The American journal of medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Improving completion of advance directives in the primary care setting: a randomized controlled trial.
Since 1991, hospitals have asked patients whether they have advance directives, but few patients complete these documents. We assessed two simple interventions to improve completion of advance directives among elderly or chronically ill outpatients. ⋯ Mailing health care proxy and living will forms and literature to patients before an appointment at which their physicians received a reminder about advance directives yielded a small but significant improvement in completion of these documents. A physician reminder alone did not have an effect.
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PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. ⋯ Induced sputum was negative for Pneumocystis carinii, fungi, or acid-fast bacilli. A bronchoalveolar lavage was performed. What is the diagnosis?
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To describe the prevalence of patients admitted to hospital with a diagnosis of community-acquired pneumonia who have normal chest radiographs; the extent to which patients actually had pneumonia on radiographs; and to compare presentation and outcomes in patients with a lower respiratory tract infection and those whose clinical diagnosis of pneumonia was confirmed by radiography. ⋯ One third of patients suspected of having pneumonia and admitted to hospital did not have pneumonia, but had serious lower respiratory tract infections with substantial rates of bacteremia and mortality. The absence of radiographic findings should not supercede clinical judgment and empiric treatments in these patients.
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Meta Analysis
Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomized controlled trials.
Magnesium supplementation may reduce the incidence of arrhythmias, which often occur after cardiac surgery; however, recent findings of the effectiveness of magnesium prophylaxis have yielded discrepant results. ⋯ Administration of prophylactic magnesium reduced the risk of supraventricular arrhythmias after cardiac surgery by 23% (atrial fibrillation by 29%) and of ventricular arrhythmias by 48%. Supplementation had no notable benefit with respect to length of hospitalization, incidence of myocardial infarction, or mortality.