Neurology
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Intravenous Calcitonin Gene-Related Antibodies for the Prevention of Migraine
In a Phase 2 trial, antibodies to calcitonin gene-related peptide resulted in a significant decrease in migraine days measured from baseline to weeks 5 to 8 after one intravenous infusion of the medication, as compared to a placebo infusion. But the high-rate of placebo response (50%) warrants caution in the interpretation of the study results and requires more investigation. -
Utility of Anti-JC Virus Antibody Index to Assess the Risk of PML in Natalizumab-Treated MS Patients
Natalizumab is a monoclonal antibody that is FDA-approved for the treatment of relapsing-remitting multiple sclerosis (MS). Among the available options to treat MS, it is one of the most effective. -
DaTSCAN to Distinguish Parkinson’s Disease from Secondary Parkinsonism
DaTSCAN imaging makes use of the dopamine transporter (DAT) ligand [123I]FP-CIT used with SPECT to provide a means to visualize the integrity of the nigrostriatal dopaminergic system. DaTSCAN has been approved in the United States to aid in evaluation of patients in whom Parkinsons disease (PD) and certain other related neurodegenerative disorders are suspected. -
Peri-procedural Management of New Oral Anticoagulants
Due to the short half-life and rapid onset of action of the new oral anticoagulants (NOACs), peri-procedural anticoagulant free time intervals should be shorter than with warfarin. Thus, there is uncertainty about the use of heparin bridging. These investigators from Germany analyzed the Dresden NOAC registry data to assess peri-procedural NOAC management and safety until 30 days post-procedure. -
Health Care Utilization in the Aftermath of Severe Sepsis
SYNOPSIS: This observational cohort study of survivors of severe sepsis found that the post-discharge needs of this population are substantial. Severe sepsis survivors spent more days admitted to facilities after their acute hospitalization than prior and had greater mortality, a steeper decline in days at home, and a greater increase in proportion of days alive in a facility compared to survivors of non-sepsis hospitalizations.
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Can We Reduce Unnecessary Head CT Scans in Patients with Delirium?
This study was a retrospective review of medical records of hospitalized general medicine patients with head CT imaging performed for the evaluation of delirium. -
Nasal High-Flow Oxygen Lowers Reintubation Rate
SYNOPSIS: Use of nasal high-flow oxygen was associated with better comfort, fewer desaturations and interface displacements, and a lower reintubation rate.
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The New Guidelines Put C. difficile on the Run
SYNOPSIS: Patients have decreased disease recurrence and mortality when physicians follow the IDSA/Society for Healthcare Epidemiology of America guidelines for the treatment of C difficile infection.
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Internal Medicine Alert - Full October 29, 2014 Issue in PDF
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End-of-Life and Futile Medical Care in the Emergency Department
The purpose of this article is to review the complicated issues of end-of-life and futile medical care as applicable to the emergency department (ED). It will address sources of conflict and confusion, and will conclude with a practical discussion of how emergency physicians can best navigate these complex waters by practical case review.