The American journal of medicine
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Growing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome. ⋯ PICC-associated bloodstream infection is most associated with hospital length of stay, ICU status, and number of device lumens. Policy and procedural oversights targeting these factors may be necessary to reduce the risk of this adverse outcome.
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When primary care physicians are presented with a patient with atrial fibrillation (AFib), there are two concerns. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). One is the choice of strategy to treat the AFib, ie, whether to use rate control or a rhythm control strategy (to keep patients in sinus rhythm). The second concern is preventing the principal risk associated with AFib: stroke and systemic embolism. ⋯ Again, the evidence reveals that the patients at highest risk of bleeding are also at highest risk of stroke, and the benefits of preventing stroke with anticoagulation therapy almost always outweigh the risk of bleeding. This is discussed in the context of the new NOACs (discussed in the next review), including addressing what physicians should do if patients move from warfarin to one of the NOACs or vice versa. A final challenge for physicians treating patients with AFib has been the often mistaken belief that patients are at a low-risk status, and this review concludes with an overview of the use of the CHADS2 versus the CHA2DS2-VASc risk scoring systems, including why CHA2DS2-VASc provides a better assessment of which patients are or are not at low risk.
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Observational Study
Electronic health record use, intensity of hospital care, and patient outcomes.
Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. ⋯ Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity.