Archives of internal medicine
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Osteoarthritis (OA) of the hip and knee is a common cause of pain and disability in elderly patients. Joint replacement surgery can alleviate pain and restore function but is associated with risks and discomfort. ⋯ Elderly patients who had hip or knee replacements for severe OA took several weeks to recover but experienced excellent long-term outcomes. Physicians often do not discuss joint replacement surgery with elderly patients who might benefit.
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Randomized Controlled Trial
Physicians' shared decision-making behaviors in depression care.
Although shared decision making (SDM) has been reported to facilitate quality care, few studies have explored the extent to which SDM is implemented in primary care and factors that influence its application. This study assesses the extent to which physicians enact SDM behaviors and describes factors associated with physicians' SDM behaviors within the context of depression care. ⋯ In the context of new visits for depressive symptoms, primary care physicians performed few SDM behaviors. However, physician SDM behaviors are influenced by practice setting and patient-initiated requests for medication. Additional research is needed to identify interventions that encourage SDM when indicated.
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Current international health policy has emphasized the importance of managing long-term conditions in the community with the aim of preventing emergency hospitalizations. Previous algorithms and rules have been developed but are limited to those older than 65 years and generally only for readmission. Our aim was to develop an algorithm to predict emergency hospital admissions in the whole population of those 40 years or older. ⋯ A population-derived algorithm provided the first easy-to-use algorithm, to our knowledge, to predict future emergency admissions in all individuals 40 years or older. The model can be implemented at individual patient level as well as family practice level to target case management.
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Editorial Comment
What do certification examinations tell us about quality?
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Review Meta Analysis Comparative Study
Low-molecular-weight heparin vs unfractionated heparin for perioperative thromboprophylaxis in patients with cancer: a systematic review and meta-analysis.
The relative benefits and harms of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are required for judgments regarding the appropriate perioperative thromboprophylaxis in patients with cancer. We systematically reviewed the literature to quantify these effects. ⋯ We found no differences in mortality in patients with cancer receiving perioperative thromboprophylaxis with LMWH vs UFH. Further trials are needed to more carefully evaluate the benefits and harms of different heparin thromboprophylaxis strategies in this population.