International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism.

Objectives: This survey sought to characterize the national prescribing patterns and barriers to the use of thrombolytic agents in the treatment of pulmonary embolism, with a specific focus on treatment during actual or imminent cardiac arrest.

Design: A 19-question international, cross-sectional survey on thrombolytic use in pulmonary embolism was developed, validated, and administered. A multivariable logistic regression was conducted to determine factors predictive of utilization of thrombolytics in the setting of cardiac arrest secondary to pulmonary embolism.

Generation of Toxoplasma gondii and Hammondia hammondi Oocysts and Purification of Their Sporozoites for Downstream Manipulation.

Toxoplasma gondii tachyzoites and bradyzoites are studied extensively in the laboratory due to the ease with which they can be cultured. In contrast, oocysts and the sporozoites within them are more difficult to work with, in that cat infections are required for their generation and isolating sporozoites requires a laborious excystation procedure. More over some parasite species such as Hammondia hammondi are obligately heteroxenous and require passage through a cat for completion of the life cycle.

Implications of Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle and Initial Lactate Measurement on the Management of Sepsis.

Background: Sepsis remains a significant cause of morbidity and mortality in the United States, leading to the implementation of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). SEP-1 identifies patients with "severe sepsis" via clinical and laboratory criteria and mandates interventions, including lactate draws and antibiotics, within a specific time window. We sought to characterize the patients affected and to study the implications of SEP-1 on patient care and outcomes.

Dissection of the developmental program of reveals a link between stress sensitivity and life cycle flexibility in .

Most eukaryotic parasites are obligately heteroxenous, requiring sequential infection of different host species in order to survive. is a rare exception to this rule, having a uniquely facultative heteroxenous life cycle. To understand the origins of this phenomenon, we compared development and stress responses in to those of its its obligately heteroxenous relative, and have identified multiple growth states that are distinct from those in Of these, the most dramatic difference was that was refractory to stressors that robustly induce cyst formation in and this was reflected most dramatically in its unchanging transcriptome after stress exposure.

Evaluation of a Trainee-Led Project to Reduce Inappropriate Proton Pump Inhibitor Infusion in Patients With Upper Gastrointestinal Bleeding: Skip the Drips.

This trainee-led quality improvement study evaluates the use of the Culture, Oversight, Systems Change, Training framework to reduce inappropriate proton pump inhibitor infusions in patients with upper gastrointestinal bleeding.

Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores.

Objective: Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores.

Association Between Opioid and Benzodiazepine Use and Clinical Deterioration in Ward Patients.

Background: Opioids and benzodiazepines are frequently used in hospitals, but little is known about outcomes among ward patients receiving these medications.

Objective: To determine the association between opioid and benzodiazepine administration and clinical deterioration.

Design: Observational cohort study.

Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit.

Rationale: The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU).

Objectives: We sought to compare qSOFA with other commonly used early warning scores.

Methods: All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included.

A Multicenter Evaluation of Off-Label Medication Use and Associated Adverse Drug Reactions in Adult Medical ICUs.

Objective: Prior research indicates that off-label use is common in the ICU; however, the safety of off-label use has not been assessed. The study objective was to determine the prevalence of adverse drug reactions associated with off-label use and evaluate off-label use as a risk factor for the development of adverse drug reactions in an adult ICU population.

Design: Multicenter, observational study

Setting: : Medical ICUs at three academic medical centers.

New-onset atrial fibrillation is an independent predictor of mortality in medical intensive care unit patients.

Background: Atrial fibrillation (AF) has been extensively studied in postoperative critically ill surgical patients, but little literature exists to describe the outcomes of patients in the medical intensive care unit (ICU).

Objectives: To determine the incidence of new-onset AF in patients admitted to a medical ICU and if new-onset AF was associated with adverse clinical outcomes.

Methods: This was a single-center, retrospective study of all adult patients admitted to the medical ICU at an academic medical center for >24 hours between December 2008 and April 2010.