Annals of internal medicine
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Randomized Controlled Trial Multicenter Study Comparative Study
An evaluation of D-dimer in the diagnosis of pulmonary embolism: a randomized trial.
It may be safe to omit additional diagnostic testing in selected patients with suspected pulmonary embolism (PE) who have a negative D-dimer test, but this approach has never been evaluated in a randomized, controlled trial. ⋯ In patients with a low probability of PE who have negative D-dimer results, additional diagnostic testing can be withheld without increasing the frequency of VTE during follow-up. Low clinical probability and negative D-dimer results occur in 50% of outpatients and in 20% of inpatients with suspected PE.
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Multicenter Study Comparative Study
Outcomes of minor and subsyndromal depression among elderly patients in primary care settings.
Although depressive conditions in later life are a major public health problem, the outcomes of minor and subsyndromal depression are largely unknown. ⋯ The intermediate outcomes of minor and subsyndromal depression demonstrate the clinical significance of these conditions and suggest that they are part of a spectrum of depressive illness. Greater medical burden, poor subjective health status, and poorer subjective social support confer a higher risk for poor outcome.
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Randomized Controlled Trial Multicenter Study
Plasma exchange when myeloma presents as acute renal failure: a randomized, controlled trial.
Two small, randomized trials provide conflicting evidence about the benefits of plasma exchange for patients with acute renal failure at the onset of multiple myeloma. ⋯ In patients with acute renal failure at the onset of multiple myeloma, there is no conclusive evidence that 5 to 7 plasma exchanges substantially reduce a composite outcome of death, dialysis dependence, or glomerular filtration rate less than 0.29 mL.s(-2).m(-2) (<30 mL/min per 1.73 m2) at 6 months.
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Randomized Controlled Trial Multicenter Study
Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial.
Lateral epicondylitis is a common condition for which botulinum toxin has been reported to have a therapeutic role in uncontrolled studies. ⋯ Botulinum toxin injection may improve pain over a 3-month period in some patients with lateral epicondylitis, but injections may be associated with digit paresis and weakness of finger extension.
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Multicenter Study Comparative Study
Quality of HIV care provided by nurse practitioners, physician assistants, and physicians.
Nurse practitioners (NPs) and physician assistants (PAs) are primary care providers for patients with HIV in some clinics, but little is known about the quality of care that they provide. ⋯ For the measures examined, the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non-HIV experts. Nurse practitioners and PAs can provide high-quality care for persons with HIV. Preconditions for this level of performance include high levels of experience, focus on a single condition, and either participation in teams or other easy access to physicians and other clinicians with HIV expertise.