Clinical
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Sepsis Management: What We Think We Know
SYNOPSIS: In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.
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Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
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Going Wireless: Combining the Subcutaneous ICD With a Leadless Pacemaker
A system incorporating an entirely subcutaneous implantable cardioverter defibrillator that can command a novel leadless anti-tachycardia pacemaker unidirectionally showed success and promise in an early, short-term animal trial.
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Alcohol Septal Ablation in Younger HCM Patients: Should We Relax Guidelines?
Current guidelines recommend surgical myectomy over septal ablation for younger hypertrophic cardiomyopathy patients. A new study bridges part of the data gap, showing safety and efficacy of the procedure in young patients.
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Early Diuretic Administration Associated With Improved Survival in Acute Heart Failure Patients
Among patients presenting to the ED with acute heart failure, those who received the first dose of intravenous furosemide within 60 minutes of arrival demonstrated lower in-hospital mortality compared to those receiving the first dose after 60 minutes.
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Prevention of Myocardial Infarction in Atrial Fibrillation Patients
A large observational study showed that the primary prevention of myocardial infarction and stroke in patients with atrial fibrillation is better with vitamin K antagonists alone as compared to aspirin alone and dual therapy.
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Requiem for Beta-blockers Post-Myocardial Infarction?
A propensity score analysis of all hospital survivors of acute myocardial infarction in the United Kingdom from 2007-2013 showed that one-year survival in hospital patients without heart failure or left ventricular dysfunction treated with beta-blockers did not differ from survival in those patients not so treated.
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Obesity: The New Epidemic
Obesity has risen significantly worldwide and is associated with an increased risk of morbidity and mortality in women throughout their lives. Risks include infertility, gestational diabetes, type 2 diabetes, heart disease, and cancer.
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AUGS Consensus Statement: Anticholinergic Medication Use and Cognition in Women With Overactive Bladder
Available evidence has shown significant associations between anticholinergic medication use and increased risk of cognitive impairment. Behavioral therapies for overactive bladder should be first-line treatment. If these treatments fail and pharmacologic treatment is considered, providers should counsel patients on associated risks, prescribe the lowest effective dose, and consider alternative treatments in patients at risk.
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Opioid Prescriptions After Cesarean Delivery: How Much Should We Prescribe?
This cross-sectional survey of 720 women found that 85% filled an opioid prescription after cesarean delivery, and the median number of tablets dispensed was 40. The median number of tablets consumed was only 20 tablets and the number dispensed did not correlate with patient satisfaction, pain control, or the need for a refill.