The American journal of medicine
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Randomized Controlled Trial Multicenter Study
Long-Term Courses of Sepsis Survivors: Effects of a Primary Care Management Intervention.
Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare. ⋯ Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
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Ivabradine, a heart rate-slowing drug used to treat heart failure and (in Europe) angina, had varying impacts upon cardiovascular events in its 3 large outcome trials. Food and Drug Administration (FDA) analyses may explain the reasons for the variability. ⋯ Ivabradine used concomitantly with a loop diuretic has a beneficial impact upon cardiovascular death.
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Integrity and trust are essential attributes of medical researchers. Research misconduct represents clear and present dangers to academic institutions and their faculty, residents, students, and staff. To achieve and maintain public trust, medical researchers must achieve and maintain research integrity. ⋯ This, in turn, will lead to avoidable consequences of substantial penalties, financial and otherwise, adverse publicity, and reputational damage. Researchers must self-regulate to avoid pitfalls, including those created by changes in the medical care delivery system that have decreased the influence of health care providers and increased the influence of outside legal and business interests. Our common goal should be to return public trust in our research enterprise that has done so much good for so many, but requires the establishment and maintenance of vigilance to establish and maintain research integrity.
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We propose a unifying perspective of heart failure in patients with type 2 diabetes mellitus. The reasoning is as follows: cellular responses to fuel overload include dysregulated insulin signaling, impaired mitochondrial respiration, reactive oxygen species formation, and the accumulation of certain metabolites, collectively termed glucolipotoxicity. ⋯ Conversely, restricting fuel supply by means of caloric restriction, surgical intervention, or certain pharmacologic agents will improve cardiac function by restoring metabolic homeostasis. The concept is borne out by clinical interventions, all of which unload the heart from metabolic stress.