Clinical
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Self-administered Weekly Therapy for Latent Tuberculosis Is Non-inferior to Directly Observed Therapy in the United States
A randomized clinical trial conducted in the United States and three other countries compared self-administered isoniazid and rifapentine with and without weekly reminders to directly observed therapy (DOT). Self-administered therapy without reminders was non-inferior to DOT in the United States; no other comparisons met non-inferiority criteria.
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Physician Burnout: A Multi-specialty Perspective
Although different specialties address the problem of physician burnout, studies suggest the most effect is gained from organizational interventions.
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Deflating Recruitment Maneuvers
Compared to the ARDSNet lower positive end-expiratory pressure (PEEP)/low tidal volume strategy, use of an “open lung ventilation” strategy consisting of aggressive alveolar recruitment maneuvers and higher PEEP is associated with higher mortality in patients with moderate to severe acute respiratory distress syndrome.
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ORBITA: Learning the Right Lessons From a Sham-controlled Trial of Angioplasty
In this sham-controlled trial of 200 patients with single-vessel coronary artery disease and stable angina, percutaneous coronary intervention did not increase exercise time significantly compared to a placebo procedure.
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Risk of Major Bleeding With Concurrent Medications in Atrial Fibrillation Patients Taking New Oral Anticoagulants
A large nationwide comprehensive clinical database showed that concomitant use of the new oral anticoagulants with amiodarone, fluconazole, rifampin, and phenytoin increases the risk of major bleeding.
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Accuracy of Right Atrial Pressure Estimates by Echocardiography
Researchers compared echocardiographically determined right atrial pressure and characteristics of the inferior vena cava to right heart catheterization-measured values. They concluded that echo estimates reached through this technique should not be used clinically to estimate pulmonary artery pressure.
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CT Calcium Score vs. Stress Testing
A subgroup analysis of the PROMISE trial showed that CT coronary calcium scores in symptomatic patients at low to intermediate risk for coronary artery disease are more sensitive but less specific for major adverse cardiac events over a two-year follow-up period than stress testing. Consequently, both approaches exhibited similar but modest discriminatory ability.
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Patent Foramen Ovale Closure Falls Short in Treatment of Migraines
This randomized trial of patent foramen ovale closure in severe refractory migraine showed no significant difference in responder rate compared to sham control.
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Cardiac MRI Most Valuable Test for Diagnosis and Prognosis in Cardiac Sarcoidosis
Among patients with extracardiac sarcoidosis, cardiac MRI was the best test for diagnosing cardiac involvement and the strongest independent predictor of adverse outcomes.
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ARNI Therapy Associated With Reduction in Ventricular Arrhythmias
In patients with congestive heart failure due to reduced ejection fraction who underwent remote arrhythmia monitoring via an implantable cardioverter defibrillator (ICD), both ventricular arrhythmias and appropriate ICD shocks were reduced while on sacubitril-valsartan compared to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker alone.