Cover photograph by Ronan Allencherril
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The 1990 Americans with Disabilities Act requires equal access to health care for persons with disabilities. Investigators called 256 subspecialty practices in 4 cities to make an appointment for a fictional obese, hemiparetic patient who used a wheelchair and could not self-transfer to an examination table. Fifty-six practices could not accommodate the patient. Twenty-two practices had height-adjustable tables or lifts for transfer, but others reported the use of potentially unsafe transfer methods. These findings suggest that patients with impaired mobility encounter difficulty accessing care.
Some evidence suggests that chlorthalidone may be superior to hydrochlorothiazide for treating hypertension. This study of elderly patients found little difference between the 2 treatments in a composite outcome of death and hospitalization with heart failure, stroke, or myocardial infarction. However, patients treated with hydrochlorothiazide had fewer hospitalizations for hypokalemia. Hydrochlorothiazide in commonly prescribed doses may be superior to chlorthalidone for treating uncomplicated hypertension.
International travel is rapidly increasing, as are travelers presenting with illness after they return home. Researchers used a large surveillance database to examine the frequency and patterns of illness in ill returned travelers. They found that diagnoses varied widely by destination and reason for travel and that serious diseases were reported even with travel to developed countries. Fewer than half of ill returned travelers had medical evaluations before travel, but illness from vaccine-preventable diseases occurred even in those who had evaluations before travel. These findings suggest opportunities for improving pretravel medical evaluation.
Aristolochic acid nephropathy was first described 20 years ago, after an epidemic of progressive renal disease associated with consumption of Chinese herbs. The acid is associated with a high long-term risk for renal failure and urothelial cancer. This review describes the epidemiology of aristolochic acid nephropathy, its pathophysiologic basis and clinical presentation, and diagnostic criteria and management strategies to help better identify and treat patients.
This U.S. Preventive Services Task Force updates its 2004 statement on screening for family and intimate partner violence. It recommends screening women of childbearing age for intimate partner violence and referring those who screen positive to intervention services. It also concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening all elderly or otherwise vulnerable adults for abuse and neglect.
This commentary discusses the political and practical obstacles over the next 4 years on the “road to health care reform” and describes how physicians in the United States can chart a path to a better health care system.
This commentary discusses the Office of Inspector General's recommendation that the Centers for Medicare&Medicaid Services (CMS) issue guidance concerning the documentation providers should keep to justify their meaningful use payments and that CMS conduct prepayment audits for at least some providers before dispensing payments. The CMS rejected the latter over concerns about undue burden on providers and delayed incentive payments, and many providers share these concerns.
In this issue, Lagu and colleagues found many physical access barriers in subspecialty practices for patients with mobility impairment. The editorialist discusses the study, as well as the findings in the context of the Americans with Disabilities Act of 1990, and suggests the use of adjustable-height examination tables, which can improve physical comfort, safety, and access.
The Editors discuss how physicians, who have long been powerful voices in discussions of issues that threaten public health, should draw on similar motivations and strategies to promote sensible, evidence-based laws to decrease the harms associated with gun violence.
It was raining the morning that I met Mr. F. He looked out the window, and in a tone dripping with frustration he announced that it was his 32nd day in the hospital. He did not seem proud of this particular achievement.
As I returned, instead of finding my patient, I found only his mother, sitting there alone. She shared her story with me as we sat together amidst the chaos. “I can't do it anymore, Doctor,” she said. “I'm too old for this.” I realized then that her son never really was my patient.