***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care ; however , disparities due to age and race have been described in emergency department pain treatment . Although pain is a common patient complaint in emergency departments , many people receive no analgesia . This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practice s. METHODS This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty .  Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics . RESULTS A total of 868 patient records were examined . Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department , but patient characteristics including race , age , chronic pain , and trauma influenced prescription of ED opioids and discharge analgesics . No gender or financial status disparities were found . Fewer  opioids and discharge analgesics  were prescribed for black patients than for white patients . Younger patients , those with trauma , and those with chronic pain received more  opioids and discharge analgesics  compared with older patients and those without trauma or chronic pain . Providers who completed emergency medicine residencies and had fewer than 3 years ' experience prescribed more analgesics in the emergency department . DISCUSSION Pain management in our emergency department is widely variable , with some disparities based on patient and physician characteristics . Multicenter prospect i ve studies are needed to vali date these findings and examine knowledge and attitude development about pain and its management . Protocol s for nurse-initiated analgesia may help improve and st and ardize ED pain care Context Studies documenting racial/ethnic disparities in health care frequently implicate physicians ’ unconscious biases . No study to date has measured physicians ’ unconscious racial bias to test whether this predicts physicians ’ clinical decisions . Objective To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes . Design , Setting , and Participants An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome , followed by a question naire and three Implicit Association Tests ( IATs ) . Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston ; 287 completed the study , met inclusion criteria , and were r and omized to either a black or white vignette patient . Main Outcome Measures IAT scores ( normal continuous variable ) measuring physicians ’ implicit race preference and perceptions of cooperativeness . Physicians ’ attribution of symptoms to coronary artery disease for vignette patients with r and omly assigned race , and their decisions about thrombolysis . Assessment of physicians ’ explicit racial biases by question naire . Results Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness . In contrast , IATs revealed implicit preference favoring white Americans ( mean IAT score = 0.36 , P < .001 , one- sample t test ) and implicit stereotypes of black Americans as less cooperative with medical procedures ( mean IAT score 0.22 , P < .001 ) , and less cooperative generally ( mean IAT score 0.30 , P < .001 ) . As physicians ’ prowhite implicit bias increased , so did their likelihood of treating white patients and not treating black patients with thrombolysis ( P = .009 ) . Conclusions This study represents the first evidence of unconscious ( implicit ) race bias among physicians , its dissociation from conscious ( explicit ) bias , and its predictive validity . Results suggest that physicians ’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infa rct ion & NA ; Previous retrospective studies have suggested that patient demographics may influence analgesic administration . These studies have not taken physicians ’ impression of patient pain into account . This prospect i ve study investigates the influence of ( i ) physician impression of the degree of pain and ( ii ) patient demographics on the use of analgesic .  A convenience sample of adults with non‐traumatic lower back pain was studied . Possible predictors of analgesic administration included physician pain scores ( assessed by visual analogue scale ) , patient ethnicity , gender , age , and insurance . These variables were tested individually and then using logistic regression . For the total of 91 patients enrolled , only physician pain scale was found to be associated with analgesic use . Median scores were 68 mm ( interquartile range=62–80 mm ) for those receiving treatment versus 48 mm ( interquartile range=30–58 mm ) for those who did not ( P<0.001 ) . This study therefore suggests that physician impression of patient pain rather than patient demographics influences analgesic use OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND We have observed that many black and Hispanic patients receiving palliative care at a major urban teaching hospital are unable to obtain prescribed opioids from their neighborhood pharmacies . In this study , we investigated the availability of commonly prescribed opioids  in New York City pharmacies . METHODS We surveyed a r and omly selected sample of 30 percent of New York City pharmacies to obtain information about their stock of opioids . For each pharmacy , U.S. Census estimates for 1997 were used to determine the racial and ethnic composition of the neighborhood ( defined as the area within a 0.4-km [ 0.25-mile ] radius of the pharmacy ) and the proportion of residents who were more than 65 years old . Data on robberies , burglaries , and arrests involving illicit drugs in 1997 were obtained for the precinct in which each pharmacy was located . We used a generalized linear model to examine the relation between the racial or ethnic composition of neighborhoods and the opioid supplies of pharmacies , while controlling for the proportion of elderly persons at the census-block level and for crime rates at the precinct level . RESULTS Pharmacists representing 347 of 431 eligible pharmacies ( 81 percent ) responded to the survey . A total of 176 pharmacies ( 51 percent ) did not have sufficient supplies of opioids to treat patients with severe pain . Only 25 percent of pharmacies in predominantly nonwhite neighborhoods ( those in which less than 40 percent of residents were white ) had opioid supplies that were sufficient to treat patients in severe pain , as compared with 72 percent of pharmacies in predominantly white neighborhoods ( those in which at least 80 percent of residents were white ) ( P<0.001 ) . CONCLUSIONS Pharmacies in predominantly nonwhite neighborhoods of New York City do not stock sufficient medications to treat patients with severe pain adequately OBJECTIVE To describe the patterns of opioid prescribing and the factors associated with reductions in the potency of patients ' analgesic medications at the time of hospital discharge . DESIGN Prospect i ve cohort . SETTING Two hundred forty-four patients ( 171 surgical and 73 nonsurgical ) hospitalized in an urban academic medical center who have experienced moderate or severe pain and who are taking opioid analgesics prior to discharge . OUTCOME Step-down ( or reduction ) in the potency of patients ' analgesic medication at the time of discharge . A step-down is defined as the analgesic medication that a patient is prescribed for outpatient analgesia at the time of discharge being less potent then the last pain medication administered to that patient just prior to hospital discharge . RESULTS Thirty-three percent of all patients had reductions in the potency of their opioid pain medication at the time of discharge ( 36 % for surgical and 26 % for nonsurgical patients ) . For nonsurgical patients , we found a trend toward Hispanic ethnicity being an independent risk factor for having a step-down in analgesic potency at discharge ( odds ratio [ OR ] : 3.7 , 95 % confidence interval [ CI ] : 0.9 - 14.9 ) . CONCLUSION Physicians frequently reduce the potency of hospitalized patients ' pain medications at discharge and Hispanic patients may be at increased risk of this occurring . Further research is needed to determine if the reductions in analgesic potency we observed are associated with poor posthospital pain outcomes UNLABELLED Little is known about physical barriers to adequate pain treatment for minorities . This investigation explored sociodemographic determinants of pain medication availability in Michigan pharmacies . A cross-sectional survey-based study with census data and data provided by Michigan community retail pharmacists was design ed . Sufficient opioid analgesic supplies was defined as stocking at least one long-acting , short-acting , and combination opioid analgesic . Pharmacies located in minority ( < or=70 % minority residents ) and white ( > or=70 % white residents ) zip code areas were r and omly selected by using a 2-stage sampling selection process ( response rate , 80 % ) . For the 190 pharmacies surveyed , most were located in white areas ( 51.6 % ) and had sufficient supplies ( 84.1 % ) . After accounting for zip code median age and stratifying by income , pharmacies in white areas ( odds ratio , 13.36 high income vs 54.42 low income ) and noncorporate pharmacies ( odds ratio , 24.92 high income vs 3.61 low income ) were more likely to have sufficient opioid analgesic supplies ( P < .005 ) . Racial differences in the odds of having a sufficient supply were significantly higher in low income areas when compared with high income areas . Having a pharmacy located near a hospital did not change the availability for opioid analgesics . Persons living in predominantly minority areas experienced significant barriers to accessing pain medication , with greater disparities in low income areas regardless of ethnic composition . Differences were also found on the basis of pharmacy type , suggesting variability in pharmacist 's decision making . PERSPECTIVE Michigan pharmacies in minority zip codes were 52 times less likely to carry sufficient opioid analgesics  than pharmacies in white zip codes regardless of income . Lower income areas and corporate pharmacies were less likely to carry sufficient opioid analgesics . This study illustrates barriers to pain care and has public health implication UNLABELLED This study investigated the association between effectiveness of  ED pain treatment and race of patients , race of providers , and the concordance of patient and provider race , with a prospect i ve , multicenter study of patients presenting to 1 of 20 US and Canadian EDs with moderate to severe pain . Primary outcome is a 2-point or greater reduction in pain intensity , measured with an 11-point verbal scale , considered the minimum clinical ly important reduction in pain intensity .  A total of 776 patients were enrolled . The sample included 57 % female , 44 % white , 26 % black , and 26 % Hispanic . The physician was white in 85 % of encounters . Arrival pain score ( adjusted odds ratio , 1.14 ; 95 % CI 1.06 , 1.24 ) , receipt of any ED analgesia ( 1.59 ; 95 % CI 1.17 , 2.17 ) , and physician nonwhite race ( 1.68 ; 95 % CI 1.10 , 2.55 ) were significant predictors of clinical ly significant reduction in pain intensity in multivariate analysis . Nonwhite physicians achieved better pain control without using more analgesics . Future research should explore the determinants of this difference in patient response to pain treatment related to provider race including provider characteristics and training that were not measured in this study . This study provided no evidence supporting an effect of racial concordance on the primary outcome . PERSPECTIVE This article presents analysis of predictors of clinical ly important reduction in pain intensity among emergency department patients , finding non 
    Output:
    
Our study quantifies the magnitude of  analgesic treatment disparities in subgroups of minorities .
The treatment gap does not appear to be closing with time or existing policy initiatives .