JAMA internal medicine
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JAMA internal medicine · Jan 2014
Randomized Controlled TrialGabapentin treatment for alcohol dependence: a randomized clinical trial.
Approved medications for alcohol dependence are prescribed for less than 9% of US alcoholics. ⋯ Gabapentin (particularly the 1800-mg dosage) was effective in treating alcohol dependence and relapse-related symptoms of insomnia, dysphoria, and craving, with a favorable safety profile. Increased implementation of pharmacological treatment of alcohol dependence in primary care may be a major benefit of gabapentin as a treatment option for alcohol dependence.
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JAMA internal medicine · Jan 2014
Randomized Controlled TrialA 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial.
Patients with chest pain represent a high health care burden, but it may be possible to identify a patient group with a low short-term risk of adverse cardiac events who are suitable for early discharge. ⋯ Using the accelerated diagnostic protocol in the experimental pathway almost doubled the proportion of patients with chest pain discharged early. Clinicians could discharge approximately 1 of 5 patients with chest pain to outpatient follow-up monitoring in less than 6 hours. This diagnostic strategy could be easily replicated in other centers because no extra resources are required.
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Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. ⋯ AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.
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JAMA internal medicine · Jan 2014
Randomized Controlled TrialAn education program for risk factor management after an acute coronary syndrome: a randomized clinical trial.
Lifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve. ⋯ Compared with conventional care, the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome.