Annals of internal medicine
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In randomized trials with subgroup analyses, the primary treatment or intervention of interest is randomized, but the secondary factors defining subgroups are not. This article clarifies when confounding is an issue in subgroup analyses. ⋯ If investigators are interested in intervening on the secondary factors that define the subgroups to increase the treatment effect or in attributing the subgroup differences to the secondary factors themselves, then confounding is relevant and must be controlled for. The authors demonstrate this point by using examples from published randomized trials.
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The adverse effect of obesity on health outcomes may be lower in older and African American adults than in the general U.S. population. ⋯ National Institute of Diabetes and Digestive and Kidney Diseases.
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To reduce costs of care and improve quality, the federal government is stimulating adoption of health information technology through meaningful use policy. The legislation, however, is built on several assumptions that are unrealistic from a provider's perspective-the group that is expected to purchase, use, and sustain the information technology infrastructure. A viable meaningful use policy may do better to account for the realities of patient care by using a bottom-up approach for adoption rather than the current top-down strategy.