Archives of internal medicine
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Preferences for life-sustaining treatment elicited in one state of health may not reflect preferences in another state of health. ⋯ Periodic reassessment of preferences is most critical for patients who desire aggressive end-of-life care or who do not have advance directives.
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While some experimental and clinical research suggests that statins improve outcomes after severe infections, the evidence for pneumonia is conflicting. We examined whether preadmission statin use decreased risk of death, bacteremia, and pulmonary complications after pneumonia. ⋯ The use of statins is associated with decreased mortality after hospitalization with pneumonia.
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Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism.
The revised Geneva score is a fully standardized clinical decision rule (CDR) in the diagnostic workup of patients with suspected pulmonary embolism (PE). The variables of the decision rule have different weights, which could lead to miscalculations in an acute setting. We have validated a simplified version of the revised Geneva score. ⋯ This study suggests that simplification of the revised Geneva score does not lead to a decrease in diagnostic accuracy and clinical utility, which should be confirmed in a prospective study.
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Randomized Controlled Trial Multicenter Study Comparative Study
Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care.
Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day. ⋯ As an adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome. In practice, this could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics.