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Wider use of noninvasive ventilation in managing severe COPD exacerbations has improved overall outcomes, but this study of a large nationwide database shows that increasing numbers of patients fail NIV and require intubation. This subset of patients has substantially higher mortality and hospital costs.
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Shah et al used an administrative database, the California State Inpatient Database from the Healthcare Utilization Project, to analyze the short and intermediate success and complication rates associated with catheter ablation for atrial fibrillation (AF).
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Several decades ago, two patients arrived in my emergency department with intense vomiting, bronchorrhea, and seizure-like activity. Their symptoms started about 30 minutes after consuming a mushroom stew. The wife considered herself to be an expert in mushroom identification and had picked several species of mushrooms, including a few very large ones with bright red tops. Both patients required intubation and several milligrams of atropine to handle their bronchial secretions. Several hours before, they had eaten a mushroom stew containing mushrooms they had picked that morning.
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Newer, more sensitive troponin assays have the potential to identify acute myocardial infarction (AMI) earlier, but some detect troponin in 50% of normal populations, which renders them clinically useless.
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This retrospective study of all non-psychiatric patients admitted to an academic medical center found that although those placed in contact isolation from the time of admission had no increased risk for delirium, patients moved into isolation after admission were twice as likely to develop delirium during the hospital stay.
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Patients have referred to receiving mechanical ventilatory support as, "the most inhumane ever experienced".... While mechanical ventilation is one of the most commonly used treatment modalities in the ICU, this life-saving modality causes great anxiety, distress, and discomfort in patients.
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In this issue: New treatment for prostate cancer; avastin and breast cancer; new CMS disclosure rule; and FDA actions.