Internal and emergency medicine
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Pneumonia is an important cause of mortality in intensive care units. The incidence of pneumonia in such patients ranges between 7 and 40%, and the crude mortality from ventilator associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to pneumonia, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths. ⋯ A combination of topical and systemic prophylactic antibiotics reduces respiratory tract infections and overall mortality in adult patients receiving intensive care. A treatment based on the use of topical prophylaxis alone reduces respiratory infections, but not mortality. The risk of occurrence of resistance as a negative consequence of antibiotic use was appropriately explored only in the most recent trial by de Jonge, which did not show any such effect.
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With the arrival of point-of-care cardiac marker determination, emergency physicians may be able to arrive at the diagnosis of cardiac ischemia faster than ever before. However, these tests must be used with care, as a lack of understanding about when and how they should be obtained is important both for good patient care and to avoid medicolegal pitfalls. This report reviews risk stratification of patients who present with chest pain, provides an overview of cardiac markers and literature supporting their use, and concludes with a practice guideline for the utilization of cardiac markers in the emergency department.
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Comparative Study
A comparison between the efficacy of lectures given by emergency and non-emergency physicians in an international emergency medicine educational intervention.
The Tuscan Emergency Medicine Initiative is an international collaboration designed to create a sustainable emergency medicine training and qualification process in Tuscany, Italy. Part of the program involves training all emergency physicians currently practicing in the region. This qualification process includes didactic lectures, clinical rotations and practical workshops for those with significant emergency department experience. Lectures in the didactic portion were given by both emergency medicine (EM) and non-EM faculty. We hypothesized that faculty who worked clinically in EM would give more effective lectures than non-EM faculty. ⋯ When teaching EM, evaluations of lectures in this training intervention were higher for lectures given by EM faculty than by non-EM faculty.