Patient involvement in medical decision-making and pain among elders: physician or patient-driven?

BACKGROUND: Pain is highly prevalent among older adults, but little is known about how patient involvement in medical decision-making may play a role in limiting its occurrence or severity. The purpose of this study was to evaluate whether physician-driven and patient-driven participation in decision-making were associated with the odds of frequent and severe pain. METHODS: A cross-sectional population-based survey of 3,135 persons age 65 and older was conducted in the 108-county region comprising West Texas. The survey included self-reports of frequent pain and, among those with frequent pain, the severity of pain. RESULTS: Findings from multivariate logistic regression analyses showed that higher patient-driven participation in decision-making was associated with lower odds (OR, 0.82; 95% CI, 0.75–0.89) of frequent pain, but was not significantly associated with severe pain. Physician-driven participation was not significantly associated with frequent or severe pain. CONCLUSIONS: The findings suggest that patients may need to initiate involvement in medical decision-making to reduce their chances of experiencing frequent pain. Changes to other modifiable health care characteristics, including access to a personal doctor and health insurance coverage, may be more conducive to limiting the risk of severe pain

Absolute frequency measurement of the neutral 40Ca optical frequency standard at 657 nm based on microkelvin atoms

We report an absolute frequency measurement of the optical clock transition at 657 nm in 40Ca with a relative uncertainty of 7.5 x 10-15 , one of the most accurate frequency measurements of a neutral atom optical transition to date. The frequency (455986240494135.8 ± 3.4) Hz was measured by stabilizing a diode laser system to a spectroscopic signal derived from an ensemble of 106 atoms cooled in two stages to a temperature of 10 flK. The measurement used a femtosecond-laser-based frequency comb to compare the Ca transition frequency with that of the single-ion 199Hg+ optical frequency standard at NIST. The Hg+ frequency was simultaneously calibrated relative to the NIST Cs fountain via the NIST time scale to yield an absolute value for the Ca transition frequency. The relative fractional instability between the two o~tical standards was 2 x 10-15 for 10 s of averagmg tIme and 2 x 10-1 for 2000 s