Annals of internal medicine
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Review Meta Analysis
Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose.
Previous meta-analyses demonstrated that high-dose glucocorticoids were not beneficial in sepsis. Recently, lower-dose glucocorticoids have been studied. ⋯ Although short courses of high-dose glucocorticoids decreased survival during sepsis, a 5- to 7-day course of physiologic hydrocortisone doses with subsequent tapering increases survival rate and shock reversal in patients with vasopressor-dependent septic shock.
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Meta Analysis
Meta-analysis: respiratory tolerance to regular beta2-agonist use in patients with asthma.
The regular administration of beta2-agonists may be associated with the development of tolerance to their effects. ⋯ Regular beta2-agonist use for at least 1 week in patients with asthma results in tolerance to the drug's bronchodilator and nonbronchodilator effects and may be associated with poorer disease control compared with placebo.
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Review Meta Analysis
D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review.
Despite extensive literature, the diagnostic role of d-dimer for deep venous thrombosis (DVT) or pulmonary embolism (PE) remains unclear, reflecting multiple d-dimer assays and concerns about differing sensitivities and variability. ⋯ The ELISAs in general dominate the comparative ranking among the d-dimer assays for sensitivity and negative likelihood ratio. For excluding PE or DVT, a negative result on quantitative rapid ELISA is as diagnostically useful as a normal lung scan or negative duplex ultrasonography finding.
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Low-molecular-weight heparin has greatly simplified the management of deep venous thrombosis. However, for patients who present with pulmonary embolism, the role of low-molecular-weight heparin is uncertain and unfractionated heparin remains widely used. ⋯ Fixed-dose low-molecular-weight heparin treatment appears to be as effective and safe as dose-adjusted intravenous unfractionated heparin for the initial treatment of nonmassive pulmonary embolism.
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Review Meta Analysis
The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review.
The Ottawa knee rule is a clinical decision aid that helps rule out fractures and avoid unnecessary radiography. ⋯ A negative result on an Ottawa knee rule test accurately excluded knee fractures after acute knee injury. However, because the rule is calibrated toward 100% sensitivity and actual fracture prevalences are usually low, large-scale, multicentered studies are still needed to establish the cost-effectiveness of routinely implementing the rule.