Annals of family medicine
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Statins reduce the risk of mortality and coronary artery disease in individuals at high cardiovascular risk. Using nationally representative data, we examined the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors. ⋯ In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events. This undertreatment appears to be related to placing too much emphasis on hyperlipidemia and not enough on cardiovascular risk. Recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.
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William Osler is quoted as saying, "Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life-the poetry of the commonplace, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs."(1) A family physician reflects how he continues to derive sustenance from having cared for a dying woman and her family over several home visits in his earliest years of private practice. The author's memory of these house calls continues to reinforce his love for medicine. Today, when physicians are overburdened with countless numbers of interruptions, requirements, and measures we are reminded that one of the things which can maintain our passion for medicine is in realizing that caring for others is the focus of our sacred vocation. By appreciating the impact we have on the lives of those less fortunate, we may find meaning in our own lives.
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Annals of family medicine · May 2014
Randomized Controlled Trial Multicenter StudySociopsychological tailoring to address colorectal cancer screening disparities: a randomized controlled trial.
Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. ⋯ Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.
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Annals of family medicine · May 2014
ReviewMedication taking in coronary artery disease: a systematic review and qualitative synthesis.
Despite the compelling evidence supporting cardiovascular medications in the secondary prevention of coronary artery disease, many patients discontinue treatment. In this synthesis, we sought to understand from a patient perspective the factors that promote medication persistence. ⋯ Strategies to promote higher persistence of secondary prevention medications in patients with coronary artery disease need to recognize the key role of the prescribing clinician. Providing medication-specific information at the time of initiating therapy, improving the transition between secondary and primary care, and explaining the risk of disease recurrence may all help to modify patient attitudes toward drugs to prevent further cardiovascular disease.