Hospital Medicine Alert
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Sepsis Management: What We Think We Know
SYNOPSIS: In the Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM), 3,723 patients’ outcomes from the ProCESS, ARISE, and ProMISe randomized, controlled trials of early goal-directed therapy (EGDT) were evaluated. EGDT did not result in better outcomes than usual care and was associated with higher costs. The authors of a second study looked at outcomes of 49,331 patients with sepsis treated in New York from April 2014 to June 2016. More rapid completion of the three-hour sepsis bundle and antibiotic administration (but not rapid bolus administration of IV fluids) was associated with reduced in-hospital mortality.
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Dual Antibiotic Therapy Is Not Routinely Necessary for Uncomplicated Cellulitis
SYNOPSIS: A randomized, multicenter, placebo-controlled clinical trial that enrolled patients presenting to emergency departments with uncomplicated cellulitis found the addition of trimethoprim-sulfamethoxazole to cephalexin did not lead to better outcomes.
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Are There Definitive Clues?
How certain are you that the run of wide complex tachycardia that begins with beat #4 is ventricular tachycardia?
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Encephalitis Due to Powassan Virus
Powassan virus is transmitted by the same tick that carries the etiologic agent of Lyme disease and several other pathogens. The number of cases of encephalitis caused by this virus may be increasing in the endemic areas.
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Ready for Dengue in the United States?
Dengue is increasingly recognized in the southern United States. When recently surveyed, however, clinicians in Texas seemed incompletely prepared to understand and manage patients with dengue.
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Infective Endocarditis Trends and Outcomes
Using large databases from New York and California, investigators found the overall incidence of infective endocarditis remained stable between 1998 and 2013, and 90-day mortality declined. Changes were noted in pathogen etiology and patient characteristics over time.
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Is Exposure to Arterial Hyperoxia During Critical Illness Dangerous?
Exposure to severe hyperoxia during critical illness is associated positively with increased ICU and hospital mortality and associated negatively with ventilator-free days.
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Predicting Electrical Cardioversion Failure
A study of the 30-day success rate of electrical cardioversion of acute atrial fibrillation revealed five clinical predictors of recurrence. These were combined into a risk score that could be useful to avoid unnecessary cardioversions in the acute setting.
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Tolvaptan Fails to Improve Dyspnea in Acute Heart Failure
In patients hospitalized for acute heart failure, adding tolvaptan to furosemide lead to increased weight and fluid loss, but did not improve dyspnea at 24 hours.
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Restricting Fluoroquinolone Use Reduces CDI More Than Infection Control Methods
An observational study from England showed that restricting fluoroquinolone use reduced incidence of Clostridium difficile infection more than would be predicted by improved infection control methods alone.