Current medical research and opinion
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Prophylactic probiotics have been shown to be effective in preventing Clostridioides difficile infection (CDI), according to multiple meta-analyses. However, different medical societies have varying recommendations on their use for preventing CDI. ⋯ We highlight four areas for future improvement: considering baseline risk for CDI, timing of probiotics with antibiotics, combining efficacy data from different probiotic strains, and safety. All societies agree on the need for more high-quality and adequately powered randomized controlled trials to further strengthen the evidence.
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The aim of this study was to investigate the association between dose reduction of renin-angiotensin-aldosterone system inhibitors (RAASis) and Acute kidney injury (AKI). AKI, which is commonly observed in hospitalized patients, increases mortality. Although RAASis and coronary artery angiography (CAG) are reported to be risk factors for AKI, whether dose reduction of RAASis can prevent AKI after CAG remains unknown. ⋯ A reduction in the dose of RAASis did not prevent the development of AKI among patients undergoing CAG.
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Infections caused by carbapenem-nonsusceptible gram-negative (C-NS) pathogens are associated with increased mortality and high treatment costs. Identification of potentially modifiable factors that may improve patient outcomes is important for better management of C-NS GN infections. ⋯ Adverse postdischarge outcomes were common among hospitalized patients with C-NS GN infections and were significantly associated with previous carbapenem use and patient clinical characteristics such as higher comorbidity burden and immunocompromised status. Adoption of antimicrobial stewardship and consideration of individual patient risk factors in making treatment decisions may help improve clinical outcomes.
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Insulin pump use is increasing among people with type 2 diabetes (T2D), albeit at a slower rate compared to people with type 1 diabetes (T1D). Factors associated with insulin pump initiation among people with T2D in the real-world are understudied. ⋯ Many of these predictors could represent a clinical indication for treatment intensification, greater patient engagement in diabetes management, or proactive management by healthcare providers. Improved understanding of predictors for pump initiation may lead to more targeted efforts to improve access and acceptance of insulin pumps among persons with T2D.
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COVID-19 has had a negative impact on the health care of patients with cardiovascular disease and patients at high risk of cardiovascular disease. The restrictions affecting access to the health care system have conditioned the care received, resulting in poorer control and a higher risk of events. Taking action to improve the care provided during health emergencies is mandatory. ⋯ In addition, primary care and coordination between health care levels should be improved. Moreover, the simplification and optimization of treatment, for example, using the cardiovascular polypill, have led to an improvement in adherence, better control of vascular risk factors, and a reduced risk of events. The present document provides specific recommendations for improving the care provided to patients under a health emergency.