Hospital practice (1995)
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Hospital practice (1995) · Apr 2010
ReviewPractice implications of recent clinical trials for the prevention of acute kidney injury in cardiovascular surgery.
Acute kidney injury in patients undergoing cardiovascular surgery is a complex problem with associated increased risks for dialysis, short- and long-term mortality, and progression to end-stage renal disease. Interventions to prevent and treat renal complications in this cohort have seldom been uniformly satisfactory due to the differences in strategies for intervention, drug doses and duration of treatment, baseline renal functions, and population studied. Nonetheless, significant advances have been made and include recognition of the effect of preexisting organ dysfunction on renal outcomes, reassessment of existing therapeutic interventions, and exploration of the feasibility of newer agents to prevent and treat acute kidney injury in cardiovascular surgery patients. This article briefly reviews several of these issues with an emphasis on recent clinical trials in this cohort.
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Hospital practice (1995) · Apr 2010
Intensive insulin therapy in the intensive care unit, hypoglycemia, and cardiovascular mortality.
Several studies have shown that elevated glucose concentrations in patients with acute coronary syndrome and other acute severe illnesses are associated with increased short- and long-term all-cause and cardiovascular mortality (CVM). This has subsequently led to the use of intensive insulin therapy (IIT) to control hyperglycemia. Earlier studies have shown that the prevention of hyperglycemia in acute illness through the use of IIT reduces mortality. ⋯ A strong association between hypoglycemia and adverse cardiovascular events has been observed in several studies. This article will encompass the various studies that have used IIT to treat patients during acute illnesses. Furthermore, it will aim to provide a mechanistic basis for the observed association between hypoglycemia and CVM.
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Hospital practice (1995) · Apr 2010
Approach to non-ST-segment elevation acute coronary syndrome in the emergency department: risk stratification and treatment strategies.
Cardiovascular disease remains a leading cause of morbidity and mortality among Americans. A significant share of all resources for health care is allocated for the diagnosis and treatment of acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Because millions of patients visit emergency departments with chest pain and other symptoms that might indicate ACS, the clinician must be familiar with appropriate diagnostic and therapeutic treatment measures. ⋯ New information has emerged since the release of the 2007 updated ACC/AHA guidelines. The 2009 update of the ACC/AHA guidelines includes new recommendations on antiplatelet therapy, early invasive therapy, and the timing of glycoprotein IIb/IIIa inhibitor therapy for patients with NSTE ACS. Considering this new information during the application of the ACC/AHA guidelines will enhance selecting the optimal treatment for the NSTE ACS patient and ensure appropriate use of health care resources.
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Since the onset of the 2009 influenza A (H1N1) pandemic, the virus has caused significant morbidity and mortality. Most cases of 2009 H1N1 have presented as mild febrile illnesses with cough, sore throat, and occasional gastrointestinal symptoms. Dyspnea has been more commonly associated with the onset of severe pulmonary disease. ⋯ Compared with prior influenza seasons, the need for rescue oxygenation therapy with nitric oxide, prone ventilation, high-frequency oscillation, and extracorporeal membrane oxygenation has increased. Specific medical care with neuraminidase inhibitors and antibiotics for secondary bacterial pneumonia are the mainstays of therapy. With optimal care, mortality rates range from 5% to 7% among those hospitalized and reach approximately 20% among those admitted to the intensive care unit.
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Hospital practice (1995) · Feb 2010
ReviewMethicillin-resistant Staphylococcus aureus in community-acquired and health care-associated pneumonia: incidence, diagnosis, and treatment options.
Pneumonia is one of the leading causes of death in the United States. As health care has expanded into community settings, including outpatient clinics, long-term care facilities, and dialysis centers, a new category of pneumonia-health care-associated pneumonia (HCAP)-has been defined. Bacterial resistance to antibiotics is rising among community-acquired infections, and the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections, particularly the severe form of necrotizing pneumonia mediated by USA 300 in young and healthy individuals, warrants attention. ⋯ The spread of resistant pathogens in the community challenges currently available antimicrobial agents for effective treatment of MRSA-mediated pneumonia. Approval of newer antimicrobials with MRSA activity may provide additional options for the management of pneumonia. This article provides a review of the role of MRSA as a causative pathogen in CAP and HCAP.