Clinical
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SIRS Criteria vs. qSOFA for Predicting Short-term Mortality From Sepsis
A meta-analysis that included 38 studies found the SIRS criteria had a higher sensitivity than qSOFA in predicting short-term mortality from sepsis. SIRS criteria remain useful as a screening tool for sepsis and as a prompt to initiate diagnostic work-up and treatment.
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Neuroimaging Before Lumbar Puncture?
The investigators retrospectively evaluated ESCMIID, IDSA, and Swedish guidelines for neuroimaging in 815 adults with acute bacterial meningitis. Swedish guidelines omit altered mental status and immunosuppression as indications for imaging prior to lumbar puncture. Adherence to Swedish guidelines resulted in decreased mortality and more favorable outcomes.
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Permanent His-bundle Pacing Cardiac Resynchronization: The Way Nature Intended
When used as either a primary alternative to biventricular pacing or a rescue therapy for failed biventricular pacing, permanent His-bundle pacing was associated with significant QRS narrowing, an increase in left ventricular ejection fraction, and an improvement in New York Heart Association functional class.
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Age-stratified NT-proBNP Thresholds Identify Acute Heart Failure
In patients presenting to the ED with acute dyspnea, age-based NT-proBNP cutpoints help diagnose acute heart failure.
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Are Beta-blockers Indicated for Heart Failure at all LVEF Levels?
A meta-analysis of 11 trials of beta-blockers for heart failure showed that beta-blockers increased left ventricular ejection fraction and reduced cardiovascular mortality in patients in sinus rhythm with baseline ejection fractions < 50%, including those in the 40-49% range.
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CABG vs. PCI in Diabetes With Multivessel Coronary Artery Disease and LV Dysfunction
A propensity score-matching analysis of all patients undergoing coronary angiography in Alberta, Canada, identified a subgroup with diabetes, multivessel coronary artery disease, and left ventricular ejection fraction < 50% who were undergoing revascularization and could be separated into a group undergoing percutaneous coronary intervention (PCI) and another coronary artery bypass grafting (CABG). At five years' follow-up, the CABG group experienced significantly fewer major cardiac or cerebral vascular events compared to PCI and a low risk of stroke that was similar to that observed with PCI.
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TAVR in Lower-risk Patients: How Low Should We Go?
A meta-analysis of studies comparing transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement over a two-year follow-up in low surgical risk patients exhibits a higher mortality in the TAVR group, prompting the authors to recommend caution in applying TAVR to low-risk patients until randomized trials are completed.
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Clinical Briefs
In this section: improving cardiovascular outcomes in type 2 diabetes patients; digging deeper into penicillin allergies; and treating osteoporosis.
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Apalutamide Tablets (Erleada)
Apalutamide is indicated for the treatment of patients with non-metastatic, castration-resistant prostate cancer.
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Providers Facilitate Transmission of Resistant Organisms
A closer look at the role providers play in the transmission of carbapenem-resistant Enterobacteriaceae.