Annals of internal medicine
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Randomized Controlled Trial Multicenter Study
Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.
Little is known about the efficacy and safety of renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function. ⋯ Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. The study findings favor a conservative approach to patients with ARAS, focused on cardiovascular risk factor management and avoiding stenting.
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Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is 1 of the hospital-acquired complications chosen by the Centers for Medicare & Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help readers understand the potential consequences of the recent CMS rule changes, the authors examine the preventability of catheter-associated infection, review the CMS rule changes regarding catheter-associated urinary tract infection, offer an assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. ⋯ However, even if forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection is commendable, these efforts will have opportunity costs and may have unintended consequences. Therefore, how hospitals and physicians respond to the CMS rule changes must be monitored closely.
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Practice Guideline
Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement.
Reaffirmation of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for hepatitis B virus hepatitis B virus infection in pregnancy. ⋯ Screen for hepatitis B virus infection in pregnant women at their first prenatal visit. (Grade A recommendation.).
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Biography Historical Article
Paul Epstein, MD, MACP (20 November 1940-12 March 2009): a good and honorable man.
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Meta Analysis
Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure.
Guidelines recommend that patients with heart failure receive beta-blockers in doses used in the trials that have proven their efficacy. Although the adverse effects of beta-blockade are dose-related, it is unclear whether the benefits are. ⋯ The magnitude of heart rate reduction is statistically significantly associated with the survival benefit of beta-blockers in heart failure, whereas the dose of beta-blocker is not.