Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis

2018 ◽  
pp. 61-67
Author(s):  
Anna M. Ward ◽  
Richard M. Pino
Keyword(s):  
Severe Sepsis ◽  
Study Design ◽  
Protein C ◽  
Clinical Case ◽  
Activated Protein C ◽  
Efficacy And Safety ◽  
Prowess Trial ◽  
Study Intervention ◽  
Prowess Study

This chapter provides a summary of the landmark study known as the PROWESS Study. Does treatment with DAA reduce the rate of death from any cause among patients with severe sepsis? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The PROWESS trial demonstrated a mortality benefit for DAA among patients with severe sepsis. However, the subsequent ADDRESS, RESOLVE, and PROWESS-SHOCK trials did not demonstrate a benefit of the medication, thus calling the results of PROWESS into question.

Hydrocortisone Therapy for Patients with Septic Shock

2018 ◽  
pp. 301-306
Author(s):  
Ryan J. Horvath ◽  
Edward Bittner
Keyword(s):  
Septic Shock ◽  
Study Design ◽  
Steroid Therapy ◽  
Clinical Case ◽  
Low Dose ◽  
Vasopressor Therapy ◽  
Surviving Sepsis Campaign ◽  
Number Of Patients ◽  
Study Intervention

This chapter provides a summary of the landmark study known as the CORTICUS trial. Among patients suffering from septic shock, does low dose hydrocortisone improve mortality? Starting with that question, it describes the basics of the study, including funding, study location, the population studies, number of patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CORTICUS trial failed to demonstrate a benefit on mortality with steroid therapy among patients with septic shock. Based on CORTICUS and other studies, the Surviving Sepsis Campaign guidelines no longer recommend steroids for all patients with septic shock. Corticosteroids should be considered, however, for patients with septic shock who do not respond to fluids and vasopressor therapy.

Comparison of 8 versus 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults

2018 ◽  
pp. 257-262
Author(s):  
Laurie O. Mark ◽  
Jean Kwo
Keyword(s):  
Antibiotic Therapy ◽  
Randomized Trial ◽  
Study Design ◽  
Clinical Case ◽  
Pulmonary Infection ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study “Comparison of 8 versus 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.” In adult patients with ventilator-associated pneumonia (VAP), is treatment with an 8-day course of antimicrobials as effective as a 15-day course? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. In ICU patients who develop microbiologically proven VAP, an 8-day antimicrobial course is not inferior to a 15-day course with respect to all-cause mortality or recurrence of pulmonary infection. However, these findings may not apply to patients who are immunocompromised, and shorter or longer duration of antibiotics may sometimes be indicated.

Cognitive Therapy versus Medication in the Treatment of Moderate to Severe Depression

2018 ◽  
Author(s):  
Daniel Barron ◽  
Robert Ostroff
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cognitive Therapy ◽  
Study Design ◽  
Clinical Case ◽  
Severe Depression ◽  
Major Depressive ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study on major depressive disorder. Is paroxetine or cognitive therapy more effective in treating patients with moderate to severe major depressive disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Global Burden of Mental and Substance Use Disorders

2018 ◽  
Author(s):  
Stephanie Yarnell ◽  
Ellen Edens
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Study Design ◽  
Burden Of Disease ◽  
Clinical Case ◽  
Global Burden ◽  
Disease Study ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study in epidemiology. The Global Burden of Disease Study was a ground breaking venture in answering the question regarding the prevalence of various diseases. By analyzing this database, the current study was sought to determine the burden of disease attributable to mental and substance use disorders. With this in mind, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Carotid Endarterectomy for Symptomatic Carotid Stenosis

2017 ◽  
Author(s):  
Hardik A. Amin
Keyword(s):  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Study Design ◽  
Clinical Case ◽  
Nonsurgical Treatment ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Study Intervention

This chapter provides a summary of the landmark surgical study known as the NASCET trial, which compared surgical versus nonsurgical treatment for patients with symptomatic carotid stenosis. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case regarding vascular surgery.

Heller Myotomy versus Heller Myotomy with Dor Fundoplication for Achalasia

2017 ◽  
Author(s):  
Jerald Borgella ◽  
Michael Choi ◽  
Miguel Burch
Keyword(s):  
Gastroesophageal Reflux ◽  
Study Design ◽  
Heller Myotomy ◽  
Clinical Case ◽  
Partial Fundoplication ◽  
Dor Fundoplication ◽  
Design Study ◽  
Study Intervention

This chapter provides a summary of the management of patients with achalasia and how the addition of a fundoplication can affect outcomes. The primary question asked is could the addition of a Dor fundoplication to a Heller myotomy decrease the incidence of pathologic gastroesophageal reflux? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case regarding treating a patient with either Heller myotomy or Heller myotomy plus partial fundoplication.

Gastroesophageal Junction Tumors Does Location Determine Treatment?

2017 ◽  
Author(s):  
Emily L. Siegel ◽  
Miguel Burch
Keyword(s):  
Study Design ◽  
Clinical Case ◽  
Classification Scheme ◽  
Treatment Approach ◽  
Gastroesophageal Junction ◽  
Design Study ◽  
Appropriate Treatment ◽  
Study Intervention ◽  
Landmark Study

This chapter summarizes a landmark study in treatment of gastroesophageal (GE) junction tumors. Should an anatomically based classification scheme of GE tumors define the appropriate treatment approach for these tumors? Starting with that question, it describes the basis of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving possible gastrectomy and esophagectomy.

Switching Antipsychotics to Reduce Metabolic Risk

2018 ◽  
Author(s):  
Eric Lin ◽  
John Cahill
Keyword(s):  
Study Design ◽  
Clinical Case ◽  
Population Characteristics ◽  
Metabolic Risk ◽  
Design Study ◽  
Study Population ◽  
Clinical Considerations ◽  
Location Study ◽  
Study Intervention

This chapter provides a summary of the landmark Comparison of Antipsychotics for Metabolic Problems trial on schizophrenia treatment. This trial was designed to help clarify some of the clinical considerations in choosing antipsychotics. Does switching to aripiprazole from olanzapine, quetiapine, or risperidone confer metabolic benefits? Does the switch to aripiprazole cause clinical destabilization? Starting with these questions, it describes the basics of the study, including funding, study location, study population characteristics, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Mastectomy versus Lumpectomy for Invasive Breast Cancer

2017 ◽  
Author(s):  
Michael E. Hochman
Keyword(s):  
Breast Cancer ◽  
Study Design ◽  
Invasive Breast Cancer ◽  
Clinical Case ◽  
Breast Conserving Therapy ◽  
Total Mastectomy ◽  
Design Study ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study known as the B-06 trial, which compared total mastectomy versus breast-conserving therapy (i.e., lumpectomy) for treating women with invasive breast cancer. Do all women with invasive breast cancer require a total mastectomy, or is breast conserving therapy (i.e., lumpectomy) appropriate in some women? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving total mastectomy versus lumpectomy.

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