Clinical

Delirium, Falls Reduced by Nonpharmacological Intervention

Clinical question: Are multicomponent, nonpharmacological interventions effective in decreasing delirium and falls? Background: Delirium is prevalent among elderly hospitalized patients and is associated with increased morbidity, length of stay, healthcare costs, and risk of institutionalization. Multicomponent nonpharmacologic interventions have been used to prevent incident delirium in the elderly, but data regarding their effectiveness and impact… [Read More]

Bridging Anticoagulation for Patients with Atrial Fibrillation

Bridging prior to procedures linked with higher bleeding risk, adverse outcomes

Restrictive Transfusion Strategy No Benefit for Cardiac Surgery Patients

Clinical question: Does a restrictive transfusion strategy improve outcomes following nonemergent cardiac surgery? Bottom line: For patients undergoing cardiac surgery, using a restrictive transfusion strategy with a hemoglobin threshold of 7.5 g/dL does not decrease serious infections or ischemic events and may lead to increased all-cause mortality at 90 days. (LOE = 1b) Reference: Murphy… [Read More]

Endovascular Treatment for Acute Ischemic Stroke Decreases Mortality

Clinical question: Does endovascular treatment improve outcomes for patients with acute ischemic stroke? Bottom line: For patients with acute ischemic stroke and imaging that suggests a proximal artery occlusion with evidence of good collateral circulation, the use of rapid endovascular treatment improves functional outcomes and reduces mortality. (LOE = 1b) Reference: Goyal M, Demchuk AM,… [Read More]

Pituitary gland in the brain. Computer artwork of a person's head showing the left hemisphere of the brain inside. The highlighted area (center) shows the pituitary gland. The pituitary gland is a small endocrine gland about the size of a pea protruding off the bottom of the hypothalamus at the base of the brain. It secretes hormones regulating homoeostasis, including trophic hormones that stimulate other endocrine glands. It is functionally connected to and influenced by the hypothalamus.

When Should Hypopituitarism Be Suspected?

Case A 53-year-old woman with a history of a suprasellar meningioma resected nine years ago with recurrence of a 4.5×2 cm mass one year ago and recent ventriculoperitoneal (VP) shunt placement for hydrocephalus presented with altered mental status (AMS) and hallucinations. She was admitted for radiation therapy to the mass. The patient had little improvement… [Read More]

High-Dose Barium Enemas Prevent Recurrent Diverticular Bleeding

Clinical question Does barium impaction therapy using high-dose barium enemas prevent recurrent diverticular bleeding? Bottom line This small study demonstrates that barium impaction therapy using high-dose barium enemas is safe and effective at reducing the rate of recurrent diverticular bleeding. Note that this study was conducted in Japan, where the rate of rebleeding for patients… [Read More]

Steroids May Benefit Patients With Severe CAP and High CRP Levels

Clinical question: Do steroids improve outcomes in patients with severe community-acquired pneumonia and a high inflammatory response? Bottom line In patients with severe community-acquired pneumonia (CAP) who have elevated levels of C-reactive protein (CRP), a short course of methylprednisolone decreases treatment failure, mainly by reducing radiographic progression of pulmonary infiltrates within 3 days to 5… [Read More]

4.2.7

Palliative Care and Last-Minute Heroics

4/8/15 Session: Last-Minute Heroics and Palliative Care – Do They Meet in the Middle? HM15 Presenter: Tammie Quest, MD Summation: Heroics– a set of medical actions that attempt to prolong life with a low likelihood of success. Palliative care– an approach of care provided to patients and families suffering from serious and/or life limiting illness;… [Read More]

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Hot Topics in Practice Management; HM15 Session Analysis

HM15 Session  RAPID FIRE PANEL: Hot Topics in Practice Management Updates on Key Issues, Including the Key Characteristics of an Effective HMG HM15 Presenters: Roy Sittig MD SFHM, Jeffrey Frank MD MBA, Jodi Braun Summation: Speakers covered timely topics regarding the Accountable Care Act, namely Medicaid Expansion and Bundled Payment arrangements; and reviewed the seminal paper… [Read More]

Hospital Management of Patients Presenting with ALTE: An Evidence-Based Approach

In a presentation on guidelines for ALTE, Jack Percelay, SHM representative to the AAP Subcommittee, provided further insight to the work that has been done for the clinical entity known as apparent life-threatening events (ALTE) since a consensus statement was put forward by the NIH in 1986. The original statement emphasized 4 possible features to constitute… [Read More]