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IMPORTANCE: Chronic kidney disease (CKD) affects 37 million adults in the United States, and for patients with CKD, hypertension is a key risk factor for adverse outcomes, such as kidney failure, cardiovascular events, and death. OBJECTIVE: To evaluate a computerized clinical decision support (CDS) system for the management of uncontrolled hypertension in patients with CKD. DESIGN, SETTING, AND PARTICIPANTS: This multiclinic, randomized clinical trial randomized primary care practitioners (PCPs) at a primary care network, including 15 hospital-based, ambulatory, and community health center–based clinics, through a stratified, matched-pair randomization approach February 2021 to February 2022. All adult patients with a visit to a PCP in the last 2 years were eligible and those with evidence of CKD and hypertension were included. INTERVENTION: The intervention consisted of a CDS system based on behavioral economic principles and human-centered design methods that delivered tailored, evidence-based recommendations, including initiation or titration of renin-angiotensin-aldosterone system inhibitors. The patients in the control group received usual care from PCPs with the CDS system operating in silent mode. MAIN OUTCOMES AND MEASURES: The primary outcome was the change in mean systolic blood pressure (SBP) between baseline and 180 days compared between groups. The primary analysis was a repeated measures linear mixed model, using SBP at baseline, 90 days, and 180 days in an intention-to-treat repeated measures model to account for missing data. Secondary outcomes included blood pressure (BP) control and outcomes such as percentage of patients who received an action that aligned with the CDS recommendations. RESULTS: The study included 174 PCPs and 2026 patients (mean [SD] age, 75.3 [0.3] years; 1223 [60.4%] female; mean [SD] SBP at baseline, 154.0 [14.3] mm Hg), with 87 PCPs and 1029 patients randomized to the intervention and 87 PCPs and 997 patients randomized to usual care. Overall, 1714 patients (84.6%) were treated for hypertension at baseline. There were 1623 patients (80.1%) with an SBP measurement at 180 days. From the linear mixed model, there was a statistically significant difference in mean SBP change in the intervention group compared with the usual care group (change, −14.6 [95% CI, −13.1 to −16.0] mm Hg vs −11.7 [−10.2 to −13.1] mm Hg; P = .005). There was no difference in the percentage of patients who achieved BP control in the intervention group compared with the control group (50.4% [95% CI, 46.5% to 54.3%] vs 47.1% [95% CI, 43.3% to 51.0%]). More patients received an action aligned with the CDS recommendations in the intervention group than in the usual care group (49.9% [95% CI, 45.1% to 54.8%] vs 34.6% [95% CI, 29.8% to 39.4%]; P < .001). CONCLUSIONS AND RELEVANCE: These findings suggest that implementing this computerized CDS system could lead to improved management of uncontrolled hypertension and potentially improved clinical outcomes at the population level for patients with CKD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03679247

Abstract:This article provides an overview of the medieval manuscript items found in University Archives and Special Collections at Xavier University in Cincinnati, Ohio. After describing the history of the Xavier University collection, it offers descriptions of nineteen binding fragments recently found within twelve early print volumes and includes provenance information for those volumes when possible. The article ends by reflecting on the benefits of participation in the Peripheral Manuscripts Project and sharing how project outcomes are influencing Special Collections work at Xavier.

A few years ago I worked with a small group of teachers and the director of an alternative high school program who were experiencing significant conflict during team meetings. Every [...]

One day a moose was walking along a well-worn mountain trail. The moose moved down the range, emerging from a wooded area just above a creek. Gazing toward a row [...]

Would you be willing to put on scuba gear and dive into a giant aquarium holding over a million gallons of water to encourage innovation in your school district? That's [...]

Saint Anselm of Canterbury’s Orationes sive meditationes, written in the late eleventh century, influenced generations of later authors of devotional and mystical literature, and the prologue to the Orationes, in particular, was repeatedly translated and reworked by vernacular authors in the thirteenth and fourteenth centuries in England. This essay examines the textual and codicological contexts in which this prologue occurs in four late medieval manuscripts, and situates Anselm’s prologue within broader theoretical conversations regarding the respective values of indexical and affective modes of reading. Although selective modes of reading are at times perceived as being less sophisticated than those that engage with written works more comprehensively, the late medieval interest in translations of Anselm’s prologue indicates that reading selectively could be seen as a sophisticated method for engaging the reader’s emotions so as to propel him or her towards a more devout and pious lifestyle.