Arch Intern Med
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Randomized Controlled Trial
Long-term survival in elderly patients hospitalized for heart failure: 14-year follow-up from a prospective randomized trial.
The growing heart failure epidemic imposes a substantial burden on the US health care system. The ability to accurately assess prognosis would allow clinicians to triage patients to appropriate therapy and to plan the intensity of care following hospital discharge. ⋯ Among elderly patients hospitalized with heart failure, median survival is about 2.5 years. However, there is considerable heterogeneity in survival, with 25% of patients dying within 1 year and 25% surviving for more than 5 years. A simple 7-item risk score, based on data readily available at the time of admission, provides a reliable estimate of prognosis.
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Meta Analysis
A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis.
This systematic meta-analysis on randomized controlled trials with diacerein was performed to provide an evidence-based assessment of its symptomatic efficacy in the treatment of osteoarthritis. ⋯ This systematic meta-analysis provides evidence for the symptomatic efficacy of diacerein in the treatment of knee and hip osteoarthritis, with reasonable tolerability.
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Comparative Study
Improved adherence and less toxicity with rifampin vs isoniazid for treatment of latent tuberculosis: a retrospective study.
Treatment of latent tuberculosis infection (LTBI) is an important aspect of tuberculosis control in the United States, but the effectiveness of this strategy is compromised by poor adherence to the recommended 9-month isoniazid regimen. In this study, we compared treatment completion and clinically recognized adverse drug reactions in patients prescribed 9 months of isoniazid therapy or 4 months of rifampin therapy for LTBI. ⋯ Compared with a 9-month isoniazid regimen, a 4-month rifampin regimen was associated with a higher percentage of patients completing treatment and a lower percentage of patients with clinically recognized adverse reactions. Additional studies are warranted to determine efficacy and effectiveness of rifampin therapy for LTBI.
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Chronic illness may not only directly impact the sleep of a patient but also indirectly impact the sleep of the family members who provide nighttime care. For parents of children with chronic illnesses, few studies have examined sleep disruptions that may account for elevated rates of depression and fatigue. Our objectives were to examine sleep patterns and causes of sleep disturbances in caregivers of children with and without chronic illnesses and to determine whether sleep mediates the relationship between a child's chronic illness and daytime functioning in caregivers. ⋯ Sleep in caregivers of children with chronic illnesses, in particular ventilator dependency, is significantly disrupted, resulting in chronic partial sleep deprivation. Owing to the level of attention and care required by these children, interventions and support for caregivers to improve their sleep quality and quantity are necessary.
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Randomized Controlled Trial
A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea.
Sildenafil prolongs the action of cyclic guanosine monophosphate and nitric oxide by inhibiting cyclic guanosine monophosphate-specific phosphodiesterase 5. It is largely used for erectile dysfunction, a highly prevalent condition in obstructive sleep apnea. Because nitric oxide promotes upper airway congestion, muscle relaxation, and pulmonary vasodilation, the aim of this study was to establish the impact of a single 50-mg dose of sildenafil on the sleep of patients with severe obstructive sleep apnea. ⋯ In patients with severe obstructive sleep apnea, a single 50-mg dose of sildenafil at bedtime worsens respiratory and desaturation events.