Hospital practice (1995)
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Hospital practice (1995) · Feb 2012
Comparative StudyCost analysis of varenicline versus bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua.
In Nicaragua, 30% of current morbidities are associated with tobacco smoking. Tobacco control policy measures have been initiated in this Central American country; however, the population does not have a complete understanding of the long-term consequences of tobacco use. The aim of this study was to compare the direct medical costs of smoking cessation therapies with varenicline, bupropion, nicotine replacement therapy, and unaided cessation in Nicaragua over 5 time horizons: 2, 5, 10, and 20 years, and lifetime. ⋯ The use of a smoking cessation therapy with varenicline would generate long-term savings to Nicaragua's health care institutions of > US$11 million in the lifetime time horizon.
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Hospital practice (1995) · Feb 2012
ReviewPrevention and management of central line-associated bloodstream infections in hospital practice.
In this article aimed at hospitalists, we examine the literature on preventive measures for central line-associated bloodstream infections (CLABSIs) and optimal management once a CLABSI has been established. We focus on a number of core preventive measures and the contemporary approach of bundling these measures for maximal impact in reducing infection rates. We then discuss empiric and pathogen-specific antibiotic therapy, including the role of newer antimicrobial agents, as well as the management of an infected central venous catheter.
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Hospital practice (1995) · Feb 2012
ReviewPosterior reversible encephalopathy syndrome: clinicoradiological spectrum and therapeutic strategies.
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of encephalopathy, headache, visual disturbance, and seizures. In most cases, symptoms present acutely or subacutely in the setting of accelerated hypertension, eclampsia, autoimmune disease, immunosuppressive treatment, or cancer chemotherapy. One essential feature of PRES is the presence of reversible cerebral vasogenic edema that has a predominantly posterior distribution on brain imaging. ⋯ In most cases, both clinical and radiological findings are reversible, although permanent imaging abnormalities and residual neurological sequelae can be seen in a minority of patients. The syndrome is thought to be caused by a breakdown of the blood-brain barrier and an extravasation of the intravascular fluid. Treatment of hypertension and seizures, and withdrawal of causative agents are the mainstays of therapy in PRES.
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Hospital practice (1995) · Feb 2012
ReviewAn update in options for the treatment of pain: a review of new opioid formulations.
In the past 2 decades, there has been a significant increase in the use of opioids for the management of chronic nonmalignant pain. This increase in usage has led to concerns of misuse and abuse of opioids. ⋯ In addition, alternative delivery systems have been developed to provide physicians with more options to provide adequate pain management for those with chronic pain. This article reviews new opioid options for the treatment of pain management and requirements of the Risk Evaluation and Mitigation Strategies program.
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Hospital practice (1995) · Feb 2012
Outpatient antibiotic prescribing in a low-risk veteran population with acute respiratory symptoms.
Acute respiratory tract infections are usually caused by viruses and are self-limited in healthy adults. Providers frequently provide antibiotic prescriptions for sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections, despite no evidence of improved clinical outcomes. We sought to determine: 1) primary care providers' antibiotic prescribing practices for acute respiratory tract infections in low-risk outpatient veterans and 2) short-term health outcome differences between those receiving and not receiving an antibiotic prescription. ⋯ Many low-risk veterans received antibiotics for acute respiratory tract infections despite guidelines indicating that symptomatic treatment is sufficient for most patients. Novel interventions are required to reduce unnecessary and potentially harmful antibiotic use for low-risk outpatients with acute respiratory complaints.