Annals of internal medicine
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Randomized Controlled Trial Clinical Trial
Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial.
Alveolar hypoxia causes pulmonary hypertension and enhanced right ventricular afterload, which may impair exercise tolerance. The phosphodiesterase-5 inhibitor sildenafil has been reported to cause pulmonary vasodilatation. ⋯ Sildenafil reduces hypoxic pulmonary hypertension at rest and during exercise while maintaining gas exchange and systemic blood pressure. To the authors' knowledge, sildenafil is the first drug shown to increase exercise capacity during severe hypoxia both at sea level and at high altitude.
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Randomized Controlled Trial Clinical Trial
Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial.
Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown. ⋯ The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.
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Randomized Controlled Trial Clinical Trial
Brief communication: American ginseng reduces warfarin's effect in healthy patients: a randomized, controlled Trial.
People using prescription medication often concurrently take herbal supplements. In a case report, the anticoagulant effect of warfarin decreased after patients consumed ginseng. ⋯ American ginseng reduces warfarin's anticoagulant effect. When prescribing warfarin, physicians should ask patients about ginseng use.
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Randomized Controlled Trial Clinical Trial
The effectiveness of depression care management on diabetes-related outcomes in older patients.
Depression frequently occurs in combination with diabetes mellitus, adversely affecting the course of illness. ⋯ Collaborative care improves affective and functional status in older patients with depression and diabetes; however, among patients with good glycemic control, such care minimally affects diabetes-specific outcomes.
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Randomized Controlled Trial Clinical Trial
Effects of training in direct observation of medical residents' clinical competence: a randomized trial.
Faculty observation of residents and students performing clinical skills is essential for reliable and valid evaluation of trainees. ⋯ Direct observation of competence training, a new multifaceted approach to faculty development, leads to meaningful changes in rating behaviors and in faculty comfort with evaluation of clinical skills.