David Kitchell, MD
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Differences in Care, Outcomes for In-Hospital Versus Community-Onset Stroke
November 4, 2015
Clinical question: Are there any differences in care and outcomes for in-hospital versus community-onset stroke? Background: In-hospital stroke accounts for 4%-17% of all strokes. Hospitalists and other non-neurological services have to identify and treat subsequent stroke in their patients.
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Oral Steroids Not Inferior to Intravenous Steroids in Multiple Sclerosis Relapses
November 4, 2015
Clinical question: Is there any difference between oral and intravenous methylprednisolone for multiple sclerosis relapses? Background: When relapses of multiple sclerosis occur, studies have shown that intravenous steroids are the treatment of choice.
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Clinical Care Pathway for Cellulitis Can Help Reduce Antibiotic Use, Cost
November 4, 2015
Clinical question: How would an evidence-based clinical pathway for cellulitis affect process metrics, patient outcomes, and clinical cost? Background: Cellulitis is a common hospital problem, but its evaluation and treatment vary widely.
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Can Low-Risk Patients with VTE Be Discharged from ED on Rivaroxabon?
November 4, 2015
Clinical question: Can a low-risk patient newly diagnosed with VTE in the ED be immediately discharged home on a direct factor Xa inhibitor? Background: Studies have shown that rivaroxaban incurs a risk of 2.1% in VTE recurrence and of 9.4% in clinically relevant major and non-major bleeding (in
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Coronary CT Angiography, Perfusion Imaging Effective for Evaluating Patients With Chest Pain
November 4, 2015
Clinical question: When evaluating the intermediate-risk patient with chest pain, should coronary computed tomography angiography (CCTA) be used instead of myocardial perfusion imaging (MPI)? Background: CCTA has been shown in prior randomized controlled trials to save time and money compared to
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ED Lung Ultrasound Useful for Differentiating Cardiogenic from Noncardiogenic Dyspnea
November 4, 2015
Clinical question: Is lung ultrasound a useful tool for helping to diagnose acute decompensated heart failure (ADHF)? Background: Lung ultrasound is an emerging bedside tool that has been promoted to help evaluate lung water content to help clinicians differentiate ADHF from other causes of dyspn
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Chemotherapy Does Not Improve Quality of Life with End-Stage Cancer
November 3, 2015
Clinical question: Does palliative chemotherapy improve quality of life (QOL) in patients with end-stage cancer, regardless of performance status? Background: There is continued debate about the benefit of palliative chemotherapy at the end of life.
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Post-Operative Transfusions after Noncardiac Surgery Associated with Increased Adverse Outcomes
October 29, 2015
Clinical question: Do transfusions affect post-operative outcomes after noncardiac surgery? Background: Studies have demonstrated that a restrictive transfusion strategy is probably superior to a liberal transfusion strategy in many clinical settings.
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Easing the Grieving Process for Families of Patients Dying in the ICU
October 29, 2015
Clinical question: Can we dignify death in the ICU and ease the grieving process by soliciting wishes from patients, families, and care team members? Background: The death of the critically ill patient in the ICU can be dehumanizing and overwhelming for the patient’s family and friends, leading t
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Left Atrial Appendage Closure Favorable Over Warfarin for Atrial Fibrillation
October 29, 2015
Clinical question: Is there a favorable risk-benefit ratio for left atrial appendage closure (LAAC) compared to warfarin for prevention of stroke, systemic embolism, and cardiovascular death in nonvalvular atrial fibrillation? Background: LAAC with the WATCHMAN device was shown to be noninferior