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ORIGINAL CONTRIBUTION: Geriatric Care Management for Low-Income Seniors: A Randomized Controlled Trial

from JAMA - 11 Dec 07

Context  Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended standard of care. Objectives  To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care. Design, Setting, and Patients  Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200% of the federal poverty level, whose primary care physicians


REVIEW: Pioglitazone and Risk of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Trials

from JAMA - 11 Sep 07

Context  Pioglitazone is widely used for glycemic control in patients with type 2 diabetes mellitus, but evidence is mixed regarding the influence of medications of this class on cardiovascular outcomes. Objective  To systematically evaluate the effect of pioglitazone on ischemic cardiovascular events. Data Sources and Study Selection  A database containing individual patient-level time-to-event data collected during pioglitazone clinical trials was transferred from the drug's ma


ORIGINAL ARTICLE: Oral Anticoagulant and Antiplatelet Therapy and Peripheral Arterial DiseaseThis story has been made Editorial

from NEJM - 18 Jul 07

In a randomized trial, 2161 patients with peripheral arterial disease were assigned to combination therapy with an antiplatelet agent and an oral anticoagulant or to antiplatelet therapy alone. At a mean follow-up of 35 months, the rate of myocardial infarction, stroke, or death from cardiovascular causes was not significantly different between the two groups. The group receiving combination therapy had a significantly higher rate of life-threatening bleeding.


ORIGINAL INVESTIGATION: Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus: Results From the Primary Coronary Angioplasty vs Thromboly

from ArchInte - 09 Jul 07

Background  There is growing evidence for a clinical benefit of primary percutaneous coronary intervention (PCI) compared with fibrinolysis; however, whether the treatment effect is consistent among patients with diabetes mellitus is unclear. We compared PCI with fibrinolysis for treatment of ST-segment elevation myocardial infarction in patients with diabetes mellitus. Methods  A pooled analysis of individual patient data from 19 trials comparing primary PCI with fibrinolysis for tre


Meta-analysis: acupuncture for osteoarthritis of the knee.

from Ann Int Med - 06 Jul 07

Related Articles Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007 Jun 19;146(12):868-77 Authors: Manheimer E, Linde K, Lao L, Bouter LM, Berman BM BACKGROUND: Knee osteoarthritis is a major cause of pain and functional limitation. PURPOSE: To evaluate the effects of acupuncture for treating knee osteoarthritis. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases to January 2007. No language r


Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.

from Ann Int Med - 06 Jul 07

Related Articles Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007 Jun 19;146(12):857-67 Authors: Hart RG, Pearce LA, Aguilar MI BACKGROUND: Atrial fibrillation is a strong independent risk factor for stroke. PURPOSE: To characterize the efficacy and safety of antithrombotic agents for stroke prevention in patients who have atrial fibrillation, adding 13 recent randomized trials to


ORIGINAL ARTICLE: Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence

from NEJM - 23 May 07

This multicenter, randomized clinical trial compared two surgical procedures -- the Burch colposuspension and the autologous fascial pubovaginal sling -- in women with urinary stress incontinence. Success rates (in terms of overall urinary-incontinence measures and stress-incontinence measures specifically) were higher at 2 years for the sling group, but this group also had greater morbidity. These findings inform decision making with respect to surgical treatment of stress incontinence and unde


ORIGINAL ARTICLE: Randomized Comparison of Strategies for Reducing Treatment in Mild Persistent Asthma

from NEJM - 16 May 07

In this trial, patients with mild persistent asthma who were receiving an inhaled corticosteroid twice daily were given the same treatment or were switched either to an inhaler containing a corticosteroid and a long-acting beta-agonist or to a leukotriene modifier. There was no difference in asthma control between the two corticosteroid groups. The patients switched to the leukotriene modifier had more frequent asthma exacerbations, but there was no difference in the percentage of symptom-free d


Immediate and short-term pain relief by acute sciatic nerve press: a randomized controlled trial

from - 16 May 07

Background: Despite much research, an immediately available, instantly effective and harmless pain relief technique has not been discovered. This study describes a new manipulation: a 2-minute sciatic nerve press, for rapid short-term relief of pain brought on by various dental and renal diseases. Methods: this randomized, single-blind, placebo-controlled trial ran in three hospitals in Anhui Province, China, with an enrollment of 66 out of 111 solicited patients aged 16 to 74 years. Patients we


ORIGINAL ARTICLE: Interleukin-1-Receptor Antagonist in Type 2 Diabetes Mellitus

from NEJM - 11 Apr 07

The expression of interleukin-1-receptor antagonist is reduced in pancreatic islets in type 2 diabetes, and high glucose concentrations induce interleukin-1beta production in human pancreatic beta cells, suggesting that the interleukin-1 pathway may be a treatment target. This randomized trial showed that the interleukin-1-receptor antagonist anakinra (100 mg) improved glycemia and beta-cell secretory function and reduced markers of systemic inflammation, as compared with placebo.


REVIEW: Eligibility Criteria of Randomized Controlled Trials Published in High-Impact General Medical Journals: A Systematic Sampling Review

from JAMA - 20 Mar 07

Context  Selective eligibility criteria of randomized controlled trials (RCTs) are vital to trial feasibility and internal validity. However, the exclusion of certain patient populations may lead to impaired generalizability of results. Objective  To determine the nature and extent of exclusion criteria among RCTs published in major medical journals and the contribution of exclusion criteria to the representation of certain patient populations. Data Sources and Study Selection  T


ORIGINAL ARTICLE: Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome

from NEJM - 07 Feb 07

This multicenter, randomized trial compared the effects of clomiphene citrate plus placebo, metformin plus placebo, and combination therapy in infertile women with the polycystic ovary syndrome. The rate of live birth was significantly higher with clomiphene than with metformin; there was no significant difference between the rates with combination therapy and with clomiphene alone. Multiple birth was a complication associated with clomiphene but was infrequent. These data support the use of clo


Effectiveness of management strategies for renal artery stenosis: a systematic review.

from Ann Int Med - 11 Jan 07

Related Articles Effectiveness of management strategies for renal artery stenosis: a systematic review. Ann Intern Med. 2006 Dec 19;145(12):901-12 Authors: Balk E, Raman G, Chung M, Ip S, Tatsioni A, Alonso A, Chew P, Gilbert SJ, Lau J BACKGROUND: Atherosclerotic renal artery stenosis is increasingly common in an aging population. Therapeutic options include medical treatment only or revascularization procedures. PURPOSE: To compare the effects of medical treatm


ORIGINAL ARTICLE: A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia

from NEJM - 20 Dec 06

Ventilator-associated pneumonia is an important cause of nosocomial complications. This large, multicenter study compared the usefulness in guiding therapy of two diagnostic approaches for ventilator-associated pneumonia: bronchoalveolar lavage with quantitative culture and endotracheal aspiration with nonquantitative culture. Clinical outcomes such as the 28-day mortality rate and overall use of antimicrobial agents were similar with the two strategies.


ORIGINAL ARTICLE: Ertapenem versus Cefotetan Prophylaxis in Elective Colorectal Surgery

from NEJM - 20 Dec 06

With the availability of cefotetan and cefoxitin possibly ending, effective agents for wound prophylaxis during elective colorectal surgery are needed. In this large randomized, multicenter, double-blind study, ertapenem was found to be superior to cefotetan in the prevention of surgical-site infection but was associated with an increase in Clostridium difficile infection.


EDITORIAL: Diagnosis of Ventilator-Associated Pneumonia

from NEJM - 20 Dec 06

In this issue of the Journal, Heyland et al., writing for the Canadian Critical Care Trials Group, report the results of a multicenter, randomized trial comparing the use of bronchoalveolar ...


REVIEW: Effect of Folic Acid Supplementation on Risk of Cardiovascular Diseases: A Meta-analysis of Randomized Controlled Trials

from JAMA - 12 Dec 06

Context  Epidemiologic studies have suggested that folate intake decreases risk of cardiovascular diseases. However, the results of randomized controlled trials on dietary supplementation with folic acid to date have been inconsistent. Objective  To evaluate the effects of folic acid supplementation on risk of cardiovascular diseases and all-cause mortality in randomized controlled trials among persons with preexisting cardiovascular or renal disease. Data Sources  Studies were r


Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators.

from Am J Surg - 08 Dec 06

Related Articles Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med. 2006 Dec;119(12):1048-55 Authors: Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD, PURPOSE: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on random


Effects of Glucose-Insulin-Potassium Infusion on Myocardial Perfusion and Left Ventricular Remodeling in Patients Treated With Primary Angioplasty for ST-Elevation Acute Myocardial Infarction.

from Am J Cardiol - 08 Dec 06

Related Articles Effects of Glucose-Insulin-Potassium Infusion on Myocardial Perfusion and Left Ventricular Remodeling in Patients Treated With Primary Angioplasty for ST-Elevation Acute Myocardial Infarction. Am J Cardiol. 2006 Nov 15;98(10):1349-53 Authors: Bucciarelli-Ducci C, Bianchi M, De Luca L, Battagliese A, Di Russo C, Proietti P, Vizza CD, Fedele F The role of glucose-insulin-potassium (GIK) infusion in the management of acute coronary syndrome is cont


ORIGINAL ARTICLE: Glycemic Durability of Rosiglitazone, Metformin, or Glyburide MonotherapyThis story has been made Editorial

from NEJM - 06 Dec 06

This double-blind, randomized, controlled trial evaluated rosiglitazone, metformin, and glyburide as an initial treatment in patients with type 2 diabetes. Rosiglitazone reduced the risk of treatment failure (the primary outcome) by 32% as compared with metformin and by 63% as compared with glyburide. The potential risks, benefits, and costs of these medications should all be considered to help inform the choice of pharmacotherapy for patients with type 2 diabetes.


ORIGINAL ARTICLE: CD4+ Count-Guided Interruption of Antiretroviral Treatment

from NEJM - 29 Nov 06

Long-term antiretroviral therapy for the treatment of human immunodeficiency virus infection is associated with a substantial rate of complications. Structured interruption of antiretroviral therapy, in the setting of a preserved CD4+ count, has been considered in order to minimize these side effects. In this randomized study of 5472 patients, CD4+ count-guided intermittent use of antiretroviral drugs was found to be associated with increased rates of opportunistic disease, death from any cause,


ORIGINAL ARTICLE: A Placebo-Controlled Trial of Pioglitazone in Subjects with Nonalcoholic Steatohepatitis

from NEJM - 29 Nov 06

In this placebo-controlled, randomized trial of pioglitazone in subjects with nonalcoholic steatohepatitis, pioglitazone was associated with improvements in the results of liver-function tests, hepatic fat content, and hepatic insulin sensitivity. As compared with placebo, pioglitazone significantly reduced the histologic abnormalities of steatohepatitis but did not significantly reduce fibrosis.


REVIEW ARTICLE: Primary Prevention of Cardiovascular Diseases With Statin Therapy: A Meta-analysis of Randomized Controlled Trials

from ArchInte - 27 Nov 06

Background  While the role of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) in secondary prevention of cardiovascular (CV) events and mortality is established, their value for primary prevention is less clear. To clarify the role of statins for patients without CV disease, we performed a meta-analysis of randomized controlled trials (RCTs). Methods  MEDLINE, EMBASE, Cochrane Collaboration, and American College of Physicians Journal Club databases were searched for R


ORIGINAL ARTICLE: Fetal Pulse Oximetry and Cesarean Delivery

from NEJM - 22 Nov 06

In this randomized trial of fetal pulse oximetry, there were no significant differences in the rates of cesarean delivery (overall or for the indication of a nonreassuring fetal heart rate) or in the conditions of infants at birth between women whose clinicians were made aware of the oximetry results and women whose clinicians were not. These findings do not support the use of fetal pulse oximetry in women in labor.


ORIGINAL CONTRIBUTION: Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial

from JAMA - 21 Nov 06

Context  Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. Objective  To assess the efficacy of surgery for lumbar intervertebral disk herniation. Design, Setting, and Patients  The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine cl


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