Heart & lung : the journal of critical care
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Case Reports
Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to a linezolid "tolerant" strain.
Persistent Staphylococcus aureus bacteremia is most frequently related to S. aureus acute bacterial endocarditis, myocardial abscess, extracardiac abscess, or a device-associated infection. Patients with continuous high-grade bacteremia who do not have acute bacterial endocarditis, an abscess, or a device-related infection should be considered to have antimicrobial "tolerance" as a possible cause. Antimicrobial "tolerance" is defined as a wide discrepancy between the minimal inhibitory concentration and the minimal bactericidal concentration of an isolate. ⋯ The lack of bactericidal activity of the antibiotic becomes apparent when minimal bactericidal concentrations are determined for "tolerant" strains, and there is a great discrepancy between the minimal inhibitory concentration being used. Antibiotic tolerance to S. aureus has been described with a variety of antibiotics. To the best of our knowledge, this is the first case of continuous, high-grade methicillin-resistant S. aureus bacteremia due to a linezolid-tolerant strain.
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Multicenter Study Comparative Study
Prehospital transport of patients with acute myocardial infarction: a community-wide perspective.
The objectives of this population-based study were to examine the use of emergency medical services (EMS) in greater Worcester, Massachusetts, residents (2000 census = 478,000) hospitalized with acute myocardial infarction (AMI) at all metropolitan Worcester medical centers in four biennial periods between 1997 and 2003. A secondary study aim was to describe the demographic and clinical characteristics of patients with AMI transported to metropolitan Worcester hospitals by EMS, compared with those transported by other means, and their hospital outcomes. ⋯ Our results suggest that the majority of greater Worcester residents seeking care for AMI are transported by EMS. Patients transported by ambulance differ from patients transported by other means and are more likely to experience adverse hospital outcomes. The reasons why patients use EMS in the setting of AMI need to be further explored and patients' care-seeking behavior enhanced.
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Despite the increased mortality and morbidity in patients with acute decompensated heart failure (ADHF), its management has been based primarily on anecdotal experiences and physiologic assumptions rather than on prospective randomized controlled trials. The data on diuretics have been conflicting. ⋯ Good evidence that supports the safety and efficacy of the different medications that are routinely used in ADHF is lacking. Unless properly designed prospective clinical trials are done to evaluate the safety of the various ADHF regimens, clinicians might continue to be misguided by the beneficial short-term effects at the expense of long-term mortality and morbidity.
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Comparative Study
Health-related quality of life and subjective neurocognitive function three months after coronary artery bypass graft surgery.
We compared health-related quality of life (HRQL), including patient-perceived neurocognitive function at preoperative baseline and 3 months after coronary artery bypass (CABG) surgery. ⋯ Patients reported improvements in HRQL measures, including two of three subjective neurocognitive measures. Health care providers facilitate preparation for the CABG recovery trajectory by discussing expected post-hospital experience and potential postoperative variations in emotions and neurocognitive function.
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The study's purpose was to describe patients' experiences of minimal conscious sedation during diagnostic and interventional cardiology procedures. ⋯ The minimal sedation protocol was effective for the majority of patients; however, 9% of patients experienced significant discomfort related to preexisting conditions, highlighting the need for individual patient assessment before, during, and after the procedure.