Arch Intern Med
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Comment Letter Clinical Trial
Does selenium supplementation slow progression of HIV? Potentially misleading presentation of the results of a trial.
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There has been great interest in optimizing prophylaxis against venous thromboembolism (VTE) in the hospital setting. However, data from earlier studies suggest that most VTEs occur in the outpatient setting. The purposes of this observational study were to describe the frequency of VTEs occurring in the outpatient setting, characterize the prevalence of previously identified risk factors for VTE, and identify previous use of VTE prophylaxis. ⋯ More VTEs were diagnosed in the 3 months following hospitalization than during hospitalization. Efforts to improve in-hospital use of VTE prophylaxis may help decrease the incidence of outpatient VTE. However, given the shortening of hospital stays, studies of extended VTE prophylaxis following hospital discharge are warranted.
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Persistent delirium at the time of hospital discharge is associated with poor outcomes. The objectives of this study were to develop and validate a predictive model for persistent delirium at hospital discharge. ⋯ A predictive model based on 5 risk factors has been successfully validated for prediction of delirium at discharge in hospitalized older patients. At least 4 of these risk factors are amenable to intervention strategies.
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Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. However, limited data exist to validate this entity. We aimed to ascertain the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for HCAP requiring hospitalization. ⋯ At present, a substantial number of patients initially seen with pneumonia in the emergency department have HCAP. These patients require a targeted approach when selecting empirical antibiotic therapy.
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Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action.
Warfarin sodium is widely used and causes bleeding; a review might suggest the need for regulatory action by the US Food and Drug Administration (FDA). ⋯ Use of warfarin has increased, and bleeding from warfarin use is a prevalent reaction and an important cause of mortality. Consequently, a "black box" warning about warfarin's bleeding risk was added to the US product labeling in 2006. Physicians and nurses should tell patients to immediately report signs and symptoms of bleeding. A Medication Guide, which is required to be provided with each prescription, reinforces this message.