The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study
Impact of initial blood pressure on antihypertensive response in patients with acute hypertension.
The effect profile of differing antihypertensive agents is well studied, but minimal data regarding the interaction between hemodynamic response and presenting blood pressure (BP) exist. ⋯ Initial SBP is not a predictor of the ability to achieve a prespecified target range SBP within 30 minutes.
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Multicenter Study Observational Study
Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest.
It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest. ⋯ These results show that blood glucose level at admission is associated with survival and favorable neurologic outcomes at hospital discharge in patients treated with TH after cardiac arrest. Blood glucose level at admission could be a surrogate marker of ischemic insult severity during cardiac arrest. However, randomized, controlled evidence is needed to address the significance of tight glucose control during TH after cardiac arrest.
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Comparative Study Clinical Trial
A comparison of the supraclavicular and infraclavicular views for imaging the subclavian vein with ultrasound.
Ultrasound guidance for central line placement in the subclavian vein (SCV) is more efficient and safer than landmark-based technique. The supraclavicular (SC) approach is an alternative to the infraclavicular (IC) approach, but the research is sparse. The objective was to determine which approach provides the best view. ⋯ The SC approach allows for a better view of the SCV on ultrasound than the IC approach. Future research should determine if this translates to a greater success rate when placing central lines in the SCV.
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Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). ⋯ Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts.