Hospital practice (1995)
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Hospital practice (1995) · Feb 2012
Coronary artery bypass graft surgery in acute coronary syndrome: incidence, cost impact, and acute clopidogrel interruption.
Guidelines stipulate that clopidogrel should be interrupted ≥ 5 days prior to elective coronary artery bypass graft (CABG) surgery to reduce the risk of bleeding unless the need for revascularization and/or the net benefit of the clopidogrel outweighs the potential risks of bleeding. This study describes real-world patterns of acute clopidogrel use, CABG surgery, and inpatient costs among patients with acute coronary syndrome (ACS). ⋯ Coronary artery bypass graft surgery is used relatively infrequently among patients who experience ACS episodes. When CABG surgery is performed in a real-world setting, the majority or procedures are performed < 5 days after the last acute clopidogrel dose. However, among patients for whom urgent CABG surgery is not indicated, withholding CABG surgery to allow for clopidogrel interruption may only minimally affect inpatient costs and must be considered in the broader context of patient management.
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Hospital practice (1995) · Feb 2012
Routinely assessed biochemical markers tested on admission as predictors of adverse outcomes in hospitalized elderly patients.
To explore whether routinely assessed biochemical markers tested on admission will predict 3 predefined adverse outcomes for hospitalized elderly patients: discharge to a long-term care facility, in-hospital mortality, and prolonged hospital length of stay (> 14 days). ⋯ Testing of routinely assessed biochemical markers on admission predicted adverse hospital outcomes for elderly patients. Their inclusion in a standardized prediction tool may help to create interventions to improve such outcomes.
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Hospital practice (1995) · Feb 2012
Occurrence and predictors of dexmedetomidine infusion intolerance and failure.
Dexmedetomidine, a selective α2 adrenergic receptor agonist, exhibits sedative, analgesic, anxiolytic, and sympatholytic effects, and may aid in controlling agitation in the intensive care unit (ICU). At our hospital (Barnes-Jewish Hospital, St. Louis, MO), dexmedetomidine is commonly used as a sedative in the medical ICU. Predictors of dexmedetomidine intolerance or failure have not yet been defined. ⋯ Twenty-one percent of dexmedetomidine infusion episodes met the criteria for intolerance/failure. No predictors of intolerance/failure were found to be clinically significant.
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Hospital practice (1995) · Feb 2012
Strategies for prevention of ventilator-associated pneumonia: bundles, devices, and medications for improved patient outcomes.
Ventilator-associated pneumonia is associated with significant patient morbidity, mortality, and increased health care costs. In the current economic climate, it is crucial to implement cost-effective prevention strategies that have proven efficacy. ⋯ Routine use of the Institute for Healthcare Improvement ventilator care bundle is widespread, and has been clearly demonstrated to be an effective method for reducing the incidence of ventilator-associated pneumonia. In this article, we examine specific aspects of the Institute for Healthcare Improvement bundle, better-designed endotracheal tubes, use of antibiotics and probiotics, and treatment of ventilator-associated tracheobronchitis to prevent ventilator-associated pneumonia.
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Hospital practice (1995) · Oct 2011
ReviewLung cancer screening: a review of available data and current guidelines.
Lung cancer is the leading cause of cancer mortality worldwide. A lack of clinical symptoms in early-stage disease frequently leads to diagnosis at a late stage, and a 15% 5-year survival rate in all patients so diagnosed. This has led to significant interest in effective screening methods to detect early-stage cancers, particularly for high-risk groups, such as current or former smokers. ⋯ The most recent trials have focused on LDCT scans, including the National Lung Screening Trial. Data released from the National Lung Screening Trial demonstrated a statistically significant reduction in lung cancer deaths in patients screened with LDCT scans. When data from the study, including cost-effectiveness, are completely analyzed, they may lead to revision of current lung cancer screening recommendations to include LDCT scans in specific populations at high risk of developing lung cancer.