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Editorial September 25, 2018 Treatment Algorithms for Staphylococcal Bacteremia: Improving Clinical Care and Enhancing Antimicrobial Stewardship Eli N. Perencevich, Preeti N. Malani JAMA. 2018;320(12):1243-1244. doi:10.1001/jama.2018.13315 Antimicrobial resistance is among the most important threats to human health. Lost in the episodic outbreaks of emerging pathogens such as 2009 H1N1 influenza, Ebola, and Zika virus has been the steady increase in resistance to...
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Viewpoint September 14, 2018 Antibiotics for Sepsis—Finding the Equilibrium Michael Klompas, MD, Thierry Calandra, Mervyn Singer, et al JAMA. Published online September 14, 2018. doi:10.1001/jama.2018.12179 Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock.1 This recommendation, and mandates t...
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Late parenteral nutrition beneficial to undernourished critically ill children In undernourished critically ill children, withholding parenteral nutrition (PN) for one week was clinically superior to early PN, according to a subanalysis of the Pediatric Early vs. Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC) randomised clinical trial. "In this subanalysis of 289 undernourished critically ill children with insufficient enteral nutritional intake, withholding...
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"Fluid overload" - a poorly-defined term that should be avoided Clinicians examining an oedematous patient are wont to say that the patient has “fluid overload” or “hypervolemia” or both and propose fluid restriction and/or diuretics as the logical strategy, when often during the acute phases of resuscitation from circulatory shock this approach may be inappropriate, says an editorial published in the journal Critical Care. A fundamental determinant of cardiac output an...
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News > Medscape Medical News > Neurology News New AI Platform Diagnoses Brain Disease in Seconds George W. Citroner August 15, 2018 An artificial intelligence (AI) platform accurately identifies acute neurologic events, such as stroke, from CT scans in as little as 1.2 seconds, new research suggests. If the findings are confirmed, this technology would radically speed the triage process by immediately alerting physicians to critical findings that may otherwise hav...
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PCT-guided antibiotic treatment improves outcomes in sepsis patients Procalcitonin (PCT)-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and reduced antibiotic treatment duration, according to results of a new meta-analysis published in the journal Critical Care. Early identification of sepsis and appropriate initial management including the start of antibiotic treatment and fluid resuscitation improves outcomes....
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ICU Management & Practice, Volume 17 - Issue 3, 2017 Innovations in monitoring: from smartphones to wearables There are over 320 million inpatient surgical procedures worldwide (Weiser et al. 2015). We learnt from the recent International Surgical Outcomes (ISOS) Study (ISOS Group 2016) that around 17% of these patients develop one or more complications, and among them, that 2.8% die from their complications. One can therefore estimate that around 1.5 million patients...
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Perspective > Medscape Oncology > Prasad on Medicine COMMENTARY When Do We Need Randomized Controlled Trials, and When Can We Manage Without Them? Vinay Prasad, MD, MPH August 07, 2018 Recently I watched a debate unfold on Twitter over whether we should run a randomized controlled trial (RCT) of the inferior vena cava (IVC) filter for patients with a venous thromboembolism (VTE) and a contraindication to anticoagulation.[1] Like witnessing a car accident, I was ho...
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ICU Management & Practice, Volume 17 - Issue 1, 2017 ARDS and Precision Medicine What is the path forward for treatment of acute respiratory distress syndrome (ARDS)? Is it big trials (favoured by clinical scientists) or further insight into disease physiopathology (favoured by basic scientists)? Or both? Funding resources are limited and the debate is wide open. In the post-genomic era, a new direction is needed. On 20 January 2015, then U.S. President Barack Obama ...
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ICU Management & Practice, Volume 17 - Issue 2, 2017 How to Run Successful Rounds in the Intensive Care Unit Dr. Katherine Nugent, MD Critical Care Fellow Departments of Emergency Medicine and Anesthesiology and Emory Critical Care Center Emory University School of Medicine and Emory Healthcare Atlanta, GA, USA Rounds in the intensive care unit (ICU) allow for scheduled discussions in which healthcare providers review clinical information and develop care plans for c...
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