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Post Intensive Care Syndrome: Risk Factors and Prevention Strategies

Each year, approximately 800,000 patients in the United States develop an illness that results in admission to an ICU and need for mechanical ventilation.

Peramivir: A Newly Approved Antiviral for Treatment of Influenza

Peramivir (Rapivab™) was recently approved by the FDA in December 2014 for treatment of acute uncomplicated influenza within two days of symptom onset. This newly approved antiviral is a neuraminidase inhibitor (NI) similar to oseltamivir and zanamivir but the first to be approved in an injectable formulation.1 Peramivir has been licensed in Japan (as Rapiacta) and South Korea (as PeramiFlu) since 2010. In addition, it has been used in the United States on an emergency basis during the 2009 H1N1 flu pandemic.

Multicenter Quality Improvement Project Resulted in a 23% Reduction in Medical Errors

SYNOPSIS: Implementation of a quality improvement project focused on handoffs reduced medical errors by 23% and preventable adverse events by 30%.

Benefits of NIV in COPD Supported in Routine Clinical Practice

SYNOPSIS: In a large cohort study, patients with chronic obstructive pulmonary disease managed with noninvasive ventilation had lower inpatient mortality, shorter length of stay, and lower costs compared to those managed with invasive ventilation.

Transient Ischemic Attacks: A Missed Opportunity

SYNOPSIS: Patients with transient ischemic attacks were not given evidence-based secondary prevention for stroke at discharge from the hospital as often compared to patients with stroke, thus creating a missed opportunity to decrease the incidence of future stroke and cardiovascular disease.

Does Your Patient Have a Central Venous Catheter?

Central venous catheters (CVCs) are essential to providing optimal care to many hospitalized patients.

Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis

The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.

Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina

Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?

Surgical Management of Infective Endocarditis

SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123.

Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes

Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.¹ To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.