Highlights

Maintaining weight after losing weight

Support from nurses is as effective as a more expensive intensive program to help maintain weight after participation in a weight-loss program. Dale and colleagues came to this conclusion from their randomized trial involving 200 women who had lost 5% or more of their body weight. See Research, page E39

Given the shortage of nurses, exercise specialists and dieticians could be useful in programs to maintain weight and should be included routinely in the care of these patients, suggests Ross. See Commentary, page 997

Preventing infection in outpatient settings

Although infrequent, the transmission of multidrug-resistant pathogens can occur in outpatient settings. Hand hygiene and judicious use of antibiotics are among several key strategies that can be implemented in offices and clinics, according to Matlow and Morris. See Review, page 1021

A new tool to help design trials

PRECIS (pragmatic–explanatory continuum indicator summary) is a new tool that can help researchers ensure that the decisions they make about the design of their randomized trial are consistent with the purpose of the trial. The tool, developed by Thorpe and colleagues, uses 10 domains that help researchers see where their trial fits in the pragmatic–explanatory continuum. See Analysis, page E47

Design of trials should match their purpose

Not enough pragmatic randomized trials are conducted, lament Zwarenstein and Treweek. Most often, trials should be designed to inform the decisions of real-world patients, clinicians and third-party funders, they add. See Commentary, page 998

Pragmatic versus explanatory trials

Policy-makers should be told that pragmatic research trials are real-world studies to help make decisions, whereas explanatory trials are specialized studies to provide information, explains Maclure. See Commentary, page 1001

Tako-tsubo cardiomyopathy

A 75-year-old woman with hypertension was found to have tako-tsubo cardiomyopathy, a condition usually associated with severe emotional stress. The left ventricle in systole resembles an octopus-trapping pot called tako-tsubo in Japanese. Most patients with this rare form of cardiomyopathy recover spontaneously. See Practice, page 1033

Gout in a 104-year-old woman

An elderly woman with hypertension was evaluated for severe topha-ceous gout. Her adherence to treatment with allopurinol was poor, and her condition had progressed for 30 years. See Practice, page 1035

Registering clinical trials

Although pressures to register clinical trials have increased, standardization and transparency remain major concerns. See News, page 1007

Rating doctors online

A North Carolina physician launches a campaign urging doctors to present patients with waivers prohibiting them from rating doctors online. See News, page 1010