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ProMISe Trial Adds Skepticism to Early Goal-Directed Therapy for Sepsis
July 6, 2015
Clinical question: Does EGDT for sepsis reduce mortality at 90 days compared with standard therapy? Background: EGDT is recommended in international guidelines for the resuscitation of patients presenting with early septic shock; however, adoption has been limited, and uncertainty about its effec
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Predictors of Sepsis, Septic Shock in Emergency Department Patients
July 6, 2015
Clinical question: Among patients presenting to the ED with sepsis, who will progress to septic shock within 48 hours of arrival? Background: This study describes patient characteristics present within four hours of ED arrival associated with developing septic shock between four and 48 hours afte
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Individualized Patient Care Plans Impact Utilization, Costs
July 6, 2015
Clinical question: Does developing individualized care plans in the inpatient setting reduce unnecessary ED visits, hospital readmissions, and hospital costs for frequent users of hospital services? Background: High utilizers of healthcare services are recognized as medically and psychosocially c
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Revised Guideline for Adult Bacterial Meningitis Improves Treatment, Outcome
July 6, 2015
Clinical question: Did revision of guidelines recommending computerized tomography (CT) scan before lumbar puncture (LP) reduce delayed treatment of acute bacterial meningitis (ABM)? Background: Guidelines were introduced in Sweden in 2004 identifying patients at risk for LP-induced brain herniat
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Multifaceted Intervention to Decrease Frequency of Common Labs
July 6, 2015
Clinical question: Can a multifaceted intervention decrease the frequency of unnecessary labs? Background: Implementation of a multifaceted QI intervention within a large, community-based hospitalist group to decrease ordering of common labs. Study design: QI project. Setting: Large, commun
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When Do Patient-Reported Outcome Measures Inform Readmission Risk?
July 6, 2015
Clinical question: Among patients discharged from the hospital, how do patient-reported outcome (PRO) measures change after discharge, and can they predict readmission or ED visit? Background: Variables to predict 30-day rehospitalizations of discharged general medical patients have been looked i
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PRONE Score Can Track Medicolegal Complaints
July 6, 2015
Clinical question: Is there a standardized way to identify doctors at high risk of incurring repeated medicolegal events? Background: Medicolegal agencies react to episodes of substandard care rather than intervening to prevent them due to lack of robust prediction tools at the individual practit
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Novel Rapid Response Team Can Decrease Non-ICU Cardiopulmonary Arrests, Mortality
July 1, 2015
Clinical question: Can novel configured rapid response teams (RRTs) improve non-ICU cardiopulmonary arrest (CPA) and overall hospital mortality rate? Background: RRTs are primarily executed in hospital settings to avert non-ICU CPA through early detection and intervention.
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SIRS Criteria Could Identify More Patients with Severe Sepsis
June 8, 2015
Clinical question: Does inclusion of two or more SIRS criteria in the definition of severe sepsis accurately identify patients with higher mortality risk, as compared with patients with infection and organ failure but with fewer than two SIRS criteria? Background: SIRS describes dysregulation of
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Trimethoprim-Sulfamethoxazole Use in Older Patients Taking Spironolactone
June 8, 2015
Clinical question: Does trimethoprim-sulfamethoxazole (TMP-SMX) increase the risk of sudden death in older patients taking spironolactone? Background: TMP-SMX increases the risk of hyperkalemia when used with spironolactone; however, previous studies have not examined whether the drug interaction