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Appropriate Cardiac Testing in an Inappropriate World
This two-part series will look at the rationale and causes of inappropriate testing and how to select the best, most appropriate cardiac test for each patient. The first part will focus on the theory of ordering tests and strategies to minimize unnecessary testing while the second part will focus on when and how to select each individual test given the patient's clinical scenario.
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Decision-Making Capacity in the ICU
A multicenter, one-day prevalence, prospective, observational, double-blind study in 19 ICUs revealed that the decisionmaking capacity of ICU patients was widely overestimated by all clinicians as compared with a capacity score measured by the Mini-Mental Status Examination and the Aid to Capacity Evaluation.
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Acute Kidney Injury With Combination Antibiotics in the Critically Ill
In this retrospective study, a short course (24 to < 72 hours) of combination antibiotic therapy with piperacillin-tazobactam and vancomycin was not associated with an increased risk of acute kidney injury among critically ill patients when compared with other β-lactam and vancomycin combinations.
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NOACs vs. Warfarin: What Are the Data in Patients With Traumatic Brain Injury and Intracranial Hemorrhage?
A three-year analysis of a prospectively maintained database with traumatic brain injury patients revealed that novel oral anticoagulant use is associated with increased risk of intracranial hemorrhage progression, neurosurgical intervention, and mortality.
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Early Neuromuscular Blockade in Moderate-to-Severe Acute Respiratory Distress Syndrome
When the early use of a continuous infusion of cisatracurium was compared to contemporary supportive care for moderate-to-severe ARDS, including a light sedation target, high positive-end expiratory pressure, and conservative fluid strategy, there was no difference in 90-day mortality. Patients in the early neuromuscular blockade group more frequently experienced a severe cardiovascular event and ICU-acquired weakness by day 28.
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Infectious Disease Alert Updates
Should We Be Looking for ESBL? Close the Door to That OR! -
CRP and Reduction of Antibiotic Use in Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Point-of-care C-reactive protein testing can safely and effectively reduce antibiotic use in patients with acute exacerbations of chronic obstructive lung disease.
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HIV Prevention Strategies in Africa
Several strategies have proven effective in reducing transmission of HIV, including access to confidential testing and counseling, early introduction of HIV medications, and male circumcision. Three new studies show what actually affects the spread of HIV in populations, and results vary between different African settings.
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Mycobacterium chimaera Granulomatous Encephalitis
Lau and colleagues describe a novel infectious problem — diffuse granulomatous encephalitis due to Mycobacterium chimaera infection occurring after cardiac surgery.
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Prophylactic Antibiotics Significantly Reduce the Risk of Infection Following Operative Vaginal Delivery
In a multicenter, randomized clinical trial, researchers found that a single dose of intravenous amoxicillin/clavulanic acid significantly reduced the risk of infection following operative vaginal birth (forceps or vacuum extraction) compared to placebo (180 of 1,619 [11%] vs. 306 of 1,606 [19%], respectively; P < 0.0001).