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Many patients with hypertension do not achieve adequate blood pressure control. This randomized trial assigned 299 African Americans with hypertension to receive usual care or to view 3 interactive videos that presented stories of real patients with hypertension. Among patients who had uncontrolled hypertension at baseline, those assigned to view the stories had better blood pressure control than those assigned to usual care. The study suggests that storytelling can be an effective way to teach patients about hypertension and improve blood pressure control.
Guidelines recommend screening for hepatocellular carcinoma in patients with cirrhosis, but how often patients receive recommended screening is unknown. This analysis of Veterans Affairs data showed that 12% of veterans with cirrhosis had annual screening with either serum α-fetoprotein testing or abdominal ultrasonography, 58.5% had inconsistent screening, and 29.5% had no screening. These data suggest a need for strategies to improve screening for hepatocellular carcinoma in at-risk patients.
Despite therapeutic advances, many patients with congestive heart failure have suboptimal outcomes. This study found that among patients hospitalized for heart failure in the United States, those admitted to a hospital with a higher volume of heart failure admissions had lower mortality, fewer readmissions, and higher costs than those admitted to lower-volume hospitals. Understanding which practices account for the outcome advantages in high-volume hospitals might identify ways to improve outcomes for all patients with heart failure.
This randomized trial tested whether twice-daily exenatide reduces hemoglobin A1c levels more than placebo in people with type 2 diabetes who are receiving insulin glargine. After 30 weeks, exenatide reduced hemoglobin A1c levels and body weight more than placebo but caused nausea, diarrhea, vomiting, and headache. Rates of hypoglycemia were similar in both groups.
Missing data reduce the reliability and interpretability of results from clinical trials. Frequently used approaches to address missing data are usually inadequate. Although rational imputation methods may be useful, they depend on assumptions that cannot be tested. The optimal approach is to prevent missing data. This article discusses approaches to the design, conduct, and analysis of clinical trials that can improve follow-up and reduce missing data.
This commentary discusses the debate surrounding the Affordable Care Act (ACA) and the potential impact of the November 2010 elections on health care reform. The author notes that although the United States faces an unprecedented crisis in access to health insurance coverage, the uninsured have not been a focus in the debate about the ACA. Physicians could play a crucial role in convincing lawmakers that providing all Americans with affordable health care coverage is imperative and the opportunity to expand insurance coverage must not be allowed to slip away.
This article reviewed advance directive legal statutes for all 50 states and the District of Columbia and identified the following potential barriers to end-of-life care planning: poor readability, surrogate restrictions, and requirements for execution and witnesses. These barriers present particular risks for patients with limited literacy or English-language proficiency who cannot read or execute advance directives; same-sex or domestic partners who may lack trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be bereft of witnesses and suitable surrogates.
In this issue, Houston and colleagues report that listening to stories of other patients with hypertension reduced blood pressure among African Americans with poorly controlled hypertension. The editorialists discuss the findings and explore whether clinicians might use patients' stories in other settings and with other populations as a routine part of treatment.
In this issue, Buse and colleagues report that twice-daily exenatide was superior to placebo for reducing hemoglobin A1c levels in people with type 2 diabetes who are receiving insulin glargine. The editorialist discusses the trial's limitations and, given the increasingly complex array of medications, recommends long-term comparative effectiveness studies to determine the best treatment approaches for type 2 diabetes.
There can be no doubt that chart reviews, clinical experiences, and other forms of retrospective data-gathering over the past century have contributed significantly to progress in medical science and practice. But I have learned that HIPAA has been and will continue to be a significant deterrent to this type of clinical research.
A boy stood before me, asking for help, and all I could do was hope he died in peace, maybe in his sleep one night so that he could continue to dream. I tucked away the memory of Moses in the back of my mind and heart.