Internal Medicine
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Individualized Integrative Medicine Treatment for Preoperative Anxiety
In a randomized, clinical trial investigating the treatment of preoperative anxiety, standard sedating medication with a specified add-on individualized integrative technique is the most effective intervention.
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How Good Is Passive Leg Raise at Predicting Fluid Responsiveness?
SYNOPSIS: In a meta-analysis of 23 clinical trials, passive leg raise was shown to be an excellent predictor of fluid responsiveness.
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In Patients with Intracerebral Hemorrhage, Intensive Lowering of Blood Pressure Does Not Improve Outcome
After spontaneous intracerebral hemorrhage, there is a severe hypertensive response that may be associated with hematoma expansion and increased mortality. The INERACT-2 study (N Engl J Med 2013;368:2355-2365) looked at the effectiveness of blood pressure reduction within six hours after symptom onset, to a target systolic blood pressure of < 140 mmHg.
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Screening for C. difficile Carriers at Hospital Admission Reduces Subsequent CDI
Hospital patients were screened for C. difficile. Contact isolation led to a significant decrease in hospital-acquired C. difficile infections.
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Is There Added Diagnostic Value in Tracheal Aspirate Culture in Mechanically Ventilated Community-onset Pneumonia?
Tracheal aspirate cultures identified plausible pneumonia pathogens in more than half of newly intubated mechanically ventilated patients suffering from severe community-acquired pneumonia.
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The Use of Dexmedetomidine for Sedation May Lead to Earlier Extubation and Decreased Ventilator Adverse Events
The choice of dexmedetomidine or propofol over midazolam may improve outcomes in patients mechanically ventilated for three or more days.
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Post-cardiac Arrest Targeted Temperature Management
Advances in post-cardiac arrest management, such as therapeutic hypothermia, have improved both neurological outcomes and mortality significantly.
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Screening for Coronary Artery Disease Is Underused in Heart Failure
In a large retrospective cohort of patients hospitalized for new-onset heart failure, the majority did not receive testing for ischemic heart disease.
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Ventricular Tachycardia Ablation vs. Escalation of Antiarrhythmic Drugs in Ischemic Cardiomyopathy
Among patients with an ischemic cardiomyopathy and an implantable cardioverter defibrillator (ICD), catheter ablation was more effective than escalated antiarrhythmic drug therapy in reducing the rate of death at any time or ventricular tachycardia storm or ICD shocks after a 30-day blanking period.
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The Double-edged Sword of Public Mortality Reporting
Since the exclusion of cardiogenic shock from public mortality reporting in New York in 2006, rates of intervention in these patients have risen dramatically. However, these rates remain below those in non-reporting states, suggesting continued reluctance to treat the highest-risk patients due to public reporting.