2011 Mar 23 - Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events: Systematic Review and Meta-analysis

Issa J. Dahabreh, MD; Jessica K. Paulus, ScDJAMA. 2011;305(12):1225-1233. doi: 10.1001/jama.2011.336
Context Evidence has suggested that physical and sexual activity might be triggers of acute cardiac events.

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2011 Mar 23 - Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome

Nicholas L. Mills, MD, PhD; Antonia M. D. Churchhouse, BSc, MD; Kuan Ken Lee; Atul Anand, BSc, MD; David Gamble, MD; Anoop S. V. Shah, MD; Elspeth Paterson, MD; Margaret MacLeod, BSc; Catriona Graham, MSc; Simon Walker, DM, FRCPath; Martin A. Denvir, PhD, FRCP; Keith A. A. Fox, FESC, FMedSci; David E. Newby, FESC, FMedSci. JAMA. 2011;305(12):1210-1216. doi: 10.1001/jama.2011.338
Context Although troponin assays have become increasingly more sensitive, it is unclear whether further reductions in the threshold of detection for plasma troponin concentrations will improve clinical outcomes in patients with suspected acute coronary syndrome (ACS).

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2011 Mar 23 - Hydrocortisone Therapy for Patients With Multiple Trauma: The Randomized Controlled HYPOLYTE Study

Antoine Roquilly, MD; Pierre Joachim Mahe, MD; Philippe Seguin, MD, PhD; Christophe Guitton, MD; Hervé Floch, MD; Anne Charlotte Tellier, MD; Laurent Merson, MD; Benoît Renard, MD; Yannick Malledant, MD, PhD; Laurent Flet, PharmD; Véronique Sebille, PhD;
Christelle Volteau; Damien Masson, PharmD, PhD; Jean Michel Nguyen, MD, PhD; Corinne Lejus, MD, PhD; Karim Asehnoune, MD, PhD. JAMA. 2011;305(12):1201-1209. doi: 10.1001/jama.2011.360
Context The role of stress-dose hydrocortisone in the management of trauma patients is currently unknown.

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2011 Jan 24 - Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy

Roger Sordé, MD; Vicenç Falcó, MD; Michael Lowak, MD; Eva Domingo, MD; Adelaida Ferrer, MD; Joaquin Burgos, MD; Mireia Puig, MD; Evelyn Cabral, MD; Oscar Len, MD; Albert Pahissa, MD. Arch Intern Med. 2011;171(2):166-172. Vol. 171 No. 2, January 24, 2011 Online Only
Background The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.

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2011 Jan 19 - A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care UnitsA Cluster Randomized Trial

Damon C. Scales, MD, PhD; Katie Dainty, MSc, PhD; Brigette Hales, MSc; Ruxandra Pinto, PhD; Robert A. Fowler, MDCM, MS; Neill K. J. Adhikari, MDCM, MSc; Merrick Zwarenstein, MBBCh, PhD.ONLINE FIRST, JAMA. 2011;305(4):363-372. Published online January 19, 2011. doi: 10.1001/jama.2010.2000
Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to quality improvement. 

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2011 Jan 16 - Standards for Education and Credentialing in Critical Care Medicine

Lewis J. Kaplan, MD; Andrew D. Shaw, MBBS. JAMA. 2011;305(3):296-297. Published online January 16, 2011. doi: 10.1001/jama.2010.1997
The provision of intensive care to patients in the throes of life-threatening acute illness is one of the most important and most expensive parts of US health care. Today, adults in the United States are increasingly likely to receive intensive care unit (ICU) care compared with previous generations, with the greatest ICU resource use occurring among older patients and those at the end of life. 1

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2011 Jan - Infection Acquisition Following Intensive Care Unit Room Privatization

Dana Y. Teltsch, MSc; James Hanley, PhD; Vivian Loo, MD, MSc, FRCPC; Peter Goldberg, MD, FRCPC; Ash Gursahaney, MD, FRCPC; David L. Buckeridge, MD, PhD, FRCPC  Vol. 171 No. 1, January 10, 2011 Online Only. Arch Intern Med. 2011;171(1):32-38
Background Patients in intensive care units (ICUs) often acquire infections, which impose a heavy human and financial burden. The use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.

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2010 Dec 15 - Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for TransplantationA Randomized Controlled Trial

Luciana Mascia, MD, PhD; Daniela Pasero, MD; Arthur S. Slutsky, MD; M. Jose Arguis, MD; Maurizio Berardino, MD; Salvatore Grasso, MD; Marina Munari, MD; Silvia Boifava, MD; Giuseppe Cornara, MD; Francesco Della Corte, MD; Nicoletta Vivaldi, MD; Paolo Malacarne, MD; Paolo Del Gaudio, MD; Sergio Livigni, MD; Elisabeth Zavala, MD; Claudia Filippini, PhD; Erica L. Martin, PhD; Pier Paolo Donadio, MD; Ilaria Mastromauro, MD; V. Marco Ranieri, MD. JAMA. 2010;304(23):2620-2627. doi: 10.1001/jama.2010.1796
AbstractContext Many potential donor lungs deteriorate between the time of brain death and evaluation for transplantation suitability, possibly because of the ventilatory strategy used after brain death.

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2010 Dec 8 - Therapies for Refractory Hypoxemia in Acute Respiratory Distress Syndrome

Matthew R. Pipeling, MD; Eddy Fan, MD. JAMA. 2010;304(22):2521-2527. doi: 10.1001/jama.2010.1752
Acute respiratory distress syndrome (ARDS) is a common and severe form of acute lung injury, resulting from both direct (eg, pneumonia) and indirect (eg, sepsis) pulmonary insults. It is a common cause of admission to the intensive care unit due to hypoxemic respiratory failure requiring mechanical ventilation, and is associated with significant morbidity and mortality.

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2010 Nov 17 - JAMA Editorial: Automated External Defibrillators and the Law of Unintended Consequences

David E. Haines, MD. JAMA. 2010;304(19):2178-2179. doi:10.1001/jama.2010.1674
Sudden cardiac arrest remains a significant public health problem. Successful resuscitation from tachyarrhythmic cardiac arrest increases if time to defibrillation is reduced.1-2 Therefore, early detection of life-threatening arrhythmias followed by rapid initiation of effective therapy has been the goal. Patients requiring hospitalization benefit from being admitted to a facility where special resuscitation equipment and trained personnel are in close proximity around the clock.

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2010 Nov 17 - Automated External Defibrillators and Survival After In-Hospital Cardiac Arrest

Paul S. Chan, MD, MSc; Harlan M. Krumholz, MD, SM; John A. Spertus, MD, MPH; Philip G. Jones, MS; Peter Cram, MD; Robert A. Berg, MD; Mary Ann Peberdy, MD; Vinay Nadkarni, MD; Mary E. Mancini, RN, PhD; Brahmajee K. Nallamothu, MD, MPH; for the American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators. JAMA. 2010;304(19):2129-2136. doi:10.1001/jama.2010.1576

Context Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrests, but data on their effectiveness in hospitalized patients are limited.

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2010 Nov - The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

Natalie Oake, MSc; Monica Taljaard, PhD; Carl van Walraven, MD, FRCPC, MSc; Kumanan Wilson, MD, FRCPC, MSc; Virginia Roth, MD, FRCPC; Alan J. Forster, MD, FRCPC, MSc. Arch Intern Med. 2010;170(20):1804-1810.
Background The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission.

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2010 Nov - Timing of Intubation and Ventilator-Associated Pneumonia Following Injury

Heather L. Evans, MD, MS; David H. Zonies, MD, MPH; Keir J. Warner, BS; Eileen M. Bulger, MD; Sam R. Sharar, MD; Ronald V. Maier, MD; Joseph Cuschieri, MD. Arch Surg. 2010;145(11):1041-1046.
Hypothesis In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation.

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2010 Nov 10 - Quality of Traditional Surveillance for Public Reporting of Nosocomial Bloodstream Infection Rates

Y. Lin, MD, MPH; Bala Hota, MD, MPH; Yosef M. Khan, MBBS, MPH; Keith F. Woeltje, MD, PhD; Tara B. Borlawsky, MA; Joshua A. Doherty, BS; Kurt B. Stevenson, MD, MPH; Robert A. Weinstein, MD; William E. Trick, MD; for the CDC Prevention Epicenter Program. JAMA. 2010;304(18):2035-2041. doi:10.1001/jama.2010.1637

Context Central line–associated bloodstream infection (BSI) rates, determined by infection preventionists using the Centers for Disease Control and Prevention (CDC) surveillance definitions, are increasingly published to compare the quality of patient care delivered by hospitals. However, such comparisons are valid only if surveillance is performed consistently across institutions.

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2010 Oct 27 - JAMA Editorial: The Lingering Consequences of Sepsis: A Hidden Public Health Disaster?

Derek C. Angus, MD, MPH. JAMA. 2010;304(16):1833-1834. doi:10.1001/jama.2010.1546
Sepsis, the syndrome of infection complicated by vital organ dysfunction, is a medical emergency that affects more than 750 000 patients in the United States each year and remains one of the world's leading causes of death.1 Without prompt resuscitation, antibiotics, and institution of life support, patients can quickly develop shock, multisystem organ failure, and death.

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2010 Oct 27 - Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis

Theodore J. Iwashyna, MD, PhD; E. Wesley Ely, MD, MPH; Dylan M. Smith, PhD; Kenneth M. Langa, MD, PhD. JAMA. 2010;304(16):1787-1794. doi:10.1001/jama.2010.1553
Context Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown.

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2010 Oct 13 - Transfusion Requirements After Cardiac Surgery: The TRACS Randomized Controlled Trial

Ludhmila A. Hajjar, MD, PhD; Jean-Louis Vincent, MD, PhD; Filomena R. B. G. Galas, MD, PhD; Rosana E. Nakamura, MD; Carolina M. P. Silva, MD; Marilia H. Santos, MD, PhD; Julia Fukushima, MSc; Roberto Kalil Filho, MD, PhD; Denise B. Sierra, MD; Neuza H. Lopes, MD, PhD; Thais Mauad, MD, PhD; Aretusa C. Roquim, MD; Marcia R. Sundin, MD; Wanderson C. Leão, MD; Juliano P. Almeida, MD; Pablo M. Pomerantzeff, MD, PhD; Luis O. Dallan, MD, PhD; Fabio B. Jatene, MD, PhD; Noedir A. G. Stolf, MD, PhD; Jose O. C. Auler Jr, MD, PhD. JAMA. 2010;304(14):1559-1567. doi:10.1001/jama.2010.1446

Context Perioperative red blood cell transfusion is commonly used to address anemia, an independent risk factor for morbidity and mortality after cardiac operations; however, evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery is lacking.

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2010 Oct 6 - JAMA Editorial: Compression-Only CPR: Pushing the Science Forward

David C. Cone, MD. JAMA. 2010;304(13):1493-1495. doi:10.1001/jama.2010.1420
For more than a decade, cardiopulmonary resuscitation (CPR) using only chest compressions, forgoing ventilations by rescue breathing, has been described as an option in the out-of-hospital management of sudden cardiac arrest when bystanders are unwilling or unable to provide standard CPR that combines chest compressions with rescue breathing. The "Guidelines 2005" CPR standards promulgated by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) indicate that "the best method of CPR is compressions coordinated with ventilations."1 However,

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2010 Oct 6 - Use of Advanced Radiology During Visits to US Emergency Departments for Injury-Related Conditions, 1998-2007

Frederick Kofi Korley, MD; Julius Cuong Pham, MD, PhD; Thomas Dean Kirsch, MD, MPH. JAMA. 2010;304(13):1465-1471.
Context Excessive use of medical imaging increases health care costs and exposure to ionizing radiation (a potential carcinogen) without yielding significant benefits to all patients.

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2010 Oct 6 - Out-of-Hospital Hypertonic Resuscitation Following Severe Traumatic Brain Injury: A Randomized Controlled Trial

Eileen M. Bulger, MD; Susanne May, PhD; Karen J. Brasel, MD; Martin Schreiber, MD; Jeffrey D. Kerby, MD; Samuel A. Tisherman, MD; Craig Newgard, MD; Arthur Slutsky, MD; Raul Coimbra, MD, PhD; Scott Emerson, MD; Joseph P. Minei, MD; Berit Bardarson, RN; Peter Kudenchuk, MD; Andrew Baker, MD; Jim Christenson, MD; Ahamed Idris, MD; Daniel Davis, MD; Timothy C. Fabian, MD; Tom P. Aufderheide, MD; Clifton Callaway, MD, PhD; Carolyn Williams, RN; Jane Banek; Christian Vaillancourt, MD; Rardi van Heest, MD; George Sopko, MD; J. Steven Hata, MD; David B. Hoyt, MD; for the ROC Investigators. JAMA. 2010;304(13):1455-1464.
Context Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI).

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