Going Green in the ICU In ICU Fri, 22 Mar 2024 The environmental impact of ICUs was in focus at ISICEM 2024. Nicole Hunfeld, a hospital pharmacist at Erasmus Medical Center in the Netherlands, emphasised the need for a sustainable medication process, particularly noting the heightened waste production during the COVID-19 pandemic.  There is an overwhelming level of plastic waste in the ICU, and its environmental implications need to be addresse...

Original Investigation  Anesthesiology April 23, 2024 Cognitive Training for Reduction of Delirium in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial Yu Jiang, Yanhu Xie, Panpan Fang, et al JAMA Netw Open. 2024;7(4):e247361. doi:10.1001/jamanetworkopen.2024.7361 Key Points Question  Does preoperative cognitive training reduce the incidence of delirium during recovery from cor...

Editorial  April 19, 2024 Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing Anurag N. Malani, Preeti N. Malani JAMA. Published online April 19, 2024. doi:10.1001/jama.2024.6554 Approximately half of hospitalized adults in the US receive antibiotics, with pneumonia and urinary tract infection (UTI) being the 2 most frequent indications.1 Estimates suggest about 30% of all antibiotics prescribed in US hospit...

Original Investigation  April 22, 2024 Associations Between Surrogate Markers and Clinical Outcomes for Nononcologic Chronic Disease Treatments Joshua D. Wallach, Samuel Yoon, Harry Doernberg, et al JAMA. Published online April 22, 2024. doi:10.1001/jama.2024.4175 Key Points Question  What is the strength of association between surrogate markers used as primary end points in clinical trials to s...

Vascular Leak in Sepsis In Sepsis Tue, 26 Mar 2024 Sepsis remains a major cause of mortality, accounting for nearly 20% of global deaths. Microcirculatory dysfunction, marked by irregular blood flow and increased permeability of blood vessels, is a characteristic feature of sepsis. This dysfunction can lead to tissue swelling and impaired organ function. Endothelial dysfunction, which is also seen in other acute inflammatory disorders like burns, traum...

April 19, 2024 Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial Shruti K. Gohil, Edward Septimus, Ken Kleinman, et al JAMA. Published online April 19, 2024. doi:10.1001/jama.2024.6259 Key Points Question  Can computerized provider order entry prompts that present patient-specific multidrug-resistant organism (MDRO) risk estimates redu...

ARTICLES| VOLUME 5, ISSUE 4, E390-E399, APRIL 2024 Whole-genome characterisation of Escherichia coli isolates from patients with bacteraemia presenting with sepsis or septic shock in Spain: a multicentre cross-sectional study Natalia Maldonado, Inmaculada López-Hernández, Andrea García-Montaner, et al Lancet Microbe 2024; 5: E390-E399 DOI: https://doi.org/10.1016/S2666-5247(23)00369-5 Summary Background Escherichia coli is the most frequent cause...

Original Investigation  April 19, 2024 Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial Shruti K. Gohil, Edward Septimus, Ken Kleinman, et al JAMA. Published online April 19, 2024. doi:10.1001/jama.2024.6248 Key Points Question  Can computerized provider order entry (CPOE) prompts that provide patient-specific risk estimates for multidrug-resistant organisms (MDROs) reduce e...

Tranexamic Acid for Acute UGIB in Patients With Cirrhosis In ICU Tue, 12 Mar 2024 A recent study aimed to assess the effectiveness and safety of tranexamic acid in treating acute upper gastrointestinal bleeding (UGIB) in patients with cirrhosis, particularly those classified as Child-Turcotte-Pugh (CTP) class B and C. These patients experience systemic and localised fibrinolysis in the mucosa of the oesophagus and stomach. The study included 600 pat...

Original Investigation  Emergency Medicine April 19, 2024 Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021 Dustin G. Mark, Brandon H. Horton, Mary E. Reed, et al JAMA Netw Open. 2024;7(4):e247373. doi:10.1001/jamanetworkopen.2024.7373 Key Points Question  Has the diagnostic evaluation of headache in the emergency department recently changed? Findings  In a cohort study of 21 emer...