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Blood Transfusion After Cardiac Surgery
Due to the cost of blood transfusions and the lack of data supporting liberal transfusion policies, newer guidelines recommend more restrictive transfusion thresholds (e.g., hemoglobin < 7 g/dL). However, many believe cardiac surgery is an exception due to the myocardium’s high oxygen requirement.
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Unintended Consequences of Public Reporting of Procedure Outcomes
Public reporting of clinical outcomes associated with cardiovascular care has been touted as a means to improve health care delivery and patient outcomes.
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Atrial Fibrillation Risk Scores and Anticoagulation Treatment
Several guidelines recommend using the CHA2DS2-VASc score for determining the risk of stroke in patients with atrial fibrillation (AF), but the treatment recommendations are not the same in all guidelines.
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Utility of the New Cholesterol Guidelines
The American College of Cardiology/American Heart Association (ACC/AHA) released new guidelines for the use of statin drugs to prevent atherosclerotic cardiovascular disease (CVD) in 2013.
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Statins After an MI: Does it Happen?
Following a hospitalization for coronary heart disease (CHD) or acute coronary syndrome (ACS), randomized trials demonstrate that high-intensity atorvastatin is more effective than either placebo or low- to moderate-intensity therapy with either pravastatin or atorvastatin.1-3 Based on this evidence, the American College of Cardiology and the American Heart Association guidelines recommend high-intensity therapy in cases of an acute cardiac event, and recommend therapy be initiated before discharge.
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A Guide to When and How to Stop CPR
Although health care providers undergo hours of training and re-certification to provide resuscitative efforts for patients in cardiopulmonary arrest, few are given guidance in terms of when and how to stop it.
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Post-ICU Stress Symptoms Associated with Increased Acute Care Service Utilization
Over the past two decades, advances in critical care have resulted in more patients surviving to hospital discharge, but these successes are attenuated by several sequelae of critical illness, including depression and post-traumatic stress disorder (PTSD).1 Risk factors for and the health care ramifications of these disorders are poorly understood. Given this, Davydow and colleagues aimed to investigate whether PTSD symptoms in the acute (< 1 month) ICU hospitalization period and PTSD and depressive symptoms at 3 months post-ICU were risk factors for future hospitalizations and emergency department (ED) visits.
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Nasal Screening for MRSA: The New Basis for De-escalation of Empiric Antibiotics?
Although nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) is a widely accepted method for infection control, the relationship between nasal carriage and development of MRSA lower respiratory tract infection (LRTI) is not well studied. Tilahun and colleagues sought to determine the association between MRSA nasal swab results and MRSA LRTI in a medical ICU. In this single-site, retrospective cohort study, 165 patients were diagnosed with pneumonia and had both nasal swabbing and culturing of respiratory specimens within 24 hours of admission.
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Inpatient and Outpatient Care Providers: Why Can’t We Just Work Together?
Many problems occur after a patient is discharged that are a direct result of poor coordination of care between hospitalists and primary care providers (PCPs). These issues include, but are not limited to, missed test results, medication errors, inadequate follow up, and harm to the patient. PCPs are frequently unaware that their patient was hospitalized and they often do not receive a copy of the discharge summary. The authors of this paper did a qualitative study to analyze the barriers and solutions to care coordination between hospitalists and PCPs in North Carolina.
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Low-lying Intrauterine Devices: To Remove or Not to Remove?
It is not uncommon that we receive reports from radiology regarding the location of an intrauterine device (IUD) in a patient that we have sent for a pelvic ultrasound examination for an entirely different reason (e.g., an adnexal mass). These incidental findings of low-lying or malpositioned IUDs are a conundrum for the practitioner.