JAMA internal medicine
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JAMA internal medicine · Jun 2013
Multicenter Study Comparative StudyPerioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery.
Single-site studies have described an association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes of surgery. Multicenter studies including a broad range of surgical procedures that explore rare outcomes, such as bleeding and mortality, and that account for indications for administration of SSRIs are needed. ⋯ Receiving SSRIs in the perioperative period is associated with a higher risk for adverse events. Determining whether patient factors or SSRIs themselves are responsible for elevated risks requires prospective study.
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JAMA internal medicine · Jun 2013
Randomized Controlled Trial Comparative StudyAggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.
The benefits of fluid and sodium restriction in patients hospitalized with acute decompensated heart failure (ADHF) are unclear. ⋯ Aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at 3 days and is associated with a significant increase in perceived thirst. We conclude that sodium and water restriction in patients admitted for ADHF are unnecessary.
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JAMA internal medicine · Jun 2013
Comparative StudyPoint-of-care prognosis for common musculoskeletal pain in older adults.
Many site-specific, multivariable risk models for predicting the outcome of musculoskeletal pain problems have been published. The overlapping content in these models suggests a common set of generic indicators suitable for use in primary care. ⋯ Three easy-to-obtain pieces of information followed by systematic recording of the general practitioners' prognostic judgment provide a simple generic assessment of prognosis at point of care in older persons presenting with musculoskeletal problems to primary care practices in the United Kingdom. Such an assessment offers a common foundation for investigating the usefulness of prognostic stratification for guiding management in the consultation across a range of common painful conditions.
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JAMA internal medicine · Jun 2013
Yield of routine provocative cardiac testing among patients in an emergency department-based chest pain unit.
The American Heart Association recommends routine provocative cardiac testing in accelerated diagnostic protocols for coronary ischemia. The diagnostic and therapeutic yield of this approach are unknown. ⋯ In an emergency department-based chest pain unit, routine provocative cardiac testing generated a small therapeutic yield, new diagnoses of coronary artery disease were uncommon, and false-positive results were common.