Hospital practice (1995)
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A number of factors have recently coalesced to bring hormone testing and treatment to the field of pain care. Uncontrolled, severe pain as well as opioid drugs have a profound impact on the endocrine system. Because pain is a potent stressor, it initially causes pituitary, adrenal, and gonadal hormones to elevate in the serum. ⋯ Although not a substitute for opioids, some hormone replacements may minimize their use. We know that the central nervous system produces a group of hormones called neurohormones whose natural function is neuroprotection and neurogenesis. Their clinical use in centralized pain states is new, and early reports indicate that they may have considerable benefit for treatment.
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Hospital practice (1995) · Dec 2014
Implementation of a mandated venous thromboembolism clinical order set improves venous thromboembolism core measures.
Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, is a major cause of morbidity and mortality. It results in approximately 300 000 deaths in the United States each year, and two thirds of VTE events are hospital acquired. However, VTE prophylaxis for hospitalized patients remains suboptimal. ⋯ This study demonstrates that a mandated physician VTE order set ensures that nearly all patients will be stratified for VTE risk and provided with prophylaxis based on their risk category. Adhering to the evidence-based clinical practice guidelines from the American College of Chest Physicians is effective in improving prophylaxis and decreasing the rate of hospital-acquired VTE in hospitalized patients, and in decreasing the rate of preventable VTE cases based on the Joint Commission's core measure 6.
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Hospital practice (1995) · Oct 2014
ReviewPerioperative cardiovascular medicine: an update of the literature 2013-2014.
Perioperative medicine is an important and rapidly expanding area of interest across multiple specialties, including internal medicine, anesthesiology, surgery, cardiology, and hospital medicine. A multispecialty team approach that ensures the best possible patient outcomes has fostered collaborative strategies across the continuum of patient care. ⋯ To facilitate this process, the authors performed a focused review of this literature published in 2013 and early 2014. In this update, key articles are reviewed that potentially impact clinical practice in perioperative cardiovascular risk prediction and risk management.
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Hospital practice (1995) · Oct 2014
Randomized Controlled TrialImpact of levels of simulation fidelity on training of interns in ACLS.
Identifying the modality and fidelity of simulation that offers the greatest benefit to the learner is critical to Advanced Cardiac Life Support (ACLS) training. Our hypothesis is that participants who receive ACLS training on high-fidelity mannequins will perform better than those trained on low-fidelity mannequins. ⋯ Overall, there was no difference among the 3 groups in test scores or perceived instructor or course quality; however, subjects trained on high-fidelity mannequins performed better than those trained on mid-fidelity with respect to megacode performance.
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Hospital practice (1995) · Oct 2014
Observational StudyIs glycemic control of the critically ill cost-effective?
Intensive monitoring of blood glucose levels and treatment of hyperglycemia have been associated with significant improvements in morbidity and mortality in the critically ill. In contrast to the large prospective and observational body of data relating glycemic control and clinical outcomes, the financial impact of glycemic control implementation has not been as well described. This article details data from interventional trials of intensive insulin therapy; investigations that relate dysglycemia to morbidity, particularly intensive care unit (ICU)-acquired infections and increased ICU length of stay; and evaluations of the attributable cost of nosocomial infection in order to construct a sensitivity analysis of the net economic impact of glycemic control. It concludes that glycemic control is associated with positive financial outcomes, even using very conservative assumptions, and provides the reader with an automated spreadsheet to estimate the financial implications of glycemic control using assumptions based on locally derived data.