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CT Angiography Effect on Outcome for Patients with Symptomatic Chest Pain
June 8, 2015
Clinical question: Does CT angiography (CTA) improve clinical outcomes in patients with new-onset stable chest pain more than functional testing? Background: Chest pain is a common clinical problem, and multiple noninvasive tests are available to detect coronary artery disease (CAD).
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Early Goal-Directed Therapy for Sepsis Offers No Benefit Over Usual Care
June 8, 2015
Background: Recent trials (ARISE, ProCESS) showed EGDT provided no mortality benefit over usual care. Questions remain about the effectiveness of intensive monitoring protocols, as well as the evolution of what constitutes usual care.
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NSAID Use by Patients on Antithrombotic Therapy Has Bleeding, Cardiovascular Risks
June 8, 2015
Clinical question: Is there increased risk of bleeding or cardiovascular events when using NSAIDs while on antithrombotic therapy for secondary cardiovascular prevention? Background: NSAIDs are among the most commonly used medications, despite the fact that individual NSAIDs have been associated
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Treatment of Patients with Atrial Fibrillation, Low CHA2DS2-VASc Scores
June 8, 2015
Clinical question: Is anticoagulation beneficial for patients with atrial fibrillation (Afib) and low CHA2DS2-VASc score (0 for men, 1 for women) or for those with one additional stroke risk factor? Background: Guidelines nearly universally recommend anticoagulation for patients with a CHA2DS2-VA
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Research Review: Ticagrelor for Post-Myocardial Infarction
June 8, 2015
Clinical question: Is ticagrelor for secondary prevention indicated for more than one year after myocardial infarction (MI)? Background: The efficacy and safety of ticagrelor combined with low-dose aspirin more than one year after MI for secondary prevention has not previously been established.
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How Should a Patient with Pulmonary Hypertension Be Evaluated, Managed?
June 1, 2015
Case A 62-year-old female with no significant past medical history presents with three weeks of progressive dyspnea on exertion and bilateral lower extremity edema. Family members report that the patient often snores and “gasps for air” during sleep.
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D-Dimer Not Reliable Marker to Stop Anticoagulation Therapy
May 5, 2015
Clinical question: In patients with a first unprovoked VTE, is it safe to use a normalized D-dimer test to stop anticoagulation therapy? Background: The risk of VTE recurrence after stopping anticoagulation is higher in patients who have elevated D-dimer levels after treatment.
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Noninvasive Ventilation Improves Outcomes for COPD Inpatients
May 5, 2015
Clinical question: Do patients hospitalized with acute COPD exacerbations have improved outcomes with noninvasive ventilation (NIV) compared to those treated with invasive mechanical ventilation (IMV)? Background: Previous studies have shown that in select patients, NIV has a mortality benefit ov
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Bova Risk Model Predicts 30-Day Pulmonary Embolism-Related Complications
May 5, 2015
Clinical question: Can the Bova risk model stratify patients with acute PE into stages of increasing risk for 30-day pulmonary embolism (PE)-related complications? Background: The Bova score is based on four variables assessed at the time of PE diagnosis: heart rate, systolic blood pressure, card
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Intracranial Bleeding Risk for Head Injury Patients on Warfarin
May 5, 2015
High bleeding rates reported for patients taking warfarin after minor, minimal head injuries