Hospital practice (1995)
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Hospital practice (1995) · Feb 2014
Randomized Controlled TrialEfficacy of ceftaroline fosamil for bacteremia associated with community-acquired bacterial pneumonia.
Few publications of prospective studies have described patient outcomes in community-acquired bacterial pneumonia (CABP)-associated bacteremia. Our objective, in performing this subgroup analysis, was to assess outcomes in subjects with CABP-associated bacteremia in 2 randomized, double-blind clinical studies comparing treatment with ceftaroline fosamil versus ceftriaxone. ⋯ In subjects with CABP-associated bacteremia, ceftaroline fosamil demonstrated similar clinical outcomes at Day 4, end of therapy, and test of cure compared with ceftriaxone.
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Hospital practice (1995) · Feb 2014
New health care measures: emphasis on better management of postsurgical pain and postoperative nausea and vomiting.
Value-based purchasing and the Hospital Consumer Assessment of Healthcare Providers and Systems are tying patient-centric measures to reimbursements. Hospitals should be particularly concerned about management of postoperative pain and control of postoperative nausea and vomiting (PONV), known to adversely impact overall patient satisfaction. Anesthesiologists are likely to be on the frontlines of these transitions. ⋯ Considerable work has been done in PONV to better identify high-risk patients and effective prophylactic agents. Postoperative pain control and preventing PONV are two relatively straightforward ways to respond to new quality metrics. The aim of this review is to raise practitioner awareness of these new quality metrics and provide an overview of the current tools and methods used to improve postoperative pain control and PONV.
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Hospital practice (1995) · Feb 2014
The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism.
New and innovative tools have emerged for the treatment of massive and submassive pulmonary embolism (PE). These novel treatments, when considered alongside existing therapy, such as anticoagulation, systemic intravenous thrombolysis, and open surgical pulmonary embolectomy, have the potential to improve patient outcomes. However, data comparing different treatment modalities are sparse, and guidelines provide only general advice for their use. ⋯ Because various medical and surgical specialties offer different perspectives and expertise, a multidisciplinary approach to patients with massive and submassive PE is required. To address this need, we created a novel multidisciplinary program - the Massachusetts General Hospital (MGH) Pulmonary Embolism Response Team (PERT) - which brings together multiple specialists to rapidly evaluate intermediate- and high-risk patients with PE, formulate a treatment plan, and mobilize the necessary resources to provide the highest level of care. Development of a clinical, educational, and research infrastructure, as well as the creation of a national PERT consortium, will make our experience available to other institutions and serve as a platform for future studies to improve the care of complex patients with massive and submassive PE.
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Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repeated episodes of obstructed (apnea) or reduced (hypopnea) airflow in the upper airway during sleep. Obstructive sleep apnea results in variable arterial oxygen desaturations and arousals leading to sleep fragmentation. Most patients with OSA first come to the attention of a clinician when they complain of daytime sleepiness or when their bed partner reports loud snoring and witnessed episodes. ⋯ Continuous positive airway pressure (CPAP) remains the mainstay of treatment for patients with moderate-to-severe OSA. Oral appliances may be indicated in patients with mild-to-moderate OSA who do not wish to use CPAP. Surgical therapy is generally reserved for selected patients in whom CPAP or oral appliance are not an option.
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Perioperative medicine is an important and rapidly expanding area of interest across multiple specialties, including internal medicine, anesthesiology, surgery, and hospital medicine. A multi-specialty team approach that ensures best possible patient outcomes has fostered collaborative strategies across the continuum of patient care. ⋯ To facilitate this process, we performed a focused review of this literature published in 2012. In this update, we review 9 key articles that potentially impact clinical practice in various areas of perioperative medicine including preoperative testing, cardiovascular medicine, pulmonary care, anticoagulation, and medication management.