This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Tom Delbanco, MD; Erin E. Hartman, MS
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;283:1054.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In January 1999, at Medicine Grand Rounds, Gordon Guyatt, MD, discussed care for a 75-year-old retired fisherman. Mr C had exertional dyspnea associated with congestive heart failure and chronic obstructive pulmonary disease,¹ with a history of heavy smoking and hypertension and evidence of dilated cardiomyopathy. He subsequently developed diabetes and renal failure. He was treated with a complex regimen of medicines, oxygen, and attentive care from his family and visiting nurses. Dr Guyatt discussed an approach to managing the treatment of such a patient, noting the usefulness of "N-of-1 randomized control trials" and the importance of therapeutic recommendations based on the best available medical evidence. We asked the patient's physician to comment on the months that followed the rounds.

DR M, THE PRIMARY PHYSICIAN

Mr C continued to have frequent exacerbations of his congestive heart failure. Amiodarone was started to improve cardiac output by treating the arrhythmia. Mr . . . [Full Text of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?