Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.

Approximately 1 in 70 hospital discharges in the United States are against medical advice. Both hospital and patient characteristics were associated with these decisions.

Background: The true treatment rate for hepatitis C virus (HCV) in veterans is unknown. Aim: To determine the treatment prescription rates and predictors of treatment prescription for HCV in a large national population. Methods: The Department of Veterans Affairs National Patient Care Database (NPCD) was used to identify all HCV-infected people between the fiscal years 1999 and 2003 using the International classification of diseases, 9th revision codes. Demographic information, medical and psychiatric comorbidities, and drug and alcohol use diagnoses were retrieved. Pharmacy data were retrieved from the Department of Veterans Affairs Pharmacy Benefits Management (PBM) database. Logistic regression analysis was used to determine the predictors of treatment for HCV in HCV. Results: 113 927 veterans in the Department of Veterans Affairs care with a diagnosis of HCV were identified. The treatment prescription rate for HCV was 11.8%. Patients not prescribed treatment were older, more likely to be from minority races, have more alcohol and drug misuse, and have medical and psychiatric comorbid conditions. In a multivariate logistic regression model, the following factors were predictive of nontreatment for HCV: increasing age (odds ratio (OR) 0.77 for each 5-year increase in age; 95% confidence interval (CI) 0.76 to 0.78); black race (OR 0.64; 95% CI 0.6 to 0. The following factors were associated with a higher likelihood of treatment prescription for HCV: liver cirrhosis (OR 1.6; 95% CI 1.5 to 1.7); and diabetes (OR 1.07; 95% CI 1.02 to 1.12). Conclusions: A small number of HCV-infected veterans were prescribed treatment for HCV. Non-treatment is associated with increasing age, non-white race, drug and alcohol abuse, and dependence and comorbid illnesses. Reasons for non-treatment need further study.

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Objective Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity () levels. Methods Sedentary behavior was objectively measured by accelerometer on 1,168 participants in the Osteoarthritis Initiative aged 49–83 years with radiographic knee OA at the 48 month clinic visit. Physical function was assessed using 20-meter walk and chair stand testing. Sedentary behavior was identified by accelerometer activity counts/minute <100. The cross-sectional association between sedentary quartiles and physical function was examined by multiple linear regression adjusting for demographic factors (age, sex, race/ethnicity, education level), health factors (comorbidity, body mass index, knee pain, knee OA severity, presence of knee symptoms) and average daily MVPA minutes. Results Adults with knee OA spent 2/3 their daily time in sedentary behavior. The average gait speed among the most sedentary quartile was 3.88 feet/second, which was significantly slower than the speed of the less sedentary groups (4.23, 4.33, 4.33 feet/second, respectively). The average chair stand rate among the most sedentary group was significantly lower (25.9 stands/minute) than the rates of the less sedentary behavior groups (28.9, 29.1, 31.1 stands/minute, respectively). These trends remained significant in multivariable analyses adjusted for demographic factors, health factors and average daily MVPA minutes. Conclusion Being less sedentary was related to better physical function in adults with knee OA independent of MVPA time. These findings support guidelines to encourage adults with knee OA to decrease time spent in sedentary behavior in order to improve physical function.

Accurate rates, though fundamental to epidemiology, are often very difficult to obtain. Incidence, prevalence, and mortality rates have traditionally been established through either passive reporting surveillance systems, through active surveillance systems, or by a combination of the two methods. Typically, when researchers employ these approaches they do not formally evaluate or correct for the degree of underascertainment. Undercount of cases is a potent determinant of rates which we cannot continue to ignore. We believe all rates should be adjusted for underascertainment in order to achieve a truer picture of the risk and risk factors of disease. Here, we present a procedure to ascertainment correct rates based upon well established capture-recapture methods.

Background The impact of patients’ perceptions of discrimination in health care on patient-provider interactions is unknown. Objective Examine association of past perceived discrimination with subsequent patient-provider communication. Research Design Observational cross-sectional study. Subjects African American (AA; N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in two Veterans Affairs facilities. Measures Patients were surveyed about past experiences with racism and classism in healthcare settings before a clinic visit. Visits were audio-recorded and coded for instrumental and affective communication content (biomedical exchange, psychosocial exchange, rapport-building, patient engagement/activation) and nonverbal affective tone. After the encounter, patients rated visit informativeness, provider warmth/respectfulness, and ease of communicating with the provider. Regression models stratified by patient race assessed the associations of racism and classism with communication outcomes. Results Perceived racism and classism were reported by more AA patients than by white patients (racism: 70% vs. 26%; classism: 73% vs. 53%). High levels of perceived racism among AA patients was associated with less positive nonverbal affect among patients (Beta=−0.41, 95% CI=−0.73, −0.09) and providers (Beta=−0.34, 95% CI=−0.66, −0.01) and with low patient ratings of provider warmth/respectfulness (OR=0.19, 95% CI=0.05,0.72) and ease of communication (OR =0.22, 95% CI=0.07,0.67). Any perceived racism among white patients was associated with less psychosocial communication (Beta=−4.18, 95% CI=−7.68, −0.68), and with low patient ratings of visit informativeness (OR=0.40, 95% CI=0.23,0.71) and ease of communication (OR=0.43, 95% CI=0.20,0.89). Perceived classism yielded similar results. Conclusions Perceptions of past racism and classism in healthcare settings may negatively impact the affective tone of subsequent patient-provider communication.

Family-centered multidisciplinary rounds is a method of conducting inpatient hospital rounds that fosters teamwork and empowers hospital staff. The patient and family are engaged in and are the focal point of the rounds. Staff members are able to hear everyone's perspective and give input. The impact on staff satisfaction and the family's ability to participate in their care is significant.