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To provide an estimate of vaccine effectiveness, this study analyzed data from 18 cohorts of community-dwelling elderly persons during 10 influenza seasons. With 713,872 person-seasons of observation, vaccination was significantly associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza and a 48% reduction in the risk of death. Most high-risk medical conditions were more prevalent among vaccinated than among unvaccinated subjects. The benefit persisted even after adjustment for possible unmeasured confounders.
Agitation is common in patients with Alzheimer's disease and is distressing to both patients and their caregivers. In this randomized trial of 272 patients with Alzheimer's disease who had agitated behavior that did not respond to a psychosocial treatment program, donepezil (5 mg for 4 weeks and 10 mg for 8 weeks) was not more effective than placebo in reducing agitation.
A clinical registry in Ontario, Canada, was used to compare outcomes among patients receiving drug-eluting coronary stents and those receiving bare-metal stents. The 2-year rate of target-vessel revascularization and the 3-year mortality were lower in the drug-eluting–stent group. However, the rate of myocardial infarction at 2 years was slightly (but not significantly) higher in the drug-eluting–stent group. These administrative data provide support for the efficacy and safety of drug-eluting stents but do not rule out a late excess of myocardial infarctions.
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In this study, consecutive patients were enrolled in parallel screening programs using optical colonoscopy (OC) or computed tomographic colonography (CTC) followed by OC for the removal of polyps of at least 6 mm. Advanced adenomas and carcinomas were detected in 3.2% of patients in the CTC group and in 3.4% in the OC group. The OC group had many more polyps removed than did the CTC group (2434 vs. 561). These findings suggest that, as compared with OC screening, CTC screening results in similar detection of advanced neoplasia with the removal of fewer small polyps.
A 70-year-old man reports a gradual onset of hip pain that has limited his activities for about a year. The pain initially occurred only with walking and was limited to the anterior hip area but now has spread to the side of the hip and is present at rest. He has no history of hip, back, or lower back injury and has no pain or morning stiffness in any other joints. He has been taking ibuprofen at a dose of 200 mg once or twice daily, without improvement. How should the patient be evaluated and treated?
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“Chronic Lyme disease” is often used to explain persistent pain, fatigue, and neurocognitive symptoms in patients without any evidence of previous acute Lyme disease. Once this diagnosis is given, prolonged treatment with multiple antimicrobial agents may follow. This review examines the scientific evidence for chronic borrelia infection and explains the approach to clinical evaluation and management in patients with a diagnosis of chronic Lyme disease.
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