The American journal of medicine
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Several medications have recently been introduced for the treatment of depression. We reviewed the literature to summarize their efficacy in the treatment of depression in adult patients in primary care settings. ⋯ In primary care settings, newer antidepressants are more effective than placebo and have similar efficacy compared with tricyclic agents in the acute treatment of depression. Dropout rates as a result of adverse effects are lower with newer compared with tricyclic agents. Future studies should compare the effectiveness of different therapies among primary care patients with less severe depression and greater medical and psychiatric comorbidity.
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Previous studies have suggested that specialists may achieve better clinical outcomes for patients, albeit often at greater cost. We sought to compare outcomes of care and resource utilization among patients with shoulder or knee problems who were treated by general internists, rheumatologists, and orthopedic surgeons. ⋯ The relative benefits of specialist compared with generalist care for patients with knee or shoulder pain depend on the importance attached to resource utilization, patient satisfaction, and health outcomes.
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Randomized Controlled Trial Clinical Trial
Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?
We sought to evaluate the effect of automated telephone assessment and self-care education calls with nurse follow-up on the management of diabetes. ⋯ Automated calls with telephone nurse follow-up may be an effective strategy for improving self-care behavior and glycemic control, and for decreasing symptoms among vulnerable patients with diabetes.
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Patient race is associated with decreased resource use for seriously ill hospitalized adults. We studied whether this difference in resource use can be attributed to more frequent or earlier decisions to withhold or withdraw life-sustaining therapies. ⋯ Patient race does not appear to be associated with decisions to withhold or withdraw ventilator support or dialysis, or to withhold major surgery, in seriously ill hospitalized adults.
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Comparative Study
Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents.
Several studies have found that depression and the use of antidepressant medications are associated with an increased risk of cardiovascular disease. We assessed the association between the use of antidepressant drugs and myocardial infarction, and whether that association differs between the tricyclic and selective serotonin reuptake inhibitor (SSRI) classes of medication. ⋯ The association between use of tricyclic antidepressants, but not SSRIs, with an increased risk of myocardial infarction in our patients suggests that an earlier report that there is no difference in risk between the antidepressant classes, based on short-term studies, may not apply to long-term adverse cardiovascular outcomes.