Infectious Disease
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Prolonged Empiric Antibiotic Therapy (PEAT) in Adult Intensive Care Units
Nine hundred ninety-eight patients admitted to 67 adult ICUs in 32 hospitals in the United States over a 24-hour period in 2011 were studied. Prolonged empiric antibiotic therapy was defined as continuing empiric antibiotics beyond 72 hours in patients in the absence of adjudicated infection as defined by CDC criteria. Three hundred thirty-three of 660 (50%) antibiotics were continued for at least 72 hours in patients who did not meet the CDC case definition of infection. Suspected pneumonia was the most common diagnosis in patients receiving PEAT. ICUs using invasive techniques to diagnose ventilator-associated pneumonia had lower rates of PEAT.
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Longer Course Therapy for Lyme Disease Is Not Beneficial
A randomized, placebo-controlled clinical trial from the Netherlands found that longer-term antibiotic therapy for Lyme disease did not improve health-related quality of life compared to a standard course of treatment.
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Clinical Briefs
In this section: examining autoimmune disorders associated with vitiligo; moderate alcohol consumption is not associated with reduced all-cause mortality; and rethinking the American diet.
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Ixekizumab Injection (Taltz)
Ixekizumab is indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
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Outcome of PCSK9 Inhibitor-treated Patients
In a meta-analysis of 17 studies, proprotein convertase subtilisin-kexin type 9 serine protease inhibitors markedly reduced low-density lipoprotein cholesterol levels and all-cause mortality, but was associated with a significant increase in neurocognitive adverse events.
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Menopausal Hormone Therapy: Useful and Indicated for Vasomotor Symptoms
Menopausal hormone therapy is the most effective treatment for symptoms of the menopause, and benefits may exceed risks for most women within 10 years of menopause.
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Drug-resistant Hypertension? Consider Adding a Nonpharmacologic Prescription
In patients with obstructive sleep apnea and hypertension, continuous positive airway pressure use was associated with clinically and statistically significant reductions in blood pressure for both resistant and non-resistant hypertension.
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Chest Pain and Giant T Wave Inversion
Chest pain (rather than shortness of breath) and ST elevation (rather than T wave inversion) in leads V1 and V2 make massive pulmonary embolism unlikely.
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Clinical Briefs
In this section: the insulin misadministration problem; comparing smoking cessation pharmacotherapies; more support for ambulatory BP monitoring.
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Tenofovir Alafenamide vs Tenofovir Disoproxil Fumarate
Tenofovir alafenamide has replaced the tenofovir disoproxil fumarate component of two commonly used drug combinations for HIV-1 infection.