Arch Intern Med
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Comparative Study
Association between mental health disorders, problem drug use, and regular prescription opioid use.
Use of opioids for chronic noncancer pain is increasing, but standards of care for this practice are poorly defined. Psychiatric disorders are associated with increased physical symptoms such as pain and may be associated with opioid use, but no prospective population-based studies have addressed this issue. ⋯ Common mental health disorders and problem drug use are associated with initiation and use of prescribed opioids in the general population. Attention to psychiatric disorders is important when considering opioid therapy.
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Thromboprophylaxis in elderly patients, including post-acute care patients, is at variance with scientific evidence. The purpose of this study was to determine whether a multifaceted intervention was followed by a decrease in deep venous thrombosis (DVT). ⋯ A multifaceted intervention addressing venous thromboembolism prophylaxis in post-acute care patients can be followed by a significant decrease in the rate of any DVT in elderly patients. More active interventions are needed to enforce compliance with evidence-based guidelines.
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Comparative Study
High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity.
Vancomycin hydrochloride treatment failure for infections caused by susceptible methicillin-resistant Staphylococcus aureus (MRSA) strains with high minimum inhibitory concentration (MIC) has prompted recent guidelines to recommend a higher vancomycin target trough of 15 to 20 microg/mL. ⋯ High prevalence of clinical MRSA strains with elevated vancomycin MIC (2 microg/mL) requires aggressive empirical vancomycin dosing to achieve a trough greater than 15 microg/mL. Combination or alternative therapy should be considered for invasive infections caused by these strains.
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Comparative Study Clinical Trial
Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.
Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP. ⋯ The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.
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Comparative Study
Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events.
In patients with acute pulmonary embolism, right ventricular dysfunction (RVD) on hospital admission is a predictor of adverse short-term clinical outcome. The aim of this study was to evaluate the prognostic value of RVD persistence at hospital discharge with regard to the likelihood of recurrent venous thromboembolism (VTE). ⋯ Persistent RVD at hospital discharge after an acute pulmonary embolism is associated with recurrent VTE.