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Eighty moderately obese patients were randomly assigned to laparoscopic gastric banding or to a nonsurgical program involving very low-calorie diets, weight loss drugs, and counseling (Article, p. 625). At six months, both groups lost 13.8 percent of initial weight; at 24 months, patients who had gastric banding lost an average of 21.6 percent of initial body weight compared to 5.5 percent in the nonsurgical group. Australian authors, with ties to the company that makes the adjustable gastric bands, note that the surgeons in the study had performed several hundred of the procedures and were experienced in providing follow-up and adjustment. Accompanying editorialists say that the surgery was performed on mild to moderately obese people for whom current recommendations for weight loss do not include surgery (Editorial, p. 689.) They hope that the study findings “will not cause primary care providers or their patients to overlook the positive health benefits of a five percent to 10 percent weight loss [that can be] achieved with lifestyle modification.”
Although many health systems include patient satisfaction surveys or ratings of care, a new study of 236 frail and elderly adults living independently found an overall high rating of care, directly correlated with high ratings of interpersonal communication with health care providers. However, neither of these ratings correlated with ratings of technical quality of care as measured by 207 quality indicators for 22 clinical conditions. The authors say, “Comprehensive assessment of quality of care requires measurement of both patient evaluations of care and technical quality.”
Researchers studied 35 EMS (emergency medical service) agencies in which 16 volunteered to implement new guidelines for withholding resuscitation if the patient had a terminal condition and the patient, family or a caregiver indicated, in writing or verbally, that no resuscitation was desired (Article, p. 634). Previous guidelines did not permit EMS personnel to withhold resuscitation at the end of life, particularly if there was no written do-not-resuscitate order. During the study period, personnel from the agencies who volunteered to adopt the new guidelines withheld resuscitation in 11.8 percent of patients having cardiac arrests, compared with an average of 5.3 percent of patients in control groups. Most (53 percent) of the withheld resuscitations came from honoring verbal requests. Editorial writers note that guidelines such as those in the study provide a “welcome alternative” to current guidelines to “always resuscitate,” which can lead to unnecessary and unwanted suffering at the end of life (Editorial, p. 692). However, the writers say, the study raises “practical concerns,” such as when EMS personnel agree to perhaps duplicitous family requests, or what legal protection is provided for on-the-spot decisions.