Courtney O’Rourke, DO
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Prophylaxis and Treatment of Venous Thromboembolism in Cancer Patients
January 12, 2016
The Case A 62-year-old woman with a past medical history significant for metastatic adenocarcinoma of the lung presents to the ED with complaints of fever and shortness of breath. She has recently completed her first cycle of carboplatin, pemetrexed, and bevacizumab.
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Impact of Peri-Operative Beta Blockers on Cardiovascular Morbidity, Mortality
February 2, 2015
Clinical question: What is the impact of peri-operative beta blockers on cardiovascular morbidity and mortality in patients undergoing surgery under general anesthesia? Background: Studies evaluating the effects of peri-operative beta blockers on cardiovascular outcomes have yielded conflicting r
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Resident Handoff Program Associated with Improved Inpatient Outcomes
February 2, 2015
Clinical question: Does the implementation of a handoff program lead to improved patient safety? Background: Communication failure at the time of handoff of patient care from one resident to another is a significant cause of medical errors.
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Automated Early Warning, Response System Could Improve Sepsis Outcomes
February 2, 2015
Clinical question: Does implementation of an electronic sepsis detection and response system improve patient outcomes? Background: It is known that interventions such as goal-directed resuscitation and antibiotics can reduce sepsis mortality, but their effectiveness depends on early administratio
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Intermittent, Continuous Proton Pump Inhibitor Therapies Are Comparable
February 2, 2015
Clinical question: Is intermittent proton pump inhibitor (PPI) therapy comparable to the current standard of continuous PPI infusion for high risk bleeding ulcers? Background: Current guidelines recommend an intravenous bolus dose of a PPI followed by continuous PPI infusion for three days after
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VTE Treatment Strategies Don’t Differ in Efficacy, Safety
February 2, 2015
Clinical question: Are there differences in efficacy and safety between the treatment strategies for acute venous thromboembolism (VTE)? Background: There are a number of treatment strategies available for acute VTE.
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Antimicrobial Prescribing Common in Inpatient Setting
February 2, 2015
Clinical question: What is the daily prevalence of antimicrobial use in acute-care hospitals? Background: Inappropriate antimicrobial use is associated with adverse events and contributes to the emergence of resistant pathogens. Strategies need to be implemented to reduce inappropriate use.
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Hemoglobin Transfusion Threshold Not Associated with Differences in Morbidity, Mortality Among Patients with Septic Shock
February 2, 2015
Clinical question: Is there a difference in 90-day mortality and other outcomes when a lower versus higher hemoglobin threshold is used for blood transfusions in ICU patients with septic shock? Background: Patients with septic shock frequently receive blood transfusions.
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Early, Goal-Directed Therapy Doesn’t Improve Mortality in Patients with Early Septic Shock
February 2, 2015
Clinical question: Does early goal-directed therapy (EGDT) improve mortality in patients presenting to the ED with early septic shock? Background: EGDT (achieving central venous pressure of 8-12 mmHg, superior vena oxygen saturation (ScvO2) of > 70%, mean arterial pressure ≥ 65mmHg, and urine
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Arterial Catheter Use in ICU Doesn’t Improve Hospital Mortality
February 2, 2015
Clinical question: Does the use of arterial catheters (AC) improve hospital mortality in ICU patients requiring mechanical ventilation? Background: AC are used in 40% of ICU patients, mostly to facilitate diagnostic phlebotomy (including arterial blood gases) and improve hemodynamic monitoring.