Steroids for everyone?

Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients?  Evidence shows that most patients with acute bronchitis do not need steroids.

What’s the evidence?

Study: double-blinded RCT of 401 patients with lower respiratory tract infection symptoms (wheezing) without history of asthma or COPD treated at different family practice clinics in Britain

Comparison: 40mg Prednisolone or placebo daily for 5 days

Outcome: no difference in primary or secondary outcomes

  • Primary outcomes: duration of moderately bad or worse cough, mean severity of symptoms on days 2-4
  • Secondary outcomes: duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, adverse events

 

Take home point: bronchitis without underlying lung pathology does not need steroids

Hay AD, et al.  Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults with Acute Lower Respiratory Tract Infection: A Randomized Clinical Trial.  JAMA.  2017 Aug 22;318(8):721-730.

Thanks to Dr. Trevor Pour for the pearl inspiration!

Oxigeno en la sospecha de infarto agudo de miocardio


Ya son varias entradas (aquí, aquí y aquí) en las que hemos incluido esta idea de que en los pacientes con cardiopatía isquémica aguda y sin hipoxia  no es necesario el oxigeno suplementario. La más antigua del 2010. O sea, que ya ha llovido.

Ahora se publica un trabajo titulado
Oxygen Therapy in Suspected Acute Myocardial Infarction y sus conclusiones inciden en lo mismo: 

El uso rutinario de oxígeno suplementario en pacientes con sospecha de infarto de miocardio que no tuvieron hipoxemia no se encontró que redujera la mortalidad por todas las causas a un año.

Por si todavía no lo estabais poniendo en práctica...

TruMed AccuVax for Automatic Management of Vaccine Supplies

TruMed Systems, a firm based in San Diego, California, is releasing its AccuVax vaccine management system that’s designed to improve clinical efficiency, save nurses’ time, and reduce waste. The system of course keeps the medications at the correct temperature for long-term potency and helps to reduce the chances of making errors in administration.

The system keeps a record of the temperature of the storage area within the device, as well as how much vaccine has been used and how much remains, allowing for easy inventory management. Every time the vaccine is administered, it scans the clinician’s fingerprint and makes sure the drug provided is still within its freshness limitations. It also records which patient received it for easy integration with billing and reordering systems. Additionally, vaccines that are publicly funded can be kept separate from those meant for private use.

Since there’s no door to open and close, as in a refrigerator, the vaccines are kept at an even temperature, helping to preserve their freshness. In case of a power outage, a battery inside the AccuVax will keep the contents cold for at least nine hours.

The system can be connected to remotely via the internet to check on its usage, power status, and download any of the information that it records.

Product page: AccuVax…

Via: TruMed…