Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study
Intensive blood pressure control, falls, and fractures in patients with type 2 diabetes: the ACCORD trial.
There are few rigorous studies to confirm or refute the commonly cited concern that control of blood pressure to lower thresholds may result in an increased risk of falls and fractures. ⋯ We conclude that intensive antihypertensive treatment that lowered mean systolic blood pressure to below 120 mmHg was not associated with an increased risk of falls or non-spine fractures in patients age 40 to 79 years with type 2 diabetes.
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Randomized Controlled Trial
A randomized controlled pilot trial of the functional assessment screening tablet to engage patients at the point of care.
Healthcare providers play an important role in encouraging healthy behaviors and improving health-related quality of life (HRQoL). They are most effective when they partner with informed, engaged patients. ⋯ Providing patients with immediate, personalized, guideline-based feedback prior to the clinical encounter can increase patient-initiated discussions regarding mental HRQoL. Future work should test FAST-Feedback in a larger population and evaluate the impact on tobacco cessation, increased physical activity, and improvements in HRQoL.
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Pain is the most common presenting problem in primary care. Opioid therapy (OT) for chronic pain has increased dramatically over the past decade, as have related negative outcomes. Despite the development and dissemination of policy and clinical practice guidelines for pain management and OT, adoption has been variable. The Veterans Health Administration (VHA) has established a Stepped Care Model of Pain Management (SCM-PM) as an evidence-based framework and single standard of pain care to promote guideline-concordant care, but to date its adoption and related outcomes have not been systematically examined. ⋯ We demonstrate improvements in the management of veterans receiving OT that are consistent with the SCM-PM and published practice guidelines. We highlight how partnerships among funders, researchers, clinicians, and administrators contributed to the project's design and implementation, and to the dissemination strategy and future directions for improving opioid management and pain care.
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Little is known about older women's experience with a benign breast biopsy. ⋯ The high psychological burden of a benign breast biopsy among older women significantly diminishes with time but does not completely resolve. To reduce this burden, older women need more information about undergoing a breast biopsy.
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Interpersonal care (IPC) is increasingly emphasized as health care systems focus on implementing patient-centered care. Language barriers may be a particularly important influence on IPC ratings among rural Spanish-speaking Latinos. ⋯ This study provides evidence that language concordance is independently associated with high IPC scores in rural Latino adults with diabetes. Moreover, this study suggests that language concordance may contribute to improved participation diabetes self-care activities.