Annals of internal medicine
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Randomized Controlled Trial Comparative Study
Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial.
Chronic low back pain is a common problem that has only modestly effective treatment options. ⋯ Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.
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Mortality from invasive candidiasis is high. Low culture sensitivity and treatment delay contribute to increased mortality, but nonselective early therapy may result in excess costs and drug resistance. ⋯ In patients in the ICU with suspected infection who have not responded to antibiotic treatment, empirical fluconazole should reduce mortality at an acceptable cost. The use of empirical strategies in low-risk patients is not justified.
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Comparative Study
Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients.
Acutely ill older persons often experience adverse events when cared for in the acute care hospital. ⋯ The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.
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Recent research has identified genetic traits that can be used in a laboratory setting to distinguish among global population groups. In some genetic analyses, the population groups identified resemble groups that are historically categorized as "races." On the basis of these associations, some researchers have argued that a patient's race can be used to predict underlying genetic traits and from these traits, the expected outcomes of treatment. Others have questioned the use of race in this way, arguing that racially defined groups are so heterogeneous that predictions of individual characteristics derived from group averages are bound to be problematic. ⋯ Nonetheless, many researchers have suggested that these differences are still sufficient to identify racially specific uses for pharmaceutical and other treatments. A review of recent research on the treatment of hypertension and congestive heart failure finds that race-specific treatments of this type carry a substantial risk for treating patients--black or white--inappropriately, either by withholding a treatment that may be effective or by using a treatment that may be ineffective. Only by moving beyond historical concepts of "race" to examining a patient's individual socioeconomic, cultural, behavioral, and ancestral circumstances can a practitioner select the treatment that is most likely to be effective and in doing so, can best serve that patient's needs.