients where a comprehensive search of the stomach was conducted, C. pyloridis and active chronic gastritis were associated. That is, the presence of this organism anywhere in the stomach may be taken as a marker of active chronic gastritis within that stomach, although not necessarily at the site of bacterial detection. Two main patterns of colonization are proposed: C. pyloridis either colonizes normal antra and extends proximally along the lesser curvature and into the body with subsequent development of active chronic gastritis and/or the bacterium colonizes areas of chronic-only gastritis induced by other agents resulting in active chronic gastritis. As C. pyloridis may be limited to the antrum or body of any given stomach, it is necessary to biopsy both areas when looking for the bacterium. [ABSTRACT FROM AUTHOR]