The American journal of medicine
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Asymptomatic mastoid effusions have recently been observed in astronauts returning from long-term spaceflight. In hospitalized patients, mastoid effusion increases the risks for bacterial otitis and mastoiditis. We reasoned that cephalad fluid shifts during strict -6° head down tilt bed rest could reproduce space-flight associated mastoid effusion and that artificial gravity may reverse the response. ⋯ Mastoid effusions commonly occur during strict head down tilt bed rest. The model can be applied to study the mechanisms and potential countermeasures for space flight-associated mastoid effusions. Formation of mastoid effusions during head down tilt bed rest is not prevented by daily 30 minutes short-arm intermittent or continuous centrifugation.
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Observational Study
Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction.
Complex medication regimens, often present in heart failure with preserved ejection fraction, may increase the risk of adverse drug effects and harm. We sought to characterize this complexity by determining the prevalence of polypharmacy, potentially inappropriate medications, and therapeutic competition (where a medication for 1 condition may worsen another condition) in 1 of the few dedicated heart failure with preserved ejection fraction programs in the United States. ⋯ In addition to confirming that polypharmacy was highly prevalent, we found that potentially inappropriate medications and therapeutic competition were also frequently present. This supports the urgent need to develop patient-centered approaches to mitigate the negative effects of complex medication regimens endemic to adults with heart failure with preserved ejection fraction.
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Observational Study
Retention of Point-of-care Ultrasound Skills among Practicing Physicians: Findings of the VA National Point-of-care Ultrasound Training Program.
Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. ⋯ Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
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The 30-day direct oral anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. ⋯ A significant proportion of patients using direct oral anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate direct oral anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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Comparative Study
Catheter-Directed Therapy: Outcomes vs Standard of Care and Evaluation of Current Practice.
Small studies have noted benefit with the use of catheter-directed therapy (CDT) versus standard of care in treatment of pulmonary embolism, but none have focused on the variability of clinical practice with this modality. ⋯ In this study, no significant difference in inpatient mortality or major bleeding was found in patients in the intensive care unit with pulmonary embolism who underwent CDT compared with standard care. It may be beneficial to standardize this procedure given the potential benefit of CDT in patients with submassive pulmonary embolism.