JAMA : the journal of the American Medical Association
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Tatsioni found that earlier disproven observational studies were still positively cited in 50% or more of peer reviewed publications, despite the existence of well-established contrary evidence.
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Randomized Controlled Trial Multicenter Study
Antithrombotic strategies in patients with acute coronary syndromes undergoing early invasive management: one-year results from the ACUITY trial.
At 30-day follow-up, patients with moderate- and high-risk acute coronary syndromes (ACS) undergoing early invasive treatment in the ACUITY trial with bivalirudin monotherapy vs heparin plus glycoprotein (GP) IIb/IIIa inhibitors had noninferior rates of adverse ischemic events with reduced rates of major bleeding. Deferred upstream use of GP IIb/IIIa inhibitors for selective administration to patients undergoing percutaneous coronary intervention (PCI) resulted in a significant reduction in major bleeding, although a small increase in composite ischemia could not be excluded. ⋯ At 1 year, no statistically significant difference in rates of composite ischemia or mortality among patients with moderate- and high-risk ACS undergoing invasive treatment with the 3 therapies was found. There was no statistically significant difference in the rates of composite ischemia between patients receiving routine upstream administration of GP IIb/IIIa inhibitors vs deferring their use for patients undergoing PCI.
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More than 5 million Americans have dementia, a leading cause of death among persons older than 65 years in the United States. Eating problems typically develop during the advanced stage of dementia, which requires decision making to direct care toward either palliation or more aggressive measures, such as tube feeding. The case of Mr P, a 93-year-old man with end-stage dementia and recent hip fracture, illustrates the issues involved in this challenging crossroads when his daughter is confronted with his failure to orally maintain adequate hydration and nutrition. The discussion reviews the epidemiology and natural history of advanced dementia, the barriers to providing palliative care to patients with this condition, the role of pharmacotherapy, and the treatment options for feeding problems and the advantages and disadvantages of each option, and suggests an approach to help clinicians provide effective and compassionate decision support to patients with advanced dementia and their family members.