Annals of internal medicine
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Clinical Trial Controlled Clinical Trial
Early "step-down" transfer of low-risk patients with chest pain. A controlled interventional trial.
To determine whether providing private practitioners with triage criteria for their low-risk chest pain patients would safely enhance bed utilization efficiency in coronary and intermediate care units. ⋯ The early transfer triage criteria may be a safe and efficacious decision aid for improving bed utilization in intermediate and coronary care units. In addition, this study shows the feasibility of and potential benefits from applying practice guidelines at a community hospital.
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Randomized Controlled Trial Clinical Trial
Blood culture phlebotomy: switching needles does not prevent contamination.
To determine how switching to a sterile needle after phlebotomy and before the inoculation of blood culture bottles affects the rate of skin flora contamination. ⋯ The needle switch in the conventional blood culture technique does not reduce the rate of skin flora contamination. Blood cultures should no longer be obtained by switching needles.
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Indirect evidence indicates that cervical cancer screening should reduce the incidence and mortality of invasive cervical cancer by about 90%. In the absence of screening, a 20-year-old average-risk woman has about a 250 in 10,000 chance of developing invasive cervical cancer during the rest of her life, and about a 118 in 10,000 chance of dying from it. ⋯ The particular age at which screening is begun (for example, 17 or 20 years), the requirement of several initial annual examinations before reducing the frequency, and screening every 1 or 2 years compared with every 3 years improves the effectiveness by less than 5%. Screening is recommended at least every 3 years from about age 20 to about age 65 years.
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Septic shock is the commonest cause of death in intensive care units. Although sepsis usually produces a low systemic vascular resistance and elevated cardiac output, strong evidence (decreased ejection fraction and reduced response to fluid administration) suggests that the ventricular myocardium is depressed and the ventricle dilated. In survivors, these abnormalities are reversible. ⋯ A circulating myocardial depressant substance has been closely associated with the myocardial depression of human septic shock. Therapy has emphasized early use of antibiotics, critical care monitoring, aggressive volume resuscitation, and, if shock continues, use of inotropic agents and vasopressors. Pharmacologic or immunologic antagonism of endotoxin or other mediators may prove to enhance survival in this highly lethal syndrome.