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After pelvic floor reconstructive surgery, antibiotic prophylaxis with daily nitrofurantoin during postoperative catheterization does not decrease risk of urinary tract infection.
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In an earlier study of early decompressive hemicraniectomy for large middle cerebral artery strokes, the same investigators demonstrated reduced mortality without increasing the risk of very severe disability among patients ≤ 60 years of age.
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Ascites, gastrointestinal hemorrhage, hepatic encephalopathy and bacterial infections are common complications experienced by patients with cirrhosis. Traditionally, when a cirrhotic patient experiences one of these complications and develops worsening liver function, he or she is diagnosed with acute on chronic liver failure.
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Terminally ill cancer patients who had end-of-life discussions with their physician had better quality of life during their last week, and their caregivers had an easier bereavement.
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Unfractionated heparin (UFH) is the standard bridging therapy for patients with mechanical heart valves who need to temporarily stop oral anticoagulants. Small case series have suggested that low molecular weight heparin (LMWH) may be useful for this purpose.
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Forty-four acute care hospitals participated in a prospective study over four years to determine the effect of quality improvement (QI) interventions on appropriate prescribing of surgical antimicrobial prophylaxis. Hospitals were randomly assigned to either feedback on the results of the ongoing audit vs feedback plus an intensive collaborative intervention group. Both groups showed improvement in most quality indicators, but there appeared to be no benefit of the intensive QI collaborative intervention over performance feedback.
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Valproic acid and phenytoin were equally effective in the treatment of acute repetitive seizures and status epilepticus.
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A prospective study comparing angiographic clot burden score and ECG score in 105 patients with PE found no correlation between the two, and neither predictor correlated with 12-month mortality. In a second retrospective study of 33 consecutive patients with massive PE by conventional clinical criteria, there was also no correlation between findings on CT angiography and mortality.
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Many physicians have followed the historical practice of ordering blood cultures to be drawn as close as possible to the time of the peak of the febrile episode (fever spike). In the absence of prescient knowledge of this moment, physicians order blood cultures to be drawn at intervals ranging from 30 minutes to 2 hours. A paper by Jaimes et al suggested that many factors, other than fever, such as shaking chills, WBC counts, hypotension, and more were needed to better predict whether a patient was experiencing bacteremia.
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The incidence of legionellosis in the United States increased significantly in 2003-2005 compared to previous years. This was due mostly to an upsurge of cases in the northeastern and southern United States and a shift of disease from elderly to middle-aged adults. Legionellosis should be considered as a potential cause of pneumonia in a broad range of patients, rather than a small subset with specific risk factors.