JAMA : the journal of the American Medical Association
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Recent reports from 2 European cities and an earlier observation from Seattle, Wash, suggest that the number of patients treated for out-of-hospital ventricular fibrillation (VF) has declined. ⋯ We observed a major decline in the incidence of out-of-hospital VF and in all cases of treated cardiac arrest presumably due to heart disease in Seattle. These changes likely reflect the national decline in coronary heart disease mortality.
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Low adherence to prescribed medical regimens is a ubiquitous problem. Typical adherence rates are about 50% for medications and are much lower for lifestyle prescriptions and other more behaviorally demanding regimens. In addition, many patients with medical problems do not seek care or drop out of care prematurely. ⋯ For short-term regimens (< or =2 weeks), adherence to medications is readily achieved by giving clear instructions. On the other hand, improving adherence to long-term regimens requires combinations of information about the regimen, counseling about the importance of adherence and how to organize medication taking, reminders about appointments and adherence, rewards and recognition for the patient's efforts to follow the regimen, and enlisting social support from family and friends. Successful interventions for long-term regimens are all labor-intensive but ultimately can be cost-effective.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial.
Anemia is common in critically ill patients and results in a large number of red blood cell (RBC) transfusions. Recent data have raised the concern that RBC transfusions may be associated with worse clinical outcomes in some patients. ⋯ In critically ill patients, weekly administration of 40 000 units of rHuEPO reduces allogeneic RBC transfusion and increases hemoglobin. Further study is needed to determine whether this reduction in RBC transfusion results in improved clinical outcomes.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.
Few depressed older adults receive effective treatment in primary care settings. ⋯ The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.