Mayo Clinic proceedings
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Mayo Clinic proceedings · Oct 2013
Proton Pump Inhibitors and the Risk for Hospital-Acquired Clostridium difficile Infection.
To examine the relationship between proton pump inhibitor (PPI) usage and nosocomial Clostridium difficile infection (CDI) and determine the duration of therapy at which CDI risk increases. ⋯ The duration of PPI therapy is significantly associated with CDI. Clinicians should strongly consider restricting PPI use given the short exposure time associated with this increased risk.
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Mayo Clinic proceedings · Oct 2013
Review Meta AnalysisEndovascular therapy for acute ischemic stroke: a systematic review and meta-analysis.
To consolidate the evidence from randomized trials for the use of endovascular therapy (ET) in patients with acute ischemic stroke. ⋯ Overall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B recommendation). However, ET showed promise and improved outcomes in patients with severe strokes, but the evidence is limited due to sample size. There is a need for further trials evaluating the role of ET in this high-risk group.
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Mayo Clinic proceedings · Oct 2013
ReviewEtiology and therapeutic approach to elevated lactate levels.
Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. ⋯ We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.
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Worldwide, acupuncture is integral to everyday medical practice. In recent decades its practice has gained popularity in the United States. With increasing evidence of its clinical efficacy, acupuncture is now a widely practiced treatment modality in complementary and integrative medicine. ⋯ Patients want more information from their clinicians about the use of acupuncture and its safety and efficacy. Although many clinicians may recommend acupuncture, they often believe they are not sufficiently informed to discuss acupuncture with their patients. This article provides answers to the most frequently asked questions regarding acupuncture.
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Mayo Clinic proceedings · Oct 2013
Comparative StudyImproving affordability through innovation in the surgical treatment of mitral valve disease.
To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses. ⋯ Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.