Hospital Medicine Alert
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The Choosing Wisely ® Top 5 List in Critical Care Medicine
he Choosing Wisely Campaign was introduced in 2011 by the American Board of Internal Medicine to identify practices and procedures physicians and patients should question. The critical care top 5 list was developed through a collaborative effort of several critical care societies. -
Thienopyridine Pretreatment in Patients with Non-ST Elevation Acute Coronary Syndromes: Where’s the Evidence?
Each year when I lecture the incoming cardiology fellows on the management of non-ST elevation acute coronary syndromes (NSTE-ACS), we embark on a discussion of optimal guideline-driven treatment vs. real-world practicalities. -
If Less is More, How Can We Get There?
This study, done at a tertiary care university hospital here in the U.S., was initiated in an attempt to improve patient safety, conserve a vital resource, and reduce costs a laudable tripartite goal. -
Peri-procedural Management of New Oral Anticoagulants
Due to the short half-life and rapid onset of action of the new oral anticoagulants (NOACs), peri-procedural anticoagulant free time intervals should be shorter than with warfarin. Thus, there is uncertainty about the use of heparin bridging. These investigators from Germany analyzed the Dresden NOAC registry data to assess peri-procedural NOAC management and safety until 30 days post-procedure. -
Health Care Utilization in the Aftermath of Severe Sepsis
SYNOPSIS: This observational cohort study of survivors of severe sepsis found that the post-discharge needs of this population are substantial. Severe sepsis survivors spent more days admitted to facilities after their acute hospitalization than prior and had greater mortality, a steeper decline in days at home, and a greater increase in proportion of days alive in a facility compared to survivors of non-sepsis hospitalizations.
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Can We Reduce Unnecessary Head CT Scans in Patients with Delirium?
This study was a retrospective review of medical records of hospitalized general medicine patients with head CT imaging performed for the evaluation of delirium. -
Nasal High-Flow Oxygen Lowers Reintubation Rate
SYNOPSIS: Use of nasal high-flow oxygen was associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate.
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The New Guidelines Put C. difficile on the Run
SYNOPSIS: Patients have decreased disease recurrence and mortality when physicians follow the IDSA/Society for Healthcare Epidemiology of America guidelines for the treatment of C difficile infection.
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Micafungin for Invasive Candidiasis
Micafungin at doses of both 100 mg and 150 mg daily was non-inferior to caspofungin in the treatment of invasive candidiasis and there was no significant difference in outcomes when the two doses of micafungin were compared. -
ECG Diagnosis of Acute Myocardial Infarction
In patients admitted to hospital with possible AMI, the consideration of both ST-segment elevation and depression in the standard 12 lead-ECG recording significantly increases the sensitivity for the detection of AMI with only a slight decrease in the specificity.