JAMA : the journal of the American Medical Association
-
Randomized Controlled Trial Multicenter Study Comparative Study
Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial.
Routine lorazepam premedication before surgery does not improve patient experience but does prolong time to extubation, even among anxious patients.
pearl -
Multicenter Study Observational Study
The natural history of benign thyroid nodules.
Detection of asymptomatic thyroid nodules has increased. Consensus is lacking regarding the optimal follow-up of cytologically proven benign lesions and sonographically nonsuspicious nodules. Current guidelines recommend serial ultrasound examinations and reassessment of cytology if significant growth is observed. ⋯ Among patients with asymptomatic, sonographically or cytologically benign thyroid nodules, the majority of nodules exhibited no significant size increase during 5 years of follow-up and thyroid cancer was rare. These findings support consideration of revision of current guideline recommendations for follow-up of asymptomatic thyroid nodules.
-
Are pharmacological interventions associated with better-quality sleep and alertness in shift workers? ⋯ Low-quality evidence shows that melatonin is associated with 24 minutes longer daytime sleep after the shift but not with faster falling asleep compared with placebo. There is no association between hypnotics, such as zopiclone, and sleep outcomes, alertness, or harms. The alertness-promoting medications armodafinil and modafinil are associated with improved alertness during shift work but are also associated with headache and nausea.