The American journal of medicine
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Randomized Controlled Trial Clinical Trial
Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults.
To assess the efficacy, dose stability, safety, and abuse potential of long-term, nightly benzodiazepine treatment of chronic disorders of disrupted nocturnal sleep. ⋯ Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep resulted in sustained efficacy in most cases, with low risk of dosage tolerance, adverse effects, or abuse. Data from this study on the treatment of chronic, severe insomnia (a small subset of all insomnia) are not generalizable to the typical insomnia patient.
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Physicians lack objective outcome data to define the medically appropriate length of stay (LOS) for patients hospitalized with acute upper gastrointestinal hemorrhage (UGIH), resulting in wide variations in resource utilization and quality of care. A clinical practice guideline with the ability to assign relative risk for adverse events is proposed. ⋯ The proposed clinical practice guideline may safely reduce hospital LOS for selected low-risk patients with acute UGIH. Moreover, it also may reduce premature discharge of high-risk patients prone to life-threatening events.
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For patients hospitalized with serious illnesses, we identified factors associated with a stated preference to forgo cardiopulmonary resuscitation (CPR), examined physician-patient communication about these issues, and determined the relationship of patients' preferences to intensity of care and survival. ⋯ The diagnosis, patients' perception of the prognosis, and hospital site were significantly associated with patients' resuscitation preferences after adjusting for patient demographics, severity of illness, and functional status. The rate of discussing CPR was low even for patients who did not want CPR. Patient preferences not to receive CPR were associated with a small decrease in intensity of care but no difference in hospital survival.
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Internal medicine training programs must adapt to health care systems faced with balancing the competitive priorities of patient-care responsibilities and educational needs. ⋯ Through organizational restructuring, it is possible to improve the quality of patient care and improving the efficiency of patient-care management.
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New methods of measuring and controlling glycemia in diabetes mellitus have been developed and implemented in the past 10 years. We examined whether glycemia, as measured by glycosylated hemoglobin, changed in outpatient insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) populations between 1985 and 1993 and whether contemporaneous changes in therapy could account for observed changes in glycemia. ⋯ The level of average glycemia has decreased in IDDM patients over the past 8 years, attributable, at least in part, to an increased frequency of monitoring and of insulin injections. Glycemia decreased in NIDDM, especially in the subset of patients treated with insulin. This temporal shift in glycemic control should have a salutary effect on the development of long-term microvascular and neurologic complications.