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EDITORIAL SEPSIS: IMPLICATIONS OF THE IMPRECISE SCIENCE AND THE ANTIBIOTIC TREATMENT THEREOF I suspect one of the most influential articles of our time is the one by Anand Kumar and colleagues demonstrating that delayed antibiotic administration can lead to morbidity and mortality [1]. Not only has it been quoted over 1000 times, this single article has changed clinical practice. How often is it quoted "time to antibiotics" is important or a quality indicator of a syst...
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Defining Septic Shock Manu Shankar-Hari, Mervyn Singer JAMA 2016; 316: 456 In Reply 作者回复 Sepsis-3 defines septic shock as a life-threatening, generalized form of acute circulatory dysfunction (represented as vasopressor-dependent hypotension) associated with inadequate oxygen utilization (represented as hyperlactatemia), but with the important caveat of adequate fluid resuscitation. This definition has strong similarities to the consensus recommendations [1] cited by ...
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Defining Septic Shock Glenn Hernández, MD, PhD Flávia Machado, MD
Gustavo Ospina-Tascón, MD, PhD JAMA 2016; 316: 454-455 To the Editor 致编辑 The proposed new definition of septic shock, part of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), requires the simultaneous presence of hypotension and hyperlactatemia for making the diagnosis, instead of hypotension or hyperlactatemia. [1] In our opinion, this is a step backward compared wit...
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Comment & Response | July 19, 2016 Statins to Reduce Acute Kidney Injury After Cardiac Surgery—Reply Frederic T. Billings IV, Nancy J. Brown. JAMA. 2016;316(3):349-350. doi:10.1001/jama.2016.6148 In Reply 回复 Many patient characteristics may affect incidence of AKI following cardiac surgery, including exposure to iodinated radiocontrast agents and use of cardiopulmonary bypass. Aspirin use is common in patients presenting for cardiac surgery, and most patients are ...
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Clinical Criteria to Identify Patient With Sepsis Christopher W. Seymour, Derek C. Angus JAMA 2016; 316: 454   In Reply 作者回复 Both letters suggest misunderstandings about the scientific goal of the task force, which was to explore the predictive validity of diagnostic criteria for sepsis. There is no gold standard for sepsis, which precludes simple measures of validity based on the presence of true positives (cases with sepsis) and true negatives (controls without sepsi...
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Clinical Criteria to Identify Patients With Sepsis 鉴别全身性感染患者的临床标准 Anil N. Makam, Oanh Kieu Nguyen JAMA 2016; 316: 453 To the Editor 致编辑 Dr Seymour and colleagues [1] assessed the predictive validity of various clinical criteria to identify patients with sepsis. However, their conclusion that the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores are more clinically useful than the systemic inflammatory response syndr...
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Medscape Medical News Calf DVT: Anticoagulation Lowers Risks, but at a Cost Veronica Hackethal, MD July 22, 2016 Anticoagulation for an isolated calf deep vein thrombosis (DVT) appears to decrease the risk for pulmonary embolism (PE) or proximal DVT by two thirds, but quadruples the risk of bleeding, according to a study published online July 20 in JAMA Surgery. 根据7月20日在JAMA Surgery在线发表的一项研究,针对单纯小腿深静脉血栓形成(DVT)进行抗凝治疗能够使肺动脉栓塞(PE)或...
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Comment & Response | July 19, 2016 Statins to Reduce Acute Kidney Injury After Cardiac Surgery Pingping Yang, Gaosi Xu, MD. JAMA. 2016;316(3):349. doi:10.1001/jama.2016.6134. To the Editor 致编辑 Dr Billings and colleagues1 tested the hypothesis that statins (short-term use of high-dose atorvastatin) would reduce the incidence of acute kidney injury (AKI) following cardiac surgery. The results did not support the initiation of atorvastatin therapy to prevent AKI fol...
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Comment & Response | July 19, 2016 Incidence of Acute Respiratory Distress Syndrome—Reply Giacomo Bellani, Tai Pham, John Laffey. JAMA. 2016;316(3):347. doi:10.1001/jama.2016.6471. In Reply Drs Siempos and Berlin are concerned that the computer algorithm may have overestimated the incidence of ARDS reported in our study. We used objective data (eg, arterial partial pressure of oxygen to fraction of inspired oxygen ratio, presence of an ARDS risk factor, presence of ...
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Comment & Response | July 12, 2016 Management of Community-Acquired Pneumonia—Reply Jonathan S. Lee, Daniel L. Giesler, Michael J. Fine JAMA. 2016;316(2):222-223. doi:10.1001/jama.2016.5028. In Reply Dr Paul and colleagues question our decision to exclude observational studies that did not perform statistical adjustment for illness severity or comorbidity when assessing the association between time to initiate antibiotic therapy and mortality. All studies meeting el...
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