Hospital Medicine Alert – September 1, 2012
September 1, 2012
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Early Surgery for Infective Endocarditis Decreases Risk of Embolization, Mortality
In this randomized study, patients with left-sided infective endocarditis and large vegetations who underwent valve replacement surgery within 48 hours of randomization had lower rates of embolic events and death from any cause after 6 months compared to those who underwent surgery later. -
Survival After Out-of-Hospital Cardiac Arrest
In this paper, the authors reviewed long-term survival data from a large population of out-of-hospital cardiac arrest patients who were discharged alive after their arrest. All patients who have a cardiac arrest in Seattle and King County, Washington, are entered into a registry organized to follow the Utstein guidelines for reporting cardiac arrest. -
Rapid Rule Out for Patients with Chest Pain
Chest pain presentations to the emergency department (ED) are common and very costly to the health care system. Although the event rates are low in patients with a low clinical risk profile, the price of a missed diagnosis is high. -
Invasive or Conservative Strategy in Diabetics with ACS?
Patients with diabetes mellitus (DM) are at increased risk of developing acute coronary syndromes (ACS). Furthermore, after hospitalization with ACS, patients with DM are at increased risk of suffering repeat hospitalization for ACS. -
Intravenous Thrombolysis Is Relatively Safe and Effective in Elderly Patients Up to 6 Hours After Symptom Onset
After results of the pivotal NINDS intravenous thrombolysis (IV rtPA) trial were published in 1995, there has been a gradual extension of the time window from 3 hours to 4.5 hours, based on additional trials (ECASS II and III). -
Meta-analysis of All Randomized Trials Supports the Benefits of Intravenous Thrombolysis for All Patients Up to 6 Hours
The recently published IST-3 trial has stimulated great interest in the expanded use of intravenous thrombolysis (IV rtPA). Wardlaw and colleagues assessed all of the evidence from published randomized trials for IV rtPA in acute ischemic stroke using a meta-analysis. -
Clinical Briefs in Primary Care Supplement
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Pharmacology Watch: Does Finasteride Cause Permanent Sexual Side Effects?
Side effects of finasteride; new ruling on pharmaceutical companies paying generic manufacturers; and FDA actions.