The American journal of medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking.
To determine whether sustained-release bupropion promotes smoking reduction leading to smoking cessation among persons who wish to reduce their amount of smoking, but who are unwilling to quit or who perceive themselves as being unable to quit. ⋯ Sustained-release bupropion, when used in smokers initially not willing to make a cessation attempt, can help sustain smoking reduction while subjects are on active medication, reduce the time until the next cessation attempt, and increase short-term abstinence rates. However, these benefits were modest and not sustained after bupropion was discontinued.
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In 2000, the Business Roundtable published its Leapfrog report, which contained suggestions for improving administration of critical care. The Leapfrog Group intends to influence health care policy by pressuring insurers and hospitals to implement its guidelines, and both internists and intensivists are likely to be affected if these recommendations are realized. ⋯ Aside from the guideline that all critically ill patients should be cared for by intensivists, Leapfrog's standards for critical care are based either on weak or no scientific evidence. Rather, most of the guidelines are grounded in common sense and rational extrapolation of the data; as such, they are a reasonable starting point for debate by physicians and policymakers about optimal methods of achieving intensivist-guided care of critically ill patients.
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Letter Case Reports
Aspergillus rib and vertebral osteomyelitis in a former intravenous drug user.
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We sought to assess the diagnostic accuracy of routine chest radiography for the acute aortic syndrome (dissection, intramural hematoma, penetrating ulcer, or nondissecting aneurysm). ⋯ Chest radiography is of limited value for diagnosing the acute aortic syndrome, particularly for conditions confined to the ascending aorta. Since a definitive diagnosis is required in any patient with clinically suspected acute aortic syndrome, routine chest radiography should be replaced by tomographic aortic imaging.