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EM Infectious Disease

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16 papers 0 to 25 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/27716262/new-aspects-in-the-management-of-pneumonia
#1
Elena Prina, Adrian Ceccato, Antoni Torres
Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27694410/corticosteroids-for-community-acquired-pneumonia-a-critical-view-of-the-evidence
#2
EDITORIAL
James D Chalmers
No abstract text is available yet for this article.
October 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27720233/are-antibiotics-necessary-for-dental-pain-without-overt-infection
#3
Michael Gottlieb, Basem Khishfe
No abstract text is available yet for this article.
October 5, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27567896/severe-community-acquired-pneumonia-timely-management-measures-in-the-first-24-hours
#4
REVIEW
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27076965/corticosteroids-in-the-adjunctive-therapy-of-community-acquired-pneumonia-an-appraisal-of-recent-meta-analyses-of-clinical-trials
#5
REVIEW
Charles Feldman, Ronald Anderson
Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care. Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive anti-inflammatory therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and colleagues (Ann Intern Med 2015;163:519-528)...
March 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27130585/procalcitonin-guided-therapy-for-the-initiation-of-antibiotics-in-the-ed-a-systematic-review
#6
REVIEW
Yuri van der Does, Pleunie P M Rood, Juanita A Haagsma, Peter Patka, Eric C M van Gorp, Maarten Limper
BACKGROUND: Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED). METHODS: MEDLINE, EMBASE, Web of Science, COCHRANE central, PubMed publisher, and Google scholar were searched...
July 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/15494903/practice-guidelines-for-the-management-of-bacterial-meningitis
#7
Allan R Tunkel, Barry J Hartman, Sheldon L Kaplan, Bruce A Kaufman, Karen L Roos, W Michael Scheld, Richard J Whitley
No abstract text is available yet for this article.
November 1, 2004: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/21636122/dexamethasone-and-length-of-hospital-stay-in-patients-with-community-acquired-pneumonia-a-randomised-double-blind-placebo-controlled-trial
#8
RANDOMIZED CONTROLLED TRIAL
Sabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijligenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H Biesma
BACKGROUND: Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation. METHODS: In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission...
June 11, 2011: Lancet
https://www.readbyqxmd.com/read/25608756/adjunct-prednisone-therapy-for-patients-with-community-acquired-pneumonia-a-multicentre-double-blind-randomised-placebo-controlled-trial
#9
RANDOMIZED CONTROLLED TRIAL
Claudine Angela Blum, Nicole Nigro, Matthias Briel, Philipp Schuetz, Elke Ullmer, Isabelle Suter-Widmer, Bettina Winzeler, Roland Bingisser, Hanno Elsaesser, Daniel Drozdov, Birsen Arici, Sandrine Andrea Urwyler, Julie Refardt, Philip Tarr, Sebastian Wirz, Robert Thomann, Christine Baumgartner, Hervé Duplain, Dieter Burki, Werner Zimmerli, Nicolas Rodondi, Beat Mueller, Mirjam Christ-Crain
BACKGROUND: Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia. METHODS: In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation...
April 18, 2015: Lancet
https://www.readbyqxmd.com/read/26416494/irrigation-of-cutaneous-abscesses-does-not-improve-treatment-success
#10
RANDOMIZED CONTROLLED TRIAL
Brian Chinnock, Gregory W Hendey
STUDY OBJECTIVE: Irrigation of the cutaneous abscess cavity is often described as a standard part of incision and drainage despite no randomized, controlled studies showing benefit. Our goal is to determine whether irrigation of a cutaneous abscess during incision and drainage in the emergency department (ED) decreases the need for further intervention within 30 days compared with no irrigation. METHODS: We performed a single-center, prospective, randomized, nonblinded study of ED patients receiving an incision and drainage for cutaneous abscess, randomized to irrigation or no irrigation...
March 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/23184813/adjuvant-steroid-therapy-in-community-acquired-pneumonia-a-systematic-review-and-meta-analysis
#11
REVIEW
Majid Shafiq, Muhammad S Mansoor, Adnan A Khan, M Rizwan Sohail, Mohammad H Murad
BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among adults. Although steroids appear to be beneficial in animal models of CAP, clinical trial data in humans are either equivocal or conflicting. PURPOSE: Our purpose was to perform a systematic review and meta-analysis of studies examining the impact of steroid therapy on clinical outcomes among adults admitted with CAP. DATA SOURCES AND STUDY SELECTION: We identified randomized controlled trials (RCTs) through a systematic search of published literature up to July 2011...
February 2013: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/26258555/corticosteroid-therapy-for-patients-hospitalized-with-community-acquired-pneumonia-a-systematic-review-and-meta-analysis
#12
REVIEW
Reed A C Siemieniuk, Maureen O Meade, Pablo Alonso-Coello, Matthias Briel, Nathan Evaniew, Manya Prasad, Paul E Alexander, Yutong Fei, Per O Vandvik, Mark Loeb, Gordon H Guyatt
BACKGROUND: Community-acquired pneumonia (CAP) is common and often severe. PURPOSE: To examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015. STUDY SELECTION: Randomized trials of systemic corticosteroids in hospitalized adults with CAP...
October 6, 2015: Annals of Internal Medicine
https://www.readbyqxmd.com/read/26277247/community-acquired-pneumonia
#13
REVIEW
Elena Prina, Otavio T Ranzani, Antoni Torres
Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria...
September 12, 2015: Lancet
https://www.readbyqxmd.com/read/26022752/when-practice-and-policy-conflict-blood-cultures-in-community-acquired-pneumonia
#14
Himali Weerahandi, Jashvant Poeran, Denise Nassisi, Madhu Mazumdar
Optimal evidence-based management of patients with uncomplicated community-acquired pneumonia in the emergency department (ED) setting remains a topic of discussion. This discussion was recently revitalized by a 2014 study published in JAMA Internal Medicine by Makam et al showing an increase in the use of blood cultures for patients with community-acquired pneumonia during ED visits from 29.4% of patients in 2002 to 51.1% in 2010. As the authors acknowledge, one of the most likely explanations could be the former pneumonia core measures required by the Centers for Medicaid & Medicare Services and the Joint Commission, potentially encouraging both ED and inpatient providers to reflexively order cultures...
September 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25827595/clinical-diagnosis-of-influenza-in-the-ed
#15
Andrea F Dugas, Alexandra Valsamakis, Mihir R Atreya, Komal Thind, Peter Alarcon Manchego, Annum Faisal, Charlotte A Gaydos, Richard E Rothman
BACKGROUND: Timely and accurate diagnosis of influenza remains a challenge but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza-like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. In addition, we evaluated the compliance with CDC antiviral guidelines...
June 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25640810/oseltamivir-treatment-for-influenza-in-adults-a-meta-analysis-of-randomised-controlled-trials
#16
REVIEW
Joanna Dobson, Richard J Whitley, Stuart Pocock, Arnold S Monto
BACKGROUND: Despite widespread use, questions remain about the efficacy of oseltamivir in the treatment of influenza. We aimed to do an individual patient data meta-analysis for all clinical trials comparing oseltamivir with placebo for treatment of seasonal influenza in adults regarding symptom alleviation, complications, and safety. METHODS: We included all published and unpublished Roche-sponsored randomised placebo-controlled, double-blind trials of 75 mg twice a day oseltamivir in adults...
May 2, 2015: Lancet
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