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Culture Transformation in Action: The Experience of One VA Community Living Center
Reflections of a VA Clerk
The Current State of Affairs of VA Emergency Medicine
Eliminating Ethnic and Racial Disparities in Health Care
Posttraumatic Stress Disorder: Learning the Lessons of the Past
Oral or IV steroids for inpatient COPD?
Although the oral bioavailability of corticosteroids is excellent, many physicians persist in using IV steroids for patients with exacerbations of COPD.
In this study, 210 hospitalized adults older than 40 years with COPD and at least 24 hours of exacerbation were randomized to receive 5 days of oral or IV prednisolone (60 mg daily) followed by a tapering oral dose. Patients with a severe exacerbation (pH <7.26 or PaCO2 >9.3 kPa) were excluded. Allocation was concealed and patients were randomized using a “minimization protocol” that balances groups for key variables such as age, sex, smoking history, and supplemental oxygen use.
The primary outcome was treatment failure, defined as death, admission to the intensive care unit, readmission, or the need to intensify treatment. Groups were balanced at the start of the study, and analysis was by intent to treat; withdrawals and exclusions were uncommon and similar between groups.
No difference was noted between groups in the primary outcome either early (ie, within 2 weeks), late (ie, after 2 weeks), or overall. The treatment failure rate was relatively high in both groups, usually because of the need to intensify treatment.
Although the oral bioavailability of corticosteroids is excellent, many physicians persist in using IV steroids for patients with exacerbations of COPD.
In this study, 210 hospitalized adults older than 40 years with COPD and at least 24 hours of exacerbation were randomized to receive 5 days of oral or IV prednisolone (60 mg daily) followed by a tapering oral dose. Patients with a severe exacerbation (pH <7.26 or PaCO2 >9.3 kPa) were excluded. Allocation was concealed and patients were randomized using a “minimization protocol” that balances groups for key variables such as age, sex, smoking history, and supplemental oxygen use.
The primary outcome was treatment failure, defined as death, admission to the intensive care unit, readmission, or the need to intensify treatment. Groups were balanced at the start of the study, and analysis was by intent to treat; withdrawals and exclusions were uncommon and similar between groups.
No difference was noted between groups in the primary outcome either early (ie, within 2 weeks), late (ie, after 2 weeks), or overall. The treatment failure rate was relatively high in both groups, usually because of the need to intensify treatment.
Although the oral bioavailability of corticosteroids is excellent, many physicians persist in using IV steroids for patients with exacerbations of COPD.
In this study, 210 hospitalized adults older than 40 years with COPD and at least 24 hours of exacerbation were randomized to receive 5 days of oral or IV prednisolone (60 mg daily) followed by a tapering oral dose. Patients with a severe exacerbation (pH <7.26 or PaCO2 >9.3 kPa) were excluded. Allocation was concealed and patients were randomized using a “minimization protocol” that balances groups for key variables such as age, sex, smoking history, and supplemental oxygen use.
The primary outcome was treatment failure, defined as death, admission to the intensive care unit, readmission, or the need to intensify treatment. Groups were balanced at the start of the study, and analysis was by intent to treat; withdrawals and exclusions were uncommon and similar between groups.
No difference was noted between groups in the primary outcome either early (ie, within 2 weeks), late (ie, after 2 weeks), or overall. The treatment failure rate was relatively high in both groups, usually because of the need to intensify treatment.
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Integration of Preventive Health Screening into Mental Health Clinics
Discharging the Undischargeable Patient
Combat Trauma: A Personal Perspective
Early intrathecal analgesia does not increase cesarean sections
Intrathecal fentanyl followed by epidural bupivacaine plus fentanyl, if needed for pain relief, in early labor is not associated with a higher cesarean delivery than systemic hydromorphone for early labor. The neuraxial approach also provides more effective analgesia and a shorter mean duration of first-stage labor. (LOE=1b)
Intrathecal fentanyl followed by epidural bupivacaine plus fentanyl, if needed for pain relief, in early labor is not associated with a higher cesarean delivery than systemic hydromorphone for early labor. The neuraxial approach also provides more effective analgesia and a shorter mean duration of first-stage labor. (LOE=1b)
Intrathecal fentanyl followed by epidural bupivacaine plus fentanyl, if needed for pain relief, in early labor is not associated with a higher cesarean delivery than systemic hydromorphone for early labor. The neuraxial approach also provides more effective analgesia and a shorter mean duration of first-stage labor. (LOE=1b)