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Agency for Healthcare Research and Quality.

The PCMH holds promise for improving the experiences of patients and staff and potentially for improving care processes,but current evidence is insufficient to determine effects on clinical and most economic outcomes

Screening and diagnostic tests are common in the fields of psychology, medicine, and education. Often there are several competing tests, and decisions must be made about the relative accuracy of those tests. This article describes a general measure that can be used for both continuous and dichotomous outcome measures. It is the standardized distance between the means of the 2 populations. For continuous measures, it is the effect size measure. For dichotomous measures, it is proportional to the logarithm of the odds of the sensitivity plus the logarithm of the odds of the specificity. The measure is easily computed for both kinds of outcomes. Properties of this measure are discussed, and examples are given. Ths use of this measure to compare the average performance of different tests is described.

Stopping smoking as early as possible is important, but cessation at any age provides meaningful life extensions.

HE PULMONARY ARTERY CATHeter (PAC) is used to diagnose various diseases and physiological states, monitor the progress of critically ill patients, and guide the selection and adjustment of medical therapy. 1 The PAC is often considered a cornerstone of critical care and a hallmark of the intensive care unit (ICU). 2 Approximately 1 million PACs are used annually in the United States. 3 However, despite widespread use of these devices, there are conflicting data about their utility. The majority of nonrandomized studies in critically ill patients have suggested that the PAC is associated with increased morbidity and mortality. 4 Conversely, some nonrandomized studies have shown improved quality of life when the PAC was used to direct a specific therapeutic approach. [5][6][7] Since the mid-1980s, randomized clinical trials (RCTs) have been conducted to evaluate the efficacy of the PAC. However, none of these trials have been persuasive individually, because See also pp 1625 and 1693.

Background: We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients. Methods: In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background. Results: Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values b 0). Weight loss and maximum in-hospital dose were correlated (p = 0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p = 0.003), especially at N 300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r = 0.043; p = 0.412) Conclusions: High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome.

Survival after therapy with an LHRH agonist was equivalent to that after orchiectomy. No evidence shows a difference in effectiveness among the LHRH agonists. Survival rates may be somewhat lower if a nonsteroidal antiandrogen is used as monotherapy.