Arch Intern Med
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Randomized Controlled Trial
Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients.
To determine whether patients bathed daily with chlorhexidine gluconate (CHG) have a lower incidence of primary bloodstream infections (BSIs) compared with patients bathed with soap and water. ⋯ Daily cleansing of MICU patients with CHG-impregnated cloths is a simple, effective strategy to decrease the rate of primary BSIs.
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Little is known about the training experience of minority medical students. We explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role race/ethnicity plays in students' experiences. ⋯ Symptoms of distress are prevalent among medical students. While minorities appear to be at lower risk for burnout than nonminority students, race does contribute to the distress minority students do experience. Additional studies are needed to define the causes of these perceptions and to improve the learning climate for all students.
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Randomized Controlled Trial
Informed choice in mammography screening: a randomized trial of a decision aid for 70-year-old women.
Many women who have participated in mammography screening are now approaching 70 years of age. These women are advised to consider both the benefits and harms of continuing to be screened. Doing so may be difficult for individual women, and there are no evaluated decision support tools to assist them. ⋯ This DA increased knowledge and assisted women to make an informed choice. It did not alter participation in screening. The DA is an effective way to assist women to make a decision about continuing mammography screening and seems to be a feasible intervention within a population screening program.
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Although 23-valent polysaccharide pneumococcal vaccine (PPV) does not prevent community-acquired pneumonia (CAP), it might still improve outcomes in those who develop pneumonia. We tested this hypothesis using a population-based cohort of hospitalized patients with CAP. ⋯ Patients with CAP who had prior PPV had about a 40% lower rate of mortality or ICU admission compared with those who were not vaccinated. This provides additional support for recommending PPV to those at risk of pneumonia.
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Comparative Study
Characteristics of patients hospitalized with acute decompensated heart failure who are referred for hospice care.
Hospice is a potential option for patients with end-stage heart failure whose symptoms and clinical status have progressed despite maximal medical therapy. However, little is known about hospice referral practices when patients are admitted because of acute decompensated heart failure. ⋯ A small percentage of patients admitted to acute care hospitals with decompensated heart failure are referred to hospice at rates increasing with time. Hospitals that refer patients to hospice are more likely to be in compliance with heart failure performance measures. Further investigation is required to determine if the hospice option is appropriately selected and if it should be offered to a broader cohort of patients.