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Chronic post-thrombotic sequelae develop in almost half of patients with proximal deep venous thrombosis. Ready-made below-knee elastic compression stockings reduce this rate by 50%.
The authors randomly assigned pediatrics, family medicine, and internal medicine residents to receive a 13-hour longitudinal residents-as-teachers curriculum or to a control group. Residents assigned to the curriculum consistently showed greater improvement in teaching skills, as judged by medical student raters.
In response to 4 clinical scenarios on a national survey, gastroenterologists and general surgeons recommended surveillance colonoscopy after removal of low-risk polyps far more often than practice guidelines recommended. The demand for surveillance colonoscopy probably exceeds medical need.
Diabetes care met process of care criteria more often in the Veterans Affairs (VA) system than in commercial managed care. Moreover, VA patients met standards for control of hemoglobin A1c and low-density lipoprotein cholesterol levels more often than did patients in commercial managed care. However, both systems had room for improvement in blood pressure control.
Many observers believe that oversight of research involving human participants is inadequate. The authors delineate 15 problems with the current system, critically assess proposed reforms, and outline components of a new proposal for reform.
This review critically analyzes the evidence comparing primary percutaneous coronary intervention (PCI) with thrombolytic therapy and concludes that reasonable health care professionals may still find considerable uncertainty about the superiority of primary PCI for all situations.
The authors contend that because primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction has superior outcomes, it should be available to all patients with ST-segment elevation myocardial infarction. They outline obstacles to instituting PCI as the universal treatment and propose strategies to increase its availability.
This article describes an evidence-based clinical practice guideline for preventing ventilator-associated pneumonia.
What is a clinician to do to prevent long-term complications of acute symptomatic deep venous thrombosis? Should all patients routinely use elastic compression stockings over the long term, or can clinicians use a “wait-and-see” approach? The safest approach, on the evidence from the randomized trial reported in this issue, is routine stocking therapy.
The improvement of diabetes care in the Veterans Affairs and other closed health care systems represents major progress toward optimal management for chronic diseases. Applying the experience of these organizations to the broader, less organized U.S. health care delivery system will be a far more serious challenge.
Alex, like others with autism, can't see the forest when standing in front of a tree. Rather, he is inexplicably drawn to minute details of one specific tree, a fixation that defies rational explanation. In Alex's case, the fixation is on elevators.
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