Trending Articles
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Predicting methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs) avoids inappropriate antimicrobial empirical treatment and enhances infection control. We describe risk factors for colonisation/infection related to MRSA (MRSA-C/I) in critically ill patients once in the ICU and on ICU admission, and search for an easy-to-use predictive model for MRSA colonisation/infection on ICU admission. This multicentre cohort study included 69,894 patients admitted consecutively (stay>24h) in April-June in the five-year period 2006-2010 from 147 Spanish ICUs participating in the National Surveillance Study of Nosocomial Infections in ICUs (ENVIN-HELICS). ⋯ Our conclusion is that clinical-demographic risk factors for colonisation/infection related to MRSA should not be used to accurately identify patients who would benefit from empirical anti-MRSA treatment or from specific preventive measures. Independent risk factors for MRSA colonisation/infection during ICU stay and on ICU admission are described. The latter should be considered in future studies for MRSA prediction.
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Unprotected left main (ULM) coronary artery disease is encountered in 3%-10% of coronary angiograms and is associated with high mortality. The survival of patients with ULM disease presenting with acute coronary syndromes (ACS) depends on different variables and is lowest in those with cardiogenic shock (CS). The aim of the present study was to estimate the impact of baseline characteristics on the subsequent clinical outcome in patients treated by percutaneous coronary intervention (PCI) of ULM for ACS. ⋯ Acute coronary syndrome due to critical ULM stenosis is associated with high mortality even after successful PCI. Patients presenting with CS or STEMI are at particular risk.
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Multicenter Study
Medical professionals' attitudes toward tube feeding for themselves or their families: a multicenter survey in Japan.
Many studies have shown a lack of advantages to tube feeding for elderly with advanced dementia, but tube feeding is still considered standard care in Japan. The aim of this study is to investigate what nutrition method health care professionals want for themselves or their families, if they fall into a bedridden state due to irreversible impaired cognition in old age. ⋯ Many doctors and nurses, especially with more frequent contact with tubefed patients, rejected tube feeding for themselves on their own deathbed, but did not always refuse this option for their families.
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Multicenter Study
The failed intubation attempt in the emergency department: analysis of prevalence, rescue techniques, and personnel.
The aims of this study were: To describe the prevalence of Emergency Department (ED) airway management failures requiring rescue maneuvers, to describe successful rescue methods used when the primary method chosen is unsuccessful, and to characterize the roles of emergency physicians and other specialists in rescue airway management. A prospective observational study was conducted of ED airway management in 30 hospitals in the USA, Canada, and Singapore participating in the National Emergency Airway Registry (NEAR) database project. Patients were entered in the study if they underwent ED airway management, the first method chosen was not successful in achieving intubation, and a rescue technique was required. ⋯ In conclusion, a total of 2.7% of emergency intubations required rescue. RSI is the most commonly used first line technique for ED airway management and is also the principal back-up technique when other oral or nasal intubation methods fail. Emergency physicians manage the majority of ED intubations, including those requiring rescue techniques.
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Multicenter Study
Improving asthma care in emergency departments: results of a multihospital collaborative quality initiative in rural western North Carolina.
In North Carolina, nearly one-fourth of persons with asthma visit an emergency department (ED) or urgent care center at least once a year because of an exacerbation of asthma symptoms. The Emergency Department Asthma Program was a quality-improvement initiative designed to better understand the population of patients who use the ED for asthma care in rural western North Carolina and to demonstrate whether EDs at small hospitals could, by implementing National Asthma Education and Prevention Program treatment guidelines, improve asthma care and reduce subsequent asthma-related ED visits. ⋯ Many patients who use the ED for care appear to have mild, intermittent asthma and do not identify a regular source of primary care. Efforts to improve asthma care on a communitywide basis and to reduce preventable exacerbations should include care provided in EDs, as this may be the only source of asthma care for many asthma patients. The project demonstrated that regional, collaborative performance improvement efforts in EDs are possible but that many barriers exist to this approach.