Internal Medicine
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Strategies for Prescribing Opioids Appropriately
Prescription opiate abuse and misuse has become a growing epidemic recently, and the problem seems to be propagating without an immediate end in sight. It is known that prescription opiate abuse has clear links to heroin abuse (which also has become increasingly more prevalent), and, in some instances, primary care physicians may be adding fuel to the proverbial fire.
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Is Sodium Restriction Detrimental in Chronic Heart Failure?
In an observational study of outpatients with NYHA class II or III heart failure, dietary sodium restriction (< 2500 mg/day) was associated with increased risk of death or heart failure hospitalization.
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Fecal Microbiota Transplantation: Patients Need No Convincing
Relapsing and refractory Clostridium difficile infection has become a real challenge for clinicians and affected patients alike. Some patients wind up in a seemingly never-ending cycle of illness, gradual improvement, followed by a prolonged vancomycin taper, and eventual relapse.
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Intracerebral Hemorrhages Associated with Non-vitamin K Oral Anticoagulants Appear to Be Smaller than Those Associated with Warfarin
This small prospective observational study suggests that warfarin-associated intracerebral hemorrhages may be larger and have worse clinical outcomes then hemorrhages associated with the newer anticoagulant agents.
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Blood Transfusion in Cardiac Disease Patients
An observational study confirms the hypothesis that ischemic heart disease patients may do better with higher hemoglobin levels as compared to ICU patients without heart disease.
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Symptomatic Carotid Artery Stenosis Requires Urgent Revascularization
Johansson et al identified a significant early risk of recurrent stroke in patients with symptomatic carotid artery stenosis, and advise a prospective randomized trial to determine when the optimal time for revascularization should take place.
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Early Chest CT Can Improve Treatment for Community-acquired Pneumonia
In patients with suspected community-acquired pneumonia, early chest CT significantly changed management decisions.
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The Opioids Just Keeping Coming
Most opioid prescriptions are continued after a patient overdoses accidentally. Those patients are also at risk for a recurrent overdose.
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Overdiagnosis of Idiopathic Intracranial Hypertension
Idiopathic intracranial hypertension is over-diagnosed because of a lack of physician expertise in performing accurate ophthalmoscopy. When considering the diagnosis, referral to a neuro-ophthalmologist is strongly recommended.
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Isolated Dizziness and Vertigo Are Rarely Caused by Stroke
The rate of stroke in patients discharged from the ED with a diagnosis of peripheral vestibular disorder is extremely low, and unless there are associated neurological symptoms and signs, there is no need for extensive ED evaluation.