Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Comparative Study
Resistance to empiric antimicrobial treatment predicts outcome in severe sepsis associated with Gram-negative bacteremia.
Gram-negative bacteria are an important cause of severe sepsis. Recent studies have demonstrated reduced susceptibility of Gram-negative bacteria to currently available antimicrobial agents. ⋯ In severe sepsis attributed to Gram-negative bacteremia, initial treatment with an antibiotic regimen to which the causative pathogen is resistant was associated with increased hospital mortality. This finding suggests that rapid determination of bacterial susceptibility could influence treatment choices in patients with severe sepsis potentially improving their clinical outcomes.
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Palliative care has been recommended as an approach to improve the quality of care for patients with advanced illness, while achieving hospital cost savings. However, studies are lacking that identify hospitalized patients who are more likely to have higher cost per day or length of stay (LOS) who may benefit from palliative care consultation. ⋯ Our data suggest that younger patients and those cared for by surgical specialty services may receive the most benefit from palliative care consultation, a finding that needs to be corroborated in other centers.
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Randomized Controlled Trial Multicenter Study Comparative Study
Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches.
Collaborative and toolkit approaches have gained traction for improving quality in health care. ⋯ The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve.
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Randomized Controlled Trial Comparative Study
Treatment of inpatient hyperglycemia beginning in the emergency department: a randomized trial using insulins aspart and detemir compared with usual care.
We examined the impact of an aspart insulin protocol for treatment of hyperglycemia in the emergency department (ED) coupled with rapid initiation of a detemir-aspart insulin protocol for patients admitted to the hospital. ⋯ An aspart insulin protocol safely lowers BG levels in the ED without prolonging LOS. During hospitalization, a detemir-aspart protocol achieves significantly better glycemic control compared with guideline-driven use of NPH-aspart or glargine/detemir-aspart (usual care) without increasing hypoglycemia. Standardization of insulin protocols in the ED and hospital settings leads to improvement in overall glycemic control with greater safety and efficacy than usual care.