Internal Medicine
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Antibiotic Cycling Is Not Useful for Reducing Antibiotic-resistant Gram-negative Pathogens in Patients Admitted to Intensive Care Units
A randomized study that included eight intensive care units in Europe found no reduction in mortality or carriage of antibiotic-resistant gram-negative pathogens with antibiotic cycling compared to antibiotic mixing.
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Azithromycin Saves Lives in Africa
Approximately 200,000 preschool-aged children in communities in Malawi, Niger, and Tanzania were treated twice yearly with either azithromycin or placebo. Communities in which azithromycin was provided had 13.5% less all-cause mortality than did placebo-treated communities. In children 1 to 5 months of age, the mortality was 25% lower with azithromycin than with placebo.
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Fostamatinib Disodium Hexahydrate Tablets (Tavalisse)
Fostamatinib is indicated for the treatment of thrombocytopenia in adults with chronic immune thrombocytopenia with insufficient response to a previous treatment.
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Running and Health
In a review and meta-analysis of the effects of running and longevity, researchers concluded that running provides specific and significant health benefits and proposed a threshold above which more running provides diminishing returns.
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Sleep Habits and the Development of Dementia
The relationship between quality of sleep and the development of dementia is controversial and not yet clearly elucidated nor understood.
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Neurogenesis in Older, Healthy Brains
Healthy aging allows for hippocampal neurogenesis in the brains of adults into the eighth decade of life.
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Coffin Nail for Omega-3 Fatty Acids?
A meta-analysis of 10 randomized, controlled trials of omega-3 fatty acids for the prevention of coronary heart disease and major vascular events showed no significant effect on fatal and nonfatal coronary heart disease or any major vascular event. These results do not support the use of omega-3 fatty acids supplements in patients with prior coronary heart disease.
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An International Survey of Ventilator Weaning Practices
A cross-sectional, multinational survey of adult intensivists revealed significant regional variation in several weaning practices, including screening, weaning modes, techniques to conduct spontaneous breathing trials, the use of written directives, and use of non-invasive ventilation in the peri-extubation period.
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ICU Bed Availability: Does It Make a Difference?
Nationwide, the volume of ICU admissions from the ED has increased significantly over recent years (by 50% from 2001 to 2009). When demand exceeds bed availability, complex decisions regarding ICU must be made. Does bed availability affect triage decisions? If many beds are available, patients who are too ill or too well to benefit from the ICU may be admitted. Conversely, if too few beds are available, ICU admission may be denied to patients who may benefit. In prior studies, ICU denial has been associated with increased hospital mortality.
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Is There a Role for Steroids in ARDS Management?
Mortality rates from acute respiratory distress syndrome (ARDS) remain high, even as therapy has improved over the last decade. Recent guidelines for management center on mechanical ventilation, with initial therapy beginning upon identification and treatment of the underlying cause of the ARDS. There is reasonable consensus regarding the use of lung-protective strategies, such as low tidal volume ventilation, prone positioning for those meeting criteria for severe ARDS, and restrictive fluid management after the initial resuscitation. However, for patients with the most severe disease, these treatments often are not completely effective, and we look for other therapies that might help.