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For patients with chronic insomnia, sleeping pills in combination with cognitive behavioral therapy (CBT) resulted in improved sleep satisfaction during acute therapy, but long- term treatment was enhanced by stopping the medication and continuing only CBT.
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In patients with proximal deep vein thrombosis (DVT), tailoring the duration of oral anticoagulation based on serial ultrasonography reduces the rate of recurrent DVT. Prolongation of chronic anticoagulation may accelerate vein recanalization. Residual DVT on ultrasonography is a marker of hypercoagulability.
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Iloperidone is the newest atypical antipsychotic agent to be approved by the FDA. It is chemically similar to risperidone and ziprasidone. Vanda Pharmaceuticals will market iloperidone as Fanapt™.
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In elderly patients hospitalized with heart failure and LVSD, beta-blocker use was clinically effective in reducing mortality and rehospitalization, but patients with preserved systolic function had poor outcomes and beta-blockers did not significantly influence the mortality and rehospitalization rate for these patients.
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A variety of highly effective agents for primary insomnia are currently available including benzodiazepines, benzodiazepine receptor agonists, and other classes. Agents that impact the benzodiazepine receptors (i.e., either benzodiazepines or benzodiazepine receptor agonists) are controlled substances and have occasional problematic issues such as misuse, diversion, cognitive clouding, and rebound upon withdrawal.
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I remember when the Goldman myocardial infarction (MI) algorithm came out, quickly followed by a seven-button hand-held "calculator." It promised to reduce all decision-making regarding ED chest pain patients to seven yes or no questions. But when you looked into the mathematics, if you answered no or negative to all of the questions, it indicated a 4% chance of acute cardiac ischemia. So, what would you do with this information? Could you tell the patient that there was only a 4% chance of a heart attack, so it was OK to go home?
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A significant portion of patients with irritable bowel syndrome will test positive for celiac disease.
