Hematology/Oncology
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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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Influenza, 2014-2015 — Something Old, Something New
As of early January, influenza activity had reached epidemic proportions in large parts of the United States, with many of those being affected despite prior vaccination.1 The occurrence of infection in vaccinated individuals is not unexpected since influenza vaccine efficacy is usually only approximately 60%. There is, however, an additional problem during this influenza season because of an unanticipated mismatch between the components of the 2014-2015 vaccine, which are identical to the 2013-2014 vaccine composition, and the dominating circulating virus type. Thus, current trivalent influenza vaccines contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagata lineage) virus. Quadrivalent influenza vaccines contain these antigens as well as a B/Brisbane/60/2008-like (Victoria lineage) virus.
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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Surgical Management of Infective Endocarditis
Although guidelines outline specific indications for surgery in infective endocarditis (IE), applying these recommendations in the clinical area is challenging. In order to understand these challenges, the International Collaboration on Endocarditis (ICE) conducted a prospective study to evaluate the factors that influence the decision with regard to surgical intervention in IE.
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Intravenous Fluids in Patients With Acute Heart Failure
Volume overload is a hallmark of acute heart failure (AHF). In hospitalized patients, intravenous loop diuretics are the most commonly used treatment for decongestion and symptom relief. Intravenous (IV) fluids are routinely administered to hospitalized patients, although their use in patients with AHF seems counterintuitive. No previous study has evaluated the frequency and effects of IV fluid administration among patients hospitalized for AHF.
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Do Corticosteroids Play a Role in the Treatment of Community-acquired Pneumonia?
Despite antibiotic therapy and hospital-based care, severe community-acquired pneumonia still carries a high risk for morbidity and mortality.
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Peramivir: A Newly Approved Antiviral for Treatment of Influenza
Peramivir (Rapivab™) was recently approved by the FDA in December 2014 for treatment of acute uncomplicated influenza within two days of symptom onset. This newly approved antiviral is a neuraminidase inhibitor (NI) similar to oseltamivir and zanamivir but the first to be approved in an injectable formulation.1 Peramivir has been licensed in Japan (as Rapiacta) and South Korea (as PeramiFlu) since 2010. In addition, it has been used in the United States on an emergency basis during the 2009 H1N1 flu pandemic.
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Multicenter Quality Improvement Project Resulted in a 23% Reduction in Medical Errors
SYNOPSIS: Implementation of a quality improvement project focused on handoffs reduced medical errors by 23% and preventable adverse events by 30%.
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Benefits of NIV in COPD Supported in Routine Clinical Practice
SYNOPSIS: In a large cohort study, patients with chronic obstructive pulmonary disease managed with noninvasive ventilation had lower inpatient mortality, shorter length of stay, and lower costs compared to those managed with invasive ventilation.