JAMA internal medicine
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The current view in intensive care medicine is that very sick patients need very intensive treatment. However, in this group of highly vulnerable patients, more intensive treatment may promote the chances of unwanted adverse effects and hence, iatrogenic damage. ⋯ We illustrate our case by describing the intensity of the most relevant treatment options for patients with septic shock, including mechanical ventilation, fluid management, blood pressure-targeted therapy, corticosteroids, patient monitoring, sedation, and nutrition. We conclude that treatment of critically ill patients while keeping in mind the "less is more" paradigm might not only benefit the patient but could also have a notable impact on the ever-increasing intensive care-related health care costs.
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JAMA internal medicine · Jul 2013
Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women.
Red meat consumption has been consistently associated with an increased risk of type 2 diabetes mellitus (T2DM). However, whether changes in red meat intake are related to subsequent T2DM risk remains unknown. ⋯ Increasing red meat consumption over time is associated with an elevated subsequent risk of T2DM, and the association is partly mediated by body weight. Our results add further evidence that limiting red meat consumption over time confers benefits for T2DM prevention.
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JAMA internal medicine · Jul 2013
Mortality for publicly reported conditions and overall hospital mortality rates.
Federal efforts about public reporting and quality improvement programs for hospitals have focused primarily on a small number of medical conditions. Whether performance on these conditions accurately predicts the quality of broader hospital care is unknown. ⋯ Hospital performance on publicly reported conditions can potentially be used as a signal of overall hospital mortality rates.
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JAMA internal medicine · Jul 2013
Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011.
Clostridium difficile infection (CDI) has been increasingly reported among healthy individuals in the community. Recent data suggest that community-associated CDI represents one-third of all C difficile cases. The epidemiology and potential sources of C difficile in the community are not fully understood. ⋯ Most patients with community-associated CDI had recent outpatient health care exposure, and up to 36% would not be prevented by reduction of antibiotic use only. Our data support evaluation of additional strategies, including further examination of C difficile transmission in outpatient and household settings and reduction of proton pump inhibitor use.