JAMA internal medicine
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JAMA internal medicine · Sep 2013
Randomized Controlled Trial Multicenter Study Comparative StudyEfficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial.
There is consensus that incorporating clinical decision support into electronic health records will improve quality of care, contain costs, and reduce overtreatment, but this potential has yet to be demonstrated in clinical trials. ⋯ The integrated clinical prediction rule process for integrating complex evidence-based clinical decision report tools is of relevant importance for national initiatives, such as Meaningful Use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01386047.
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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 · May 2013
Randomized Controlled Trial Comparative StudyThe Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults.
The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects. ⋯ In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population.
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JAMA internal medicine · Apr 2013
Randomized Controlled TrialEffect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial.
On July 1, 2011, the Accreditation Council for Graduate Medical Education implemented further restrictions of its 2003 regulations on duty hours and supervision. It remains unclear if the 2003 regulations improved trainee well-being or patient safety. ⋯ Compared with a 2003-compliant model, two 2011 duty hour regulation-compliant models were associated with increased sleep duration during the on-call period and with deteriorations in educational opportunities, continuity of patient care, and perceived quality of care.
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JAMA internal medicine · Feb 2013
Randomized Controlled Trial Comparative StudyA cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis.
National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the effect of 2 decision support strategies on antibiotic treatment of uncomplicated acute bronchitis. ⋯ Implementation of a decision support strategy for acute bronchitis can help reduce the overuse of antibiotics in primary care settings. The effect of printed vs computer-assisted decision support strategies for providing decision support was equivalent.