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What Are the Strategies for Secondary Stroke Prevention after Transient Ischemic Attack?
December 1, 2015
Case Mr. G is an 80-year-old man with a pacemaker, peripheral artery disease, atrial fibrillation (AF) on warfarin, and tachy-brady syndrome. He presented after experiencing episodes in which he was unable to speak and had weakness on his right side.
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Elderly Patients with Pneumonia Benefit from ICU Care
November 18, 2015
NEW YORK - Elderly patients with pneumonia whose need for intensive care unit (ICU) admission is uncertain actually fare better in the ICU than on the general medical ward, a new study suggests. "Although our results should be confirmed with a randomized trial, clinicians should be aware that man
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Younger Type 2 Diabetics Face Greater Mortality Risks
November 11, 2015
NEW YORK - People with type 2 diabetes are 15 percent more likely to die from any cause and 14 percent more likely to die from a cardiovascular cause than non-diabetics at any given time, according to data from several Swedish registries. The rates are significantly lower than previous estimates.
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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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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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When Should Hospitalists Order Continuous Cardiac Monitoring?
November 4, 2015
Case Two patients on continuous cardiac monitoring (CCM) are admitted to the hospital. One is a 56-year-old man with hemodynamically stable sepsis secondary to pneumonia. There is no sign of arrhythmia on initial evaluation.
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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