JAMA internal medicine
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JAMA internal medicine · Jun 2013
Multicenter Study Comparative StudyProvision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life.
Previous studies report associations between medical utilization at the end-of-life (EoL) and religious coping and spiritual support from the medical team. However, the influence of clergy and religious communities on EoL outcomes is unclear. ⋯ Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.
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JAMA internal medicine · Jun 2013
Yield of routine provocative cardiac testing among patients in an emergency department-based chest pain unit.
The American Heart Association recommends routine provocative cardiac testing in accelerated diagnostic protocols for coronary ischemia. The diagnostic and therapeutic yield of this approach are unknown. ⋯ In an emergency department-based chest pain unit, routine provocative cardiac testing generated a small therapeutic yield, new diagnoses of coronary artery disease were uncommon, and false-positive results were common.
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JAMA internal medicine · Jun 2013
Randomized Controlled Trial Comparative StudyAggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.
The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. ⋯ Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary.