Internal Medicine
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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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Alexander Technique, Acupuncture, or Routine Care for Chronic Neck Pain
Alexander Technique lessons or acupuncture sessions for people with chronic neck pain led to greater decreases in neck pain and disability and a more significant increase in self-efficacy than normal care at 12 months.
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Individualized Homeopathy for Moderate to Severe Depression in Menopausal Women
A higher risk of depressive symptoms has been observed in the menopausal transition period. Antidepressant medications are often recommended; however, many meta-analyses have only shown modest benefit of such medications over placebo. This study compares individual homeopathic treatment vs. placebo and the antidepressant medication fluoxetine vs. placebo for the treatment of moderate to severe depression in peri- and postmenopausal women.
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Fitness and Cognition in the Elderly
ABSTRACT & COMMENTARY: Peak levels of cardiorespiratory fitness are positively correlated with enhanced cognitive function among older adults.
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Low Back Pain Best Prevented with Exercise and Education
In a meta-analysis of studies on preventing low back pain, researchers found a combination of exercise and education were the most likely interventions to prevent recurrence of this potentially debilitating condition.
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Are Nighttime Extubations in the ICU Safe?
Compared to daytime extubations, ICU patients who undergo planned extubation at night do not experience higher likelihood of reintubation, increased length of stay, or increased mortality.
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Head-elevated Positioning May Decrease Complications of Emergent Tracheal Intubation
In emergent intubations, a position in which the angle of the back was > 30 degrees above the horizontal (head-elevated) position was associated with fewer complications than intubations performed in the supine position, but the study has several limitations.
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ICU Capacity Strain
ICUs are faced with the challenge of continuing care delivery under conditions of increasing strain that's tough to get a handle on.
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Can Chemotherapy Damage Heart Valves?
Long-term lymphoma survivors were noted to experience valvular regurgitation out of proportion to reductions in left ventricular function and degenerative valve stenosis. The most evidence appeared in those who received radiation therapy in addition to chemotherapy.