Annals of internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: Results from the LIPID trial.
The effect of cholesterol-lowering therapy on death from coronary heart disease in older patients with previous coronary heart disease and average cholesterol levels is uncertain. ⋯ In older patients with coronary heart disease and average or moderately elevated cholesterol levels, pravastatin therapy reduced the risk for all major cardiovascular events and all-cause mortality. Since older patients are at greater risk than younger patients for these events, the absolute benefit of treatment is significantly greater in older patients.
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This position paper of the American College of Physicians-American Society of Internal Medicine addresses public policy issues related to physicians' joining to negotiate issues affecting patient care and the working environment in which patient services are provided. It seeks to identify an appropriate way for physicians to negotiate jointly with health care plans while maintaining professionalism and keeping the interests of patients paramount. It proposes that physicians in nonintegrated private practices should be able to meet and communicate among themselves for the purpose of negotiating primarily with health care plans about specific issues that affect quality and access. ⋯ Physicians in residency training are protected by accreditation requirements for programs of graduate medical education, and educational content should not be subject to negotiations. The College also calls for determination of negotiating units for physicians but recommends that nonphysician providers not be included in the same units as physicians. Membership in an organization that negotiates for physicians should be voluntary, and conflict-resolution mechanisms must be available for resolving impasses.
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Unmet patient expectations are common and have been associated with decreased patient satisfaction. ⋯ Patients who seek care for physical symptoms and do not leave the encounter with an unmet expectation are more likely to be satisfied with their care and to have less worry about serious illness. Diagnostic and prognostic information are particularly valued by patients and may be associated with greater improvement in symptoms and functional status 2 weeks after the visit.
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Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome.
The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. ⋯ Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.