JAMA : the journal of the American Medical Association
-
Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.
In the intensive care unit (ICU), delirium is a common yet underdiagnosed form of organ dysfunction, and its contribution to patient outcomes is unclear. ⋯ Delirium was an independent predictor of higher 6-month mortality and longer hospital stay even after adjusting for relevant covariates including coma, sedatives, and analgesics in patients receiving mechanical ventilation.
-
Since 2000, the Centers for Medicare & Medicaid Services (CMS) has been collecting information on beneficiaries' experiences with health care for Medicare managed care (MMC) and traditional fee-for-service (FFS) Medicare. ⋯ Our data suggest that managed care was better at delivering preventive services, whereas traditional Medicare was better in other aspects of care related to access and beneficiary experiences. These relative strengths should be considered when policy decisions are made that affect the availability of choice or influence beneficiaries to choose one model of care over another.
-
Multicenter Study
A multicenter risk index for atrial fibrillation after cardiac surgery.
Atrial fibrillation is a common, but potentially preventable, complication following coronary artery bypass graft (CABG) surgery. ⋯ We have developed and validated models predicting the occurrence of atrial fibrillation after CABG surgery based on an analysis of a large multicenter international cohort. Our findings suggest that treatment with beta-blockers, ACE inhibitors, and/or nonsteroidal anti-inflammatory drugs may offer protection. Atrial fibrillation after CABG surgery is associated with important complications.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial.
Despite decades of use and considerable research, the role of estrogen alone in preventing chronic diseases in postmenopausal women remains uncertain. ⋯ The use of CEE increases the risk of stroke, decreases the risk of hip fracture, and does not affect CHD incidence in postmenopausal women with prior hysterectomy over an average of 6.8 years. A possible reduction in breast cancer risk requires further investigation. The burden of incident disease events was equivalent in the CEE and placebo groups, indicating no overall benefit. Thus, CEE should not be recommended for chronic disease prevention in postmenopausal women.