Mayo Clinic proceedings
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In February 2016, Dr. Hsiu-Ying Tseng was sentenced to 30-years to life in prison after a jury found her guilty of second-degree murder for three patient drug overdose deaths in California. For the first time in American history, a physician was held criminally liable for the murder of a patient by means of extreme recklessness in opioid prescribing. ⋯ Prescribers can take a number of steps to minimize criminal liability concerns, including following available guidelines, such as those recently issued on opioid prescribing for chronic pain by the Centers for Disease Control and Prevention. While outlier physicians like Dr. Tseng may meet the standards for criminal liability, criminal prosecution may do little to curb prescription opioid abuse—an epidemic that calls for more upstream prevention measures.
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There are a number of changes underway in modern clinical bacteriology laboratories. Panel-based molecular diagnostics are now available for numerous applications, including, but not limited to, detection of bacteria and select antibacterial resistance markers in positive blood culture bottles, detection of acute gastroenteritis pathogens in stool, and detection of selected causes of acute meningitis and encephalitis in the cerebrospinal fluid. Today, rapid point-of-care nucleic acid amplification tests are bringing the accuracy of sophisticated molecular diagnostics closer to patients. ⋯ Laboratory automation, common in chemistry laboratories, is now available for clinical bacteriology laboratories. Finally, there are several technologies under development, such as rapid phenotypic antimicrobial susceptibility testing, whole-genome sequencing, and metagenomic analysis for the detection of bacteria in clinical specimens. It is helpful for clinicians to be aware of the pace of new development in their bacteriology laboratory to enable appropriate test ordering, to enable test interpretation, and to work with their laboratories and antimicrobial stewardship programs to ensure that new technology is implemented to optimally improve patient care.
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Mayo Clinic proceedings · Oct 2016
Serum Potassium, Mortality, and Kidney Outcomes in the Atherosclerosis Risk in Communities Study.
To investigate the association between serum potassium, mortality, and kidney outcomes in the general population and whether potassium-altering medications modify these associations. ⋯ Higher values of serum potassium were associated with a higher risk of mortality in the general population. Lower levels of potassium were associated with adverse kidney outcomes and mortality among participants not taking potassium-wasting diuretics.
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Mayo Clinic proceedings · Oct 2016
Diet Quality and Mortality Risk in Metabolically Obese Normal-Weight Adults.
To examine the associations among the Dietary Approaches to Stop Hypertension (DASH)-style diet, the Healthy Eating Index (HEI), and mortality risk in metabolically obese normal-weight (MONW) adults. ⋯ Higher diet quality scores were associated with lower risk of mortality in normal-weight individuals with metabolic abnormalities.
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Mayo Clinic proceedings · Oct 2016
Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis.
To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. ⋯ Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.