The American journal of medicine
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Essential tremor is a common movement disorder that affects between 5 and 10 million persons in the United States. It is characterized primarily by an action and postural tremor most often affecting the arms, but it can also affect other body parts. Essential tremor is a progressive neurologic disorder and can cause substantial disability in some patients. ⋯ Other medications with potential efficacy include benzodiazepines, gabapentin, topiramate, and botulinum toxin. Patients with medication-resistant tremor may benefit from thalamotomy or deep brain stimulation of the thalamus. The use of medical and surgical therapies can provide benefit in up to 80% of patients with essential tremor.
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Comparative Study
Fecal occult blood testing in a general medical clinic: comparison between guaiac-based and immunochemical-based tests.
Guaiac-based fecal occult blood tests are limited by poor patient compliance, and low sensitivity, specificity, and positive predictive value. Newer immunochemical-based tests are designed to improve accuracy and patient compliance. We compared patient compliance and the test characteristics of these two types of tests. ⋯ Overall, immunochemical-based and guaiac-based fecal occult blood tests had comparable performance. However, although immunochemical-based testing is reported to be easier for patients than guaiac-based testing, we found that patients were no more likely to return cards for analysis. The similar positive predictive value and additional cost of immunochemical-based tests call into question their utility in general practice.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope.
The initial management of syncope or presyncope typically involves short-term cardiac monitoring using a Holter monitor. A loop recorder is used to extend the period of monitoring to increase the probability of obtaining a symptom-rhythm correlation. Loop recorders and Holter monitors are both used commonly, but their utility has not been compared prospectively. ⋯ Loop recorders have a much higher diagnostic yield for patients with syncope or presyncope as compared with Holter monitors. The utility of loop recorders is limited by some patients' inability to operate them correctly.
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Comparative Study
Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients.
Cancer is the leading cause of death among Asian Americans, yet little is known about their use of hospice care. We examined hospice use by Asian patients compared with white patients, and assessed whether utilization differs among those born in the United States or abroad. ⋯ Older Asian Americans dying of cancer, especially those who are born abroad, are less likely than white patients to use hospice care at the end of life. Additional research is needed to understand the reasons for these differences and to eliminate potential barriers to hospice care.
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To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa. ⋯ Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones.