Hospital Medicine Alert
RSSArticles
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Risk Factors for Hospital Readmissions Ending in Death or Transition to Hospice
In this retrospective cohort study, multiple factors were identified during initial hospitalization, including sepsis and shock, that were associated with a hospital readmission within 30 days resulting in death or transition to hospice. Infection was a frequent cause for readmissions that ended in death.
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Study Challenges Orthodoxy of IV Hydration for Prevention of Contrast Nephropathy
SYNOPSIS: This trial randomized 660 patients with chronic kidney disease and a planned procedure requiring intravascular iodinated contrast to prophylactic hydration or to no hydration. No hydration was found to be non-inferior for prevention of contrast-induced nephropathy and saved significant costs.
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Clindamycin Improves Outcomes in Necrotizing Fasciitis due to Group A Streptococcus
SYNOPSIS: Using a murine model of necrotizing fasciitis, investigators determined that clindamycin inhibits key virulence factors of Group A Streptococcus, and should be given as soon as possible and at high doses to reach levels above MIC in affected tissues.
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Surviving Sepsis Campaign Guidelines Bundle: Studying How Improved Compliance Might Affect Outcomes
SYNOPSIS: Improved compliance with the Surviving Sepsis Campaign guidelines bundle was associated with a non-statistically significant decrease in the in-hospital mortality of severe sepsis patients.
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The ABCs of In-hospital Cardiac Arrest
SYNOPSIS: In this large, propensity-matched cohort study of patients who experienced an in-hospital cardiac arrest, patients who underwent endotracheal intubation had worse survival to hospital discharge than patients who were not intubated.
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High-sensitivity Cardiac Troponin
In patients with new-onset chest pain without ECG evidence of an ST-elevation myocardial infarction, conversion to the use of a high-sensitivity troponin T assay with three-hour retesting in three hospitals was compared to maintaining the fourth-generation troponin T assay with six-hour retesting in three other hospitals. The use of high-sensitivity troponin T resulted in lower ED length of stay and costs, without increasing the use of coronary angiography or stress testing. -
Hyperoxia in ICU Patients May Cause Harm
Patients randomized to maintain oxygen saturation between 94-98% experienced better outcomes than patients allowed to receive partial pressure of oxygen > 150 mmHg. -
Hemoconcentration Associated with Lower Mortality in Acute Heart Failure
Among patients hospitalized for acute heart failure, hemoconcentration was associated with reduced 90-day mortality and may be a useful marker for guiding therapy. -
Do Antipsychotics Help with Delirium?
In palliative care patients suffering from delirium, managing delirium precipitants and individualized supportive strategies alone work better than adding risperidone or haloperidol. -
Vancomycin Combined with Piperacillin-Tazobactam Increases the Risk for Acute Kidney Injury
A retrospective cohort study found an increased risk of acute kidney injury for patients who received vancomycin in combination with piperacillin-tazobactam compared to those who received vancomycin plus cefepime (hazard ratio = 4.27; 95% confidence interval, 2.73-6.68).