Clinical Questions

Cardiac Rehabilitation: Does it Reduce Morbidity and Mortality?

June 21, 2018
Cardiac Rehabilitation: Does it Reduce Morbidity and Mortality?

By  Monil Shah, MD and Arun Manmadhan, MD

Peer Reviewed

A 64-year old male with a history of hypertension, dyslipidemia, and uncontrolled diabetes is brought to the emergency room with new onset substernal chest pressure radiating to his left arm. His electrocardiogram is notable for ST elevations in the anterior leads V2-V4. The patient undergoes percutaneous coronary intervention with deployment of a drug-eluting stent to his left anterior descending artery. His hospital course was otherwise unremarkable. The patient is initiated on an appropriate medication regimen. …

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Are Latino Cultural Beliefs Increasing Antibiotic Resistance in the US?

June 8, 2018
Are Latino Cultural Beliefs Increasing Antibiotic Resistance in the US?

By Daniela Rebollo Salazar

Peer Reviewed

In the past ten years, the number of bacterial pathogens resistant to multiple antibiotics has dramatically increased. The emergence of resistant microorganisms is a direct product of the excessive use of antibiotics, as exposure to multiple antibacterial agents provides the selective pressure for the rise and spread of these pathogens.1 Studies have shown that the overuse of antibiotics is a consequence of the increased worldwide availability of these agents and the overprescription of antimicrobials when they are not necessary.1 …

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Why We Do What We Do: The Evidence Behind Rapid Response Teams

April 26, 2018
Why We Do What We Do: The Evidence Behind Rapid Response Teams

By Thatcher Heumann, MD

Peer Reviewed

“Rapid Response Team to 7W. Rapid Response Team to 7W.” After switching elevators and waiting for security to buzz you in through the double doors, you see your fellow residents rushing to one of the corner rooms. When you arrive, med consult is calmly delegating various tasks to nursing and residents: vitals, EKG, ABG, CXR, IV access. They quickly review the patient’s history and medications. Depending on the acute condition—respiratory failure, cardiac arrest, septic shock—interventions such as NIPPV, fluids, …

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Is There Really a Link between Asthma and Reflux?

February 27, 2018
Is There Really a Link between Asthma and Reflux?

By Scott Statman, MD

Peer Reviewed

There is little doubt that an association between asthma and gastroesophageal reflux disease (GERD) exists. However clinicians have debated the nature of this relationship for decades. Asthma and GERD are among the most common disorders encountered by physicians, with prevalence in the general population estimated at 8%1 and 10 to 20%2 respectively. Studies have shown that up to 80% of asthmatics have symptomatic GERD3 and that people with GERD are nearly1.2 times more likely to have asthma.4  This may …

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NSAIDs: Are They All the Same?

February 1, 2018
NSAIDs: Are They All the Same?

By Vishal Shah, MD

Peer Reviewed

Nonsteroidal antiinflammatory drugs (NSAIDs) are a heterogenous group of non-opioid analgesics and anti-inflammatory agents. Their use is ubiquitous, from treating a simple tension headache to a sprained ankle. NSAIDs are available over the counter and in prescription form.

NSAID use in the United States is rising; from 2005 to 2010, prescriptions for NSAIDs increased by 41%.1 These numbers will continue to rise with the increasing population age and subsequent demand for analgesics to treat conditions related to increasing age …

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Game Changer? How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia?

January 16, 2018
Game Changer?  How Many Days of Antibiotics is Best for Treating Community Acquired Pneumonia?

By Calvin Ngai, MD

Peer Reviewed

A 71-year-old Caucasian woman with hypertension presented with a 2-day history of productive cough and fever. She was living alone and had no history of any recent hospitalizations. On examination, she was alert and oriented but slightly tachypneic; her lungs were clear to auscultation bilaterally. Laboratory tests were significant for a white blood cell count of 18,000 mL with 89% neutrophils. The chest x-ray showed a right lower lobe infiltrate. She was admitted and started on antibiotics for

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Is Potassium Supplementation Beneficial in Hospitalized Patients?

October 25, 2017
Is Potassium Supplementation Beneficial in Hospitalized Patients?

By Sara Stream, MD

Peer Reviewed

As resident physicians, we are taught to supplement serum potassium to a goal level of 4.0 mEq/L in all hospitalized patients. While the dangers of severe potassium abnormalities are well established, the benefit of routine potassium supplementation of normal serum levels in the general hospitalized population is unclear.

Potassium is predominantly an intracellular ion with 98% of total body potassium located in the intracellular space. The accepted reference range for serum potassium levels is 3.5 to 5.0 mEq/L. The …

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Stem cells for heart failure: What is the evidence?

September 27, 2017
Stem cells for heart failure: What is the evidence?

By Maxine Wallis Stachel, MD

Peer Reviewed

The Scale of the Problem

Despite decades of rigorous data collection, drug research, patient education and evidence-based practice, ischemic heart disease (IHD) and congestive heart failure (CHF) remain among the most deadly diagnoses in America. The standardization of medical therapy and surgical revascularization have reduced morbidity and mortality, but these measures have not kept pace with the burden and cost of disease, which continue to expand as the population ages and more patients survive acute myocardial infarction. IHD …

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