The American journal of medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of subcutaneous insulin lispro versus continuous intravenous regular insulin for the treatment of patients with diabetic ketoacidosis.
To compare the efficacy and safety of subcutaneous insulin lispro with that of a standard low-dose intravenous infusion protocol of regular insulin in patients with uncomplicated diabetic ketoacidosis. ⋯ Treatment of adult patients who have uncomplicated diabetic ketoacidosis with subcutaneous lispro every hour in a non-intensive care setting may be safe and more cost-effective than treatment with intravenous regular insulin in the intensive care unit.
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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.
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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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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.