News
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.
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Bedside Attention Tests May Be Useful in Detecting Delirium
February 2, 2015
Clinical question: Are simple bedside attention tests a reliable way to routinely screen for delirium? Background: Early diagnosis of delirium decreases adverse outcomes, but it often goes unrecognized, in part because clinicians do not routinely screen for it.
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Medical Consultants Provide Benefits for Hospitalized Surgical Patients
January 7, 2015
Clinical question: How are medical consultants used for hospitalized surgical patients, and how does this vary among regions and hospitals in the U.S.? Background: Reimbursement for surgical procedures is moving toward bundled payments, making it increasingly important to understand the use of re
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Fluid Resuscitation in Sepsis: Systematic Review and Network Meta-Analysis
January 7, 2015
Clinical question: Is there any difference between different resuscitative fluids (crystalloids or colloids) on mortality in critically ill sepsis patients? Background: Fluid resuscitation, in addition to antibiotics and source control, is a cornerstone of initial management of sepsis.
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Hip Fracture Adverse Outcomes Among Nursing Home Residents
January 7, 2015
Clinical question: What are the risk factors for mortality and functional decline following hip fracture among nursing home residents? Background: Little is known about the survival and functional outcomes of nursing home residents who sustain hip fracture.
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Post-Operative Pneumonia Reduced by Standardization in Noncritical Surgical Patients
January 7, 2015
Clinical question: What is the long-term effectiveness of a standardized pneumonia prevention program among surgical noncritical inpatients? Background: Few studies have focused on the prevention of post-operative pneumonia in non-mechanically ventilated patients.
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Aspirin vs. Anticoagulation for VTE Prevention in Lower Extremity Orthopedic Surgery
January 7, 2015
Clinical question: What are rates of venous thromboembolism (VTE) and bleeding among adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery? Background: VTE is common after hip fracture surgery and elective total knee/hip arthroplasty.
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Depletive Fluid Management Strategy During Weaning from Mechanical Ventilation Can Lower VAP Rates
January 7, 2015
Clinical question: What is the benefit associated with a depletive fluid management strategy on ventilator-associated complication (VAC) and ventilator-associated pneumonia (VAP) during weaning from mechanical ventilation? Background: VAP is common in the ICU.
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Limitations of Best Practice Alerts on Curbing Blood Transfusions
January 7, 2015
Clinical question: Why do providers continue to transfuse blood products outside of recommended guidelines, despite best practice alerts (BPAs)? Background: There is evidence that a restrictive approach to blood transfusion versus a liberal approach is beneficial in reducing cost, morbidity, and