Arch Intern Med
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Randomized Controlled Trial Comparative Study Clinical Trial
Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial.
A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes. ⋯ A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.
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Multicenter Study Comparative Study
Physician career satisfaction across specialties.
The career satisfaction and dissatisfaction physicians experience likely influence the quality of medical care. ⋯ Career satisfaction and dissatisfaction vary across specialty as well as age, income, and region. These variations are likely to be of interest to residency directors, managed care administrators, students selecting a specialty, and physicians in the groups with high satisfaction and dissatisfaction.
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Comparative Study
Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma.
Patients who visit the emergency department (ED) because of asthma frequently have a relapse. While the use of inhaled corticosteroids has been demonstrated to improve asthma symptoms and lung function, it is not clear whether their use after discharge from the ED reduces asthma relapse rates. ⋯ Inhaled corticosteroid therapy after ED discharge is associated with a significant reduction in the risk of subsequent ED visits. Low-dose therapy appears to be as effective as high-dose therapy. However, further studies are needed to determine the optimal dosing regimen for inhaled corticosteroid therapy for asthma.
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We designed a diagnostic strategy, based on clinical probability and D-dimer concentration, to select patients who were unlikely to have pulmonary embolism (PE), before further diagnostic workup was performed. The utility and safety of this strategy were evaluated in a prospective management study. ⋯ The combination of a low clinical probability and a normal D-dimer concentration appears to be a safe method to exclude PE, with a high clinical utility, and is readily accepted by clinicians.
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Randomized Controlled Trial Comparative Study Clinical Trial
Successful blood pressure control in the African American Study of Kidney Disease and Hypertension.
The African American Study of Kidney Disease and Hypertension (AASK) is an ongoing trial to evaluate the effect of blood pressure and choice of antihypertensive drug on the rate of decline of renal function. ⋯ The blood pressure goals set and achieved in AASK participants clearly demonstrate that adequate blood pressure control can be achieved even in hypertensive populations whose blood pressure is the most difficult to control.