Induction techniques that reduce redistribution hypothermia: a prospective, randomized, controlled, single blind effectiveness study.

BACKGROUND: While much effort has been devoted to correcting intraoperative hypothermia, less attention has been directed to preventing redistribution hypothermia. In this study, we compared three different anesthetic induction techniques to standard IV propofol inductions (control) in their effect on reducing redistribution hypothermia. METHODS: Elective, afebrile patients, age 18 to 55 years, were randomly assigned to one of four groups (n = 50 each). Group "INH/100" was induced with 8% sevoflurane in 100% oxygen, Group "INH/50" with 8% sevoflurane in 50% oxygen and 50% nitrous oxide, Group "PROP" with 2.2 mg/kg propofol, and Group "Phnl/PROP" with 2.2 mg/kg propofol immediately preceded by 160 mcg phenylephrine. Patients were maintained with sevoflurane in 50% nitrous oxide and 50% oxygen in addition to opioid narcotic. Forced air warming was used. Core temperatures were recorded every 15 min after induction for 1 h. RESULTS: Compared to control group PROP, the mean temperatures in groups INH/100, INH/50, and Phnl/PROP were higher 15, 30, 45 and 60 min after induction (p < 0.001 for all comparisons), averaging between 0.39 °C and 0.54 °C higher. In group PROP, 60% of patients had at least one temperature below 36.0 °C in the first hour whereas only 16% did in each of groups INH/100, INH/50, and Phnl/PROP (p < 0.0001 in each group compared to PROP). CONCLUSIONS: In this effectiveness trial, inhalation inductions with sevoflurane or with prophylactic phenylephrine bolus prior to propofol induction reduced the magnitude of redistribution hypothermia by an average of 0.4 to 0.5 °C in patients aged 18 to 55 years. TRIAL REGISTRATION: Retrospectively registered on clinical-trials.gov as NCT02331108 , November 20, 2014.

Impact of a Rewards-Based Incentive Program on Promoting Fruit and Vegetable Purchases.

Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions.

Change in childhood lead exposure prevalence with new reference level.

In 2012, the Centers for Disease Control and Prevention changed the "actionable" reference blood lead level from 10 µg/dL to 5 µg/dL, representing the highest 2.5 percentile of lead levels nationwide. In a high-risk urban community, the prevalence of children classified as lead exposed increased ninefold, from 1% to 9.1% (p < .0001) with the new reference level. This dramatic increase in the prevalence of children newly classified as lead exposed will require additional health care and public health resources for tracking, surveillance, and home lead abatement.

Using rewards-based incentives to increase purchase of fruit and vegetables in lower-income households: design and start-up of a randomized trial.

OBJECTIVE: To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households. DESIGN: A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week. SETTING: A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA. SUBJECTS: Fifty-eight households, with at least one child living in the home. RESULTS: During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited. CONCLUSIONS: At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

Photos vs silhouettes for evaluation of African American profile esthetics.

INTRODUCTION: Patient photos and silhouettes are commonly used in clinical evaluations and orthodontic research to evaluate profile esthetics. The purpose of this study was to determine whether the use of photos or silhouettes is a more appropriate method of evaluating African American profile esthetics and whether there are different profile esthetic preferences among clinicians when using photos compared with silhouettes. METHODS: Pretreatment records of 20 adolescent African American patients were selected (10 male, 10 female) from the orthodontic clinic at the Albert Einstein Medical Center in Philadelphia. Each patient's profile photo was digitally changed with imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to fabricate a series of 7 photos and 7 silhouettes with lip positions at uniform distances relative to Ricketts' E-line standard. Fifteen raters consisting of orthodontic faculty and residents were asked to select the most esthetically pleasing profile from each patient's photo series and silhouette series. RESULTS: More rater preferences for the photographs (86%) were within the acceptable esthetic range (within 2 mm of the E-line in either direction) than were their preferences for silhouettes (66%) (P <0.001). Flatter profiles with less lip projection than the esthetic norm were more often preferred in the silhouettes than in the photos. Thirty-one percent of the silhouettes preferred by the raters were flatter than the norm compared with 9% of the photos (P = 0.003). Fuller profiles were preferred in only 3% of the silhouettes and 5% of the photos (P = 0.6). CONCLUSIONS: Esthetic attractiveness of faces of African American orthodontic patients is rated differently in photos and silhouettes. When evaluating soft-tissue esthetic profile preferences, rater preferences in the photographs were closer to the established esthetic norm than were their preferences in the silhouettes. Using silhouettes to evaluate patient esthetics could influence clinicians or researchers to select profiles that are flatter than the established esthetic norm.

Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience.

BACKGROUND: Saddle pulmonary embolism represents a large clot and a risk for sudden hemodynamic collapse. However, the clinical presentation and outcomes vary widely. On the basis of the findings of right heart dysfunction on echocardiograms, computed tomography angiography, or cardiac enzyme elevation, some argue for the use of thrombolytics or catheter thrombectomy even for hemodynamically stable patients. OBJECTIVE: To investigate the outcomes and management of patients with saddle pulmonary embolism, including radiographic appearance (estimate of clot burden) and echocardiographic features. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: This study is a retrospective evaluation of all patients with computed tomography angiography positive for pulmonary embolism from June 1, 2004, to February 28, 2009. Two radiologists selected those with saddle pulmonary embolism and evaluated the clot burden score. The clinical information, echocardiography, treatments, and outcomes of these patients were extracted via chart review. Saddle pulmonary embolism was found in 37 of 680 patients (5.4%, 95% confidence interval 4% to 7%) with documented pulmonary embolism on computed tomography angiography. For patients with saddle pulmonary embolism, the median age was 60 yrs and 41% were males. Major comorbidities were neurologic (24%), recent surgery (24%), and malignancy (22%). Transient hypotension occurred in 14% and persistent shock in 8%. One patient required mechanical ventilation. Echocardiography was performed in 27 patients (73%). Right ventricle enlargement and dysfunction were found in 78% and elevated pulmonary artery systolic pressure in 67%. Computed tomography angiography demonstrated a high median pulmonary artery clot burden score of 31 points. The median right ventricle to left ventricle diameter ratio was 1.39. Inferior vena cava filters were placed in 46%. Unfractionated heparin was administered in 33 (87%) and thrombolytics in four (11%). The median hospital length of stay was 9 days. Two of 37 saddle pulmonary embolism patients (5.4%) died in the hospital (95% confidence interval 0.7% to 18%). CONCLUSIONS: Most patients with saddle pulmonary embolism found on computed tomography angiography responded to the standard management for pulmonary embolism with unfractionated heparin. Although ominous in appearance, most patients with saddle pulmonary embolism are hemodynamically stable and do not require thrombolytic therapy or other interventions.

Efficacy of a filled-resin sealant in preventing decalcification during orthodontic treatment.

INTRODUCTION: Enamel decalcification during orthodontic treatment is a persistent problem. Resin-based sealants have been developed to protect enamel from decalcification. The purpose of this in-vivo study was to compare the effect of a fluoride-releasing filled enamel sealant with that of an unfilled nonfluoride control. METHODS: A total of 177 teeth in 18 patients were evaluated over a period of 12 to 18 months. A split-mouth design was used; half the teeth were treated with the fluoride-releasing sealant (Pro Seal, Reliance Orthodontic Products, Itasca, Ill), and the contralateral teeth received the control (Transbond MIP, 3M Unitek, Monrovia, Calif). The teeth were photographed before (T1) and after (T2) treatment. A panel of 12 orthodontic faculty and residents evaluated the photographs for decalcification on a graded scale. RESULTS: Sixty-nine percent of the teeth treated with Pro Seal showed progressive decalcification from T1 to T2 vs 72% of those treated with Transbond MIP. In the comparison of the contralateral paired teeth, there was a small average net disadvantage of -0.06 of a tooth per patient (95% CI, -0.97 to 0.85) for Pro Seal compared with Transbond MIP. That difference of 0.06 of a tooth is neither statistically significant (P = 0.90) nor clinically important. CONCLUSIONS: The 2 products tested were equivalent in their inhibition of decalcification during orthodontic treatment. The additional time and expense of using the fluoride-releasing sealant to prevent decalcification does not appear to be justified.

Factors Associated With Compliance With 24-Hour Urine Collection.

OBJECTIVE: To identify how demographic factors, stone-associated medical comorbidities, and treatment predict compliance with 24-hour urine collection. MATERIALS AND METHODS: A retrospective medical record review of patients treated for urolithiasis between August 2014 and March 2017 was performed. Patient demographics, medical characteristics, stone factors, type of treatment, and compliance data were included for patients requested to submit a collection. Variables that were statistically significant on bivariate analysis were then used to formulate a model predicting submission of a 24-hour urine sample. RESULTS: Of the 303 patients who met inclusion criteria, 183 (60.4%) submitted an initial 24-hour urine collection. On bivariate analysis, patients older than 50 were more likely to submit a 24-hour urine collection (71.4% vs 51.5%; P <.001), patients with a metabolic predisposition for stones were more likely to submit a 24-hour urine collection (70.6% vs 53.1%; P <.003), and patients who did not have surgery were more likely to submit a 24-hour urine collection (97.9% vs 53.5%; P <.001). Our 3-variable prediction model found that not undergoing surgery was a strong predictor of 24-hour urine collection. CONCLUSIONS: We suspect that patients perceive surgery as a more definitive treatment for kidney stones than conservative management. Patient education on the natural history and role of metabolic management in the prevention of nephrolithiasis is essential in improving compliance with 24-hour urine collection.

Analysis of weight loss after bariatric surgery using mixed-effects linear modeling.

BACKGROUND: The standard analysis of bariatric surgery weight outcomes data (using t tests) is well known. However, these uncontrolled comparisons may yield misleading results and limit the range of research questions. The aim of the study was to develop a valid approach to the longitudinal analysis of weight loss outcomes after bariatric surgery using multivariable mixed models. This study has a multi-institutional setting. METHODS: We developed a mixed-effects model to examine weight after gastric bypass surgery while controlling for several independent variables: gender, anastomotic technique, age, race, initial weight, height, and institution. We contrasted this approach with traditional uncontrolled analyses using percent excess weight loss (%EWL). RESULTS: One thousand one hundred sixty-eight gastric bypass procedures were performed between 2000 and 2006. The average %EWL at 1, 2, and 3 years was 71%, 79%, and 76%, respectively. Using weight as the outcome variable, initial weight and gender were the only independent predictors of outcome (p<0.001). %EWL was substantially less accurate than weight as an outcome measure in multivariable modeling. Including initial weight and height as separate independent variables yielded a more accurate model than using initial body mass index. In a traditional uncontrolled analysis, average %EWL was higher in women than men. However, average weight loss was lower, not higher, in women (p<0.001) in our multivariable mixed model. Height, surgical technique, race and age did not independently predict weight loss. CONCLUSIONS: Multivariable mixed models provide more accurate analyses of weight loss surgery than traditional methods and should be used in studies that examine repeated measurements.

Outpatient antibiotic prescribing patterns in pediatric academic and community practices.

Little is known about antibiotic prescribing differences between academic and community outpatient settings. This retrospective, cross-sectional chart review compares compliance with Infectious Diseases Society of America and American Academy of Pediatrics prescribing guidelines for otitis media, sinusitis, and pharyngitis in academic and affiliated community practices. The study results for correct antibiotic prescribing rate in the academic setting (67%) compared with the community setting (21%) demonstrate the urgent need for stewardship in community outpatient clinics.

Actual and perceived activity levels in polio survivors and older controls: a longitudinal study.

OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio. DESIGN: Longitudinal study. SETTING: A research clinic and the community. PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve. RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors. CONCLUSIONS: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.

Effects of a pharmacist-driven intervention program on hospital readmissions.

PURPOSE: Results of a study to determine whether routine use of a multifaceted medication-focused intervention at a safety-net hospital was feasible and could reduce hospital readmissions in a Medicare fee-for-service population are reported. METHODS: A quality-improvement cohort study of 1,059 admissions of 667 patients at an inner-city hospital was conducted. Patients in the intervention groups received some or all components of the multifaceted "Medication REACH" intervention, with direct pharmacist involvement from admission through postdischarge aftercare. A pharmacist reconciled medications, provided patient-centered education, collaborated with healthcare providers to optimize therapy, ensured access to medications, and followed up with patients at home as needed. Rates of unplanned readmissions within 30 days of discharge in the full- and partial-intervention groups and in patients who received standard discharge care were compared. RESULTS: Among patients who received the full Medication REACH intervention, 30 of 305 admissions (9.8%) resulted in unplanned readmissions within 30 days, as compared with a readmission rate of 20.4% (110 of 538 patients) among patients who received standard discharge care (p < 0.001). Linear regression modeling, with adjustments for patient age, sex, ethnicity, and case-mix index, indicated an adjusted risk difference favoring the full-intervention group of 9.4 percentage points (95% confidence interval, 4.3-14.6 percentage points; p < 0.001). CONCLUSION: Rates of 30-day readmission were substantially lower with pharmacist involvement and collaboration with other healthcare team members during patient transitions from the hospital to the home setting.

Gestational weight gain among minority adolescents predicts term birth weight.

BACKGROUND: In adolescents, there is limited evidence on the independent and additive effect of prepregnancy body mass index (BMI) and gestational weight gain on infant birth weight. Data also show that this effect may vary by race. We sought to examine the impact of maternal prepregnancy BMI and gestational weight gain on birth weight and risk of large for gestational age (LGA) in term newborns of minority adolescent mothers. METHODS: This was a retrospective cohort study of 411 singleton live term infants born to mothers ≤ 18 years. Data were abstracted from electronic medical records. RESULTS: Gestational weight gain was related to infant birth weight (ρ = 0.36, P < 0.0001), but BMI was not (ρ = 0.025, P = 0.61). On regression analysis, gestational weight gain, gestational age and Hispanic ethnicity were independent predictors of birth weight, controlling for maternal age, BMI, parity, tobacco/drug use and preeclampsia. The probability of having an LGA infant increased with weight gain [adjusted odds ratio (aOR) 1.14, 95% confidence interval (CI) 1.07-1.21] but not with BMI. Mothers who gained weight in excess of 2009 Institute of Medicine (IOM) recommendations had a greater risk of having an LGA infant compared to those who gained within recommendations (aOR 5.7, 95% CI 1.6-19.5). CONCLUSIONS: Minority adolescents with greater gestational weight gain had infants with higher birth weight and greater risk of LGA; BMI was not associated with either outcome. Further studies are needed to examine the applicability of the 2009 BMI-specific IOM gestational weight gain recommendations to adolescents in minority populations.

Fine grain temporal analysis in aphasia: evidence from auditory gap detection.

Auditory temporal processing was investigated in individuals with acquired aphasia using a task in which they were asked to detect brief silent gaps inserted between noise segments modeled after formants in speech. To examine within-channel gap detection, gaps of 10, 20, 40, and 80ms duration were inserted between an initial segment (IS) and a trailing segment (TS) centered at the same frequency (1kHz). In a between-channel gap detection condition, gaps of 20, 40, 80, and 100ms duration were inserted between an IS that differed in frequency (4kHz) from the TS (1kHz). The effect of gap onset timing was examined in both conditions by systematically varying the duration of the IS by 10, 20, or 40ms. A combined analysis revealed that for both conditions and all gap and IS durations, individuals with aphasia produced fewer correct responses than age-matched neurologically intact controls. Separate condition analyses revealed that when noise segments were centered at the same frequency, individuals with aphasia demonstrated poorer accuracy in detecting 40 and 80ms gaps relative to normal controls (p<0.001). When gaps were inserted between noise segments differing in frequency, on average, aphasic subjects performed less accurately at durations of 40, 80 and 100ms (p<0.025). Detection in both groups decreased with smaller IS durations. The difficulties with gap detection observed in the aphasic group suggest the existence of fundamental problems in processing the temporal form or microstructure of sounds characterized by rapidly changing onset dynamics.

Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery.

BACKGROUND: The outcomes of Medicare patients undergoing bariatric surgery have been particularly scrutinized, especially with the Center of Medicare and Medicaid Services' decision to offer bariatric surgery benefits. METHODS: The length-of-stay (LOS) data were analyzed from the National Hospital Discharge Survey from 2002 to 2004. To test the hypothesis that Medicare and Medicaid beneficiaries were more likely to have a prolonged length of stay (PLOS), we used a multivariate logistic regression model controlling for age, gender, hospital size, and year of procedure. RESULTS: An estimated 312,000 bariatric procedures were performed nationally from 2002 to 2004. The average patient age was 41.5 years (range 14-75) and 83.6% were women. The in-hospital mortality rate was reported to be .17%. A PLOS occurred in 3.7% of the population. The Medicare and Medicaid beneficiaries represented 5.7% and 6.2% of the population, respectively. The Medicare beneficiaries were 6.0 times (95% confidence interval 2.5-14; P <.001) as likely to have a PLOS, and Medicaid beneficiaries were 3.2 times (95% confidence interval 1.2-8.9; P = .02) as likely to have a PLOS as others after controlling for age, gender, hospital size, and year of procedure. For every 10-year increase in age, the risk of a PLOS increased by 30% (P <.012). CONCLUSION: Medicare and Medicaid beneficiaries are both at an increased risk of a PLOS. This study was not designed to identify the potential causes of a PLOS. Data from prospectively collected bariatric registries might aid surgeons in assessing the risk/benefit ratio of surgical interventions in groups regarded as high risk.

In-vivo prospective comparison of bond failure rates of 2 self-etching primer/adhesive systems.

INTRODUCTION: The purpose of this study was to comparatively assess the bond failure rates of orthodontic brackets bonded with 2 self-etching primer (SEP) bonding systems over an 18-month period. METHODS: Thirty-six consecutively treated orthodontic patients were bonded with Transbond Plus SEP with Transbond XT adhesive (3M Unitek, Monrovia, Calif) and with Ideal 1 SEP with Ideal 1 adhesive (GAC International, Bohemia, NY). In each patient, the teeth were divided into 2 groups based on the universal numbering system (1-32). All even-numbered teeth (340) were bonded with the Transbond system, and all odd-numbered teeth (340) were bonded with the Ideal 1 system. A total of 680 teeth were bonded and followed for a minimum of 18 months. RESULTS: The average percentages of bond failures were 12.4% and 4.1% in the teeth treated with Ideal 1 and Transbond Plus, respectively (P<.001), for a difference of 8.4 percentage points (95% CI, 4.2 to 12.6 percentage points). CONCLUSIONS: Because the bond failure rate with the Transbond Plus SEP system was one third that of the Ideal 1 SEP system, Transbond Plus appears to be a better choice for routine orthodontic clinical practices.

Food Insecurity in Patients with High Hospital Utilization.

Having access to adequate and appropriate food is a major population health issue. This study investigated food insecurity in patients with high rates of inpatient hospitalization ("super-utilizers"). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed in an urban hospital in Philadelphia, Pennsylvania, between March 2015 and May 2015. Inpatient admission history was obtained from hospital billing data. The majority had ≥5 hospitalizations in the past 12 months and ≥6 chronic conditions. Using the USDA definition of food insecurity, 30% (95% CI, 17% to 47%) were food insecure and 25% (95% CI, 13% to 41%) were marginally food secure. Forty percent responded that, in the past 30 days, they worried that their food would run out; 35% that their food would not last; 17.5% that they did not eat for a full day; and 10% that they were hungry but did not eat some or all of the time. Additionally, 75% were unable to shop for food on their own and 58% were unable to prepare their own food. More than half reported using food pantries or other community food resources. The impact of unmet food needs on hospital super-utilization warrants further investigation. Interventions that educate and connect patients with unmet food needs to community resources can help engage patients in their own health and well-being. Communication with patients about whether they have enough nutritionally appropriate food for their health conditions is an important starting point.

Approaching the end of life: attitudes, preferences, and behaviors of African-American and white patients and their family caregivers.

PURPOSE: To investigate differences in attitudes, preferences, and behaviors regarding end of life in terminally ill patients and their designated family caregivers. PATIENTS AND METHODS: 68 African-American and white patients with stage III-B or IV lung or stage IV colon cancer and 68 patient-designated family caregivers interviewed between December 1999 and May 2001. RESULTS: White patients were more likely to have a durable power of attorney (34% v 8%, P =.01) and were more likely to have a living will (LW; 41% v 11%, P =.004) than were African-American patients. More African-American than white patients desired the use of life-sustaining measures (cardiopulmonary resusitation [CPR], mechanical ventilation, tube feeding) in their current condition (all P >.12). In a near-death condition, African-American patients were more likely than white patients to desire each of the life-sustaining measures (all P <.004). There was no patient-caregiver agreement beyond chance regarding preferences for initiation of CPR, tube feeding, or mechanical ventilation in the patient's current condition or in the near-death condition. In the near-death condition in patients without LWs, there was disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding. CONCLUSION: Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients' preferences being superseded at end of life.

Who enrolls in observational end of life research? Report from the cultural variations in approaches to end of life study.

BACKGROUND: Response bias in end of life research is important though not well understood. OBJECTIVES: To compare consenting advanced cancer patient participants and refusers in observational end of life research. We hypothesized that, compared with refusers, consenters would: 1) have a stronger belief in personal gain from research participation, 2) be more satisfied with their medical care, 3) be more satisfied with support from family and friends, and 4) be in less physical discomfort compared with refusers. METHODS: Sixty eight patients consented to enroll in the 'parent' observational study. Thirty six patients refused to participate. Reasons for refusal were recorded verbatim and coded using qualitative techniques. Both patient consenters and patient refusers were asked the same questions regarding personal gain, satisfaction with medical care, family and social support, and physical discomfort. RESULTS: Consenters believed that they had more to gain from participation in research compared with refusers (p = 0.04). Consenters felt that aches or pain were more of a problem for them compared with refusers (p < 0.001). Both satisfaction with medical care and with support from family and friends were similar between consenters and refusers. CONCLUSIONS: Consenting study participants in observational research at end of life believe they have more to gain from study participation than do refusers. Contrary to our hypothesis, consenting participants were those who were experiencing greater physical discomfort compared to refusers.