JAMA : the journal of the American Medical Association
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Multicenter Study
Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department.
An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown. ⋯ Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.
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Multicenter Study
Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma.
Although asthma is a chronic disease, the expected rate of spontaneous remissions of adult asthma and the stability of diagnosis are unknown. ⋯ Among adults with physician-diagnosed asthma, a current diagnosis of asthma could not be established in 33.1% who were not using daily asthma medications or had medications weaned. In patients such as these, reassessing the asthma diagnosis may be warranted.
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In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. ⋯ Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.
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Are antifungal agents associated with lower rates of mortality and invasive fungal infections when administered before definitive diagnosis of an invasive fungal infection in critically ill patients without neutropenia? ⋯ Antifungal treatment administered prior to diagnosis of an invasive fungal infection is not associated with either higher or lower rates of all-cause mortality. Antifungal treatment in this setting is associated with lower rates of invasive fungal infections compared with placebo or no intervention in critically ill patients without neutropenia, but the quality of the evidence is low.