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CAP and its treatment

September 19, 2009

This study evaluated the guideline concordant therapy on in hospital survival in adults patients treated for CAP. Of 54 619 non–intensive care unit inpatients with CAP hospitalized at 113 community hospitals and tertiary care centers, 35 477 (65%) received initial guideline-concordant therapy. After adjustment for severity of illness and other confounders, guideline-concordant therapy was associated with decreased in-hospital mortality (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.63-0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal failure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length of stay and duration of parenteral therapy by approximately 0.6 days (P < .001 for both comparisons).
Guideline-concordant therapy for CAP is associated with improved health outcomes and diminished resource use in adults. Abstract of study..
ISDA GUIDELINE




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score for acute pancreatitis

This study evaluated for bedside index for severity in acute pancreatitis(BISAP) score to predict mortality. BISAP score was calculated from data at 24 hours.
BISAP score consists of 5 variables( Urea >25 age >60, Glasgow coma scale <15, SIRS, Pleural effusion). Score of >3 was associated 1ith 18% mortality and <3 was associated 1ith 1% mortality.
CONCLUSIONS: The BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24 h of presentation. This risk stratification capability can be utilized to improve clinical care and facilitate enrollment in clinical trials.
Read abstract here..



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Statins- Another indication

In the DECREASE-III trial, 497 statin-naive patients undergoing elective vascular surgery (carotid, aortic, or lower extremity) were randomized to fluvastatin 80mg or placebo (for 1 month before and 1 month after surgery). The statin group experienced less myocardial ischemia (11% vs 19%) and non-fata MI/CV death (5% vs 10%)You would expect most of these patients should have been on statins anyway, so there is no need to start all patients on statins..
Read the abstract here...



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Evidence based Medicine

September 1, 2009


Can read this article in BMJ''



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