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This retrospective cohort study reaffirms the link between hyperglycemia and mortality in the ICU, but demonstrates that the risk does not apply equally to all patient groups and, instead, varies based on admission diagnosis.
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Many clinical trials have confirmed the benefit of early invasive therapy for high-risk patients presenting with acute coronary syndromes (ACS). However, the optimal timing of cardiac catheterization in this group remains unknown.
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Current indications for cardiac-resynchronization therapy (CRT) require that patients have New York Heart Association (NYHA) Class III or Class IV heart-failure symptoms.
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Dabigatran etexilate is an oral compound that is converted after absorption by a serum esterase to dabigatran, a direct competitive inhibitor of thrombin.
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Oseltamivir (Tamiflu®) is an FDA-approved drug for the treatment and prevention of influenza. With the anticipated emergence of seasonal influenza virus cases in October, and the recent discoveries of novel H5N1 (avian) and 2009 H1N1 (swine) influenza viruses, it is imperative to understand how to appropriately dose oseltamivir.
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Dual antiplatelet therapy with aspirin and clopidogrel has become the standard of care for patients suffering an acute coronary syndrome (ACS). However, there remains a significant incidence of recurrent ACS and mortality even in patients treated with dual antiplatelet therapy. Furthermore, clopidogrel is an irreversible platelet inhibitor, and patients requiring urgent surgery are at higher risk of bleeding if operated on within 5-7 days of clopidogrel use.
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Current recommendations for stroke prophylaxis with warfarin for patients with atrial fibrillation do not take into account the risks of hemorrhage. Thus, Singer et al from Kaiser Permanente studied more than 13,000 patients with non-valvular atrial fibrillation to estimate the net clinical benefit of warfarin therapy for atrial fibrillation (reduction in thromboembolism minus the increase in intracranial hemorrhage).
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This randomized, single-center study demonstrated that light-sedation strategies in a mixed surgical and medical ICU population are associated with decreased ICU length-of-stay and duration of mechanical ventilation without adverse effects on patient safety or mental well-being.
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Initiation of a respiratory therapist-driven protocol for assessment and management of risk for respiratory complications in the study hospital's neurosurgery step-down, trauma/surgery step-down, and trauma/surgery general units was followed by an increase in the number of patients receiving respiratory treatments, but decreases in ICU and hospital stays and overall hospital costs.
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In January 2009, the publication of an updated vancomycin monitoring guideline gave clinicians a set of recommendations on: 1) timing of monitoring, 2) optimal trough concentration, 3) dosing to achieve optimal trough concentrations, 4) loading doses for complicated infections, 5) criteria for monitoring, and 6) frequency of monitoring.