The American journal of medicine
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Rapid clinical decision-making on further management of patients with out-of-hospital cardiac arrest may be challenging. Recently, a "futility" score (NULL-PLEASE) incorporating multiple adverse resuscitation features (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood PH <7.2, Lactate >7.0 mmol/L, End-stage chronic kidney disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) has been proposed to help identify patients with out-of-hospital cardiac arrest unlikely to survive; however, external independent score validation is lacking. ⋯ The NULL-PLEASE score was predictive for early in-hospital outcome of out-of-hospital cardiac arrest, with a 3.3-fold greater odds for fatal outcome at the score values of ≥5.
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Interactive Tutorial
Severe Asthma and the Primary Care Provider: Identifying Patients and Coordinating Multidisciplinary Care.
Without proper care, patients with severe forms of asthma face substantial medical risks, marked reductions in quality of life, and other significant disease-related burdens. Therefore, it is essential that primary care clinicians and other healthcare providers are adept at identifying cases of severe asthma on the basis of symptom control, exacerbation risks, and the need for relatively aggressive treatment regimens (eg, high-dose inhaled corticosteroids with long-acting controller medications or frequent oral corticosteroid use). ⋯ Expert primary care and specialist faculty have highlighted strategies to identify cases of severe asthma, appropriate referral pathways for these individuals, and considerations on integrating patients' perspectives into clinical decision making across the continuum of care (access to an accredited educational program on these topics is available at http://courses.elseviercme.com/pcp/687). Additionally, this online program is a component of a larger platform of education activities and consolidated clinical resources designed to improve the care of patients with respiratory disorders (http://respiratorycme.elsevierresource.com/).
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Spinal epidural abscesses are uncommon but potentially devastating infections that often elude early diagnosis. An increasing incidence has been suggested; however, few contemporary data are available regarding risk factors and epidemiologic trends over time. ⋯ The incidence of spinal epidural abscesses may be increasing, with the present study demonstrating a ≥5-fold higher rate compared with historical data. Although the outcome in most cases was favorable, spinal epidural abscesses continue to cause substantial morbidity and mortality and should remain a "not to be missed diagnosis."