Annals of internal medicine
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Practice Guideline Guideline
Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients. ⋯ If effectively implemented, this guideline may decrease the morbidity, mortality, and costs of VAP in mechanically ventilated patients.
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Randomized Controlled Trial Clinical Trial
The effect of a 13-hour curriculum to improve residents' teaching skills: a randomized trial.
Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001-2002 found that 13 trained resident teachers taught better than did untrained control residents. ⋯ Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.
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Randomized Controlled Trial Clinical Trial
Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial.
Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used. ⋯ Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.
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Increasing use of colonoscopy for colorectal cancer screening and surveillance of colorectal adenomas after polypectomy has given rise to concerns about the availability of endoscopic resources in the United States. Guidelines recommend surveillance after polypectomy at 3 to 5 years for a small adenoma, and follow-up is not advised for hyperplastic polyps. The intensity of physicians' surveillance is largely unstudied. ⋯ Some surveillance colonoscopy seems to be inappropriately performed and in excess of guidelines, particularly for hyperplastic polyps and low-risk lesions such as a small adenoma. These results suggest unnecessary demand for endoscopic resources.