Internal Medicine
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Hospital Medicine Alert - Full December 2014 Issue in PDF
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Risk of Non-Cardiac Surgery with Severe Aortic Stenosis
Ever since the first Goldman index, severe aortic stenosis (AS) has been known to be a risk factor for perioperative morbidity and mortality for non-cardiac surgery. -
Is It Time to Rethink Lactulose for the Treatment of Acute Hepatic Encephalopathy?
For decades, lactulose, a non-absorbable disaccharide, has been considered to be the standard-of-care, first-line therapy for acute (overt) hepatic encephalopathy. Hepatic encephalopathy (HE), a complication of decompensated liver cirrhosis, represents a spectrum of clinical manifestations ranging from mild neuropsychiatric changes to coma and is a common indication for hospital admission. -
After-Hours ICU Discharge: A Potentially Modifiable Cause of Increased Hospital Mortality
The Australian and New Zealand Intensive Care Society Adult Patient Database prospectively records data on patients cared for in 90% of Australian and 50% of New Zealand ICUs. -
Internal Medicine Alert - Full November 29, 2014 Issue in PDF
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Primary Care Reports - Full December 2014 Issue in PDF
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Thienopyridine Pretreatment in Patients with Non-ST Elevation Acute Coronary Syndromes: Where’s the Evidence?
In their recent meta-analysis, Bellemain-Appaix and colleagues looked at thienopyridine (P2Y12 inhibitor) pretreatment in seven studies that included primarily NSTEACS patients, including four randomized, controlled trials and three registries. In the overall cohort, pretreatment did not reduce the risk of all-cause mortality or cardiovascular death. Major adverse cardiovascular events were reduced in the pretreatment group (odds ratio [OR], 0.84; 95% confidence interval [CI] 0.72 to 0.98; P = 0.02), but individual endpoints, such as myocardial infarction, were not significantly affected. Among the subset of patients who underwent percutaneous coronary intervention (PCI), which represented a minority of the total cohort, there was likewise no reduction in death or cardiovascular death, but pretreatment with P2Y12 inhibitors was associated only with a non-significant trend toward a reduction of major adverse cardiac events (MACE). Within the PCI group, pretreatment was associated with a reduction of urgent revascularization (OR, 0.72; 95% CI, 0.52 to 1.00); however, this result was driven primarily by the results of the PCI subset of the CURE, in which the delay from admission to revascularization averaged a relatively long 10 days.
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Assessment of Pain in Non-vocal or Unresponsive ICU Patients
Pain defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage1 is a common symptom experienced by critically ill patients. -
Do Arterial Catheters Improve Patient Care in the ICU?
Gershengorn and colleagues used prospectively collected data from the Project IMPACT database (a nationwide, voluntary, proprietary database for assessing performance of U.S. ICUs with respect to patient outcomes and numerous other variables) to examine the question of whether the use of arterial catheters (ACs) in critically ill, mechanically ventilated patients was associated with improved survival or other documentable benefits. -
Can the Physical Layout of an ICU Influence Delirium Rates?
Delirium, or acute brain dysfunction, is a syndrome that affects many patients in the intensive care unit (ICU). A number of modifiable and non-modifiable risk factors contribute to the development of delirium, such as illness severity, receipt of benzodiazepine medications, and metabolic alterations.