Annals of internal medicine
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Randomized Controlled Trial Multicenter Study
The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
Few studies have tested the effects of a depression intervention on the risk for death associated with depression. ⋯ Older primary care patients with major depression in practices that implemented depression care management were less likely to die over a 5-year period than were patients with major depression in usual care practices. The effect seemed to be limited to deaths due to cancer. The mechanism for such an effect is unclear and warrants further investigation. ClinicalTrials.gov registration number: NCT00000367.
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Randomized Controlled Trial Multicenter Study
A sustained mortality benefit from screening for abdominal aortic aneurysm.
Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain. ⋯ These results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time. International Standard Randomized Controlled Trial registration number: ISRCTN37381646.
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Randomized Controlled Trial Multicenter Study
Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial.
Treatment of moderate or severe chronic obstructive pulmonary disease (COPD) with combinations of inhaled corticosteroids, long-acting beta-agonists, and long-acting anticholinergic bronchodilators is common but unstudied. ⋯ Addition of fluticasone-salmeterol to tiotropium therapy did not statistically influence rates of COPD exacerbation but did improve lung function, quality of life, and hospitalization rates in patients with moderate to severe COPD. International Standard Randomised Controlled Trial registration number: ISRCTN29870041.
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Randomized Controlled Trial
Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial.
It is not known whether rigorous intraoperative glycemic control reduces death and morbidity in cardiac surgery patients. ⋯ Intensive insulin therapy during cardiac surgery does not reduce perioperative death or morbidity. The increased incidence of death and stroke in the intensive treatment group raises concern about routine implementation of this intervention.
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Randomized Controlled Trial
Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study.
Polysomnography (PSG), despite limited availability and high cost, is currently recommended for diagnosis of obstructive sleep apnea and titration of effective continuous positive airway pressure (CPAP). ⋯ In the initial management of patients with a high probability of obstructive sleep apnea, PSG confers no advantage over the ambulatory approach in terms of diagnosis and CPAP titration. The ambulatory approach may improve adherence to treatment. When access to PSG is inadequate, the ambulatory approach can be used to expedite management of patients most in need of treatment.