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1.
Kathleen A.N. Aithinne Casey W. Cooper Robert A. Lynch David L. Johnson 《American journal of infection control》2019,47(5):515-520
Introduction
Clostridium difficile is the leading cause of health care–associated gastric illness. Environmental contamination with C difficile spores is a risk factor for contact transmission, and toilet flushing causes such contamination. This work explores toilet contamination persistence and environmental contamination produced over a series of flushes after contamination.Methods
A flushometer toilet was seeded with C difficile spores in a sealed chamber. The toilet was flushed 24times, with postflush bowl water samples and settle plates periodically collected for culturing and counting. Air samples were collected after each of 12 flushes using rotating plate impactors.Results
Spores were present in bowl water even after 24 flushes. Large droplet spore deposition accumulated over the 24-flush period. Droplet nuclei spore bioaerosol was produced over at least 12 flushes.Conclusions
Toilets contaminated with C difficile spores are a persistent source of environmental contamination over an extended number of flushes. 相似文献2.
Noelle V. Pavlovic Tania Randell Tim Madeira Steven Hsu Radoslav Zinoviev Martha Abshire 《Heart & lung : the journal of critical care》2019,48(2):90-104
Background
Left ventricular assist devices (LVADs) improve quality of life in end-stage heart failure but can cause serious complications such as infections with driveline infection causing significant morbidity and mortality.Objectives
The purpose of this systematic literature review is to synthesize the literature to determine variables associated with driveline infection and seek opportunities to improve nursing management of LVAD drivelines.Methods
A systematic literature review was performed. The evidence was synthesized using the Johns Hopkins Nursing Evidence-Based Practice tools and the Chain of Infection epidemiological framework.Results
Thirty-four studies focused on vulnerable host, portal of entry, and causative organism aspects of the Chain of Infection. Increased BMI, younger age, exposed driveline velour showed increased risk of infection and driveline dressing protocol change showed lower risk of infection.Conclusions
Although some risk factors for infection were identified, evidence is still limited. Nurses are uniquely positioned to improve driveline management, disrupting the chain of infection. 相似文献3.
Stefanos Despotopoulos Anastasios Roumeliotis Nicholas G. Kounis Grigorios Tsigkas George Hahalis Periklis Davlouros 《Heart & lung : the journal of critical care》2019,48(2):138-140
Background
Kounis syndrome is a systemic complication following an allergic reaction, presenting with coronary artery spasm or thrombosis and occasionally with stent thrombosis that can have fatal outcome.Objectives
Heparins can induce allergic reactions via tissue antigenicity, heparin induced thrombocytopenia and contact system-activating effects of contaminants but allergy bivalirudin has not been reported so far.Methods
Herein, we describe a patient with fatal acute coronary in-stent thrombosis following an allergic reaction soon after an intra-arterial heparin dose and intravenous administration of bivalirudin during angioplasty.Results
The patient received intense myocardial infarction protocol treatment including angioplasty and defibillation together with antiallergic therapy but despite all of these efforts and measures, he succumbed 2 h later.Conclusions
Significant suspicion should be raised that life saving drugs such as heparin and bivalirudin could join forces with concurrent medication acting as antigens and induce fulminant and fatal stent thrombosis as a manifestation of Kounis syndrome 相似文献4.
5.
Adelita Tinoco David W. Mortara Xiao Hu Cass Piper Sandoval Michele M. Pelter 《Heart & lung : the journal of critical care》2019,48(2):114-120
Background
Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU).Objectives
To determine whether CSRPB is associated with adverse outcomes in ICU patients.Methods
The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1).Results
ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1.Conclusions
CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients. 相似文献6.
Ming Shen Li-Zhi Bao Xing Zheng Xian-Xian Zhao Zhi-Fu Guo 《The American journal of the medical sciences》2019,357(3):247-254
Background
Previous studies have found that obestatin significantly inhibited water drinking and reduced the arginine vasopressin levels in the brain to decrease renal water reabsorption. However, obestatin is unable to cross the blood-brain barrier. Its effect on the body's kidney water metabolism in peripheral remains unknown.Materials and Methods
Expression and subcellular distribution of aquaporin 2 (AQP2) were detected by immunoblotting and immunofluorescence in mouse inner medullary collecting duct-3 (mIMCD-3) cells and congestive heart failure model rats. Moreover, expression of phosphorylated AQP2 (P-AQP2; Ser256) in mIMCD-3 cells was evaluated by immunoblotting.Results
After a 30-minute treatment with obestatin in mIMCD-3 cells and congestive heart failure model rats, the AQP2 plasma membrane distribution decreased, while AQP2 protein level, P-AQP2 (Ser256) protein level and phosphorylation ratio of AQP2 showed no significant change.Conclusions
These findings suggest that obestatin has a short-term regulatory effect on the AQP2 plasma membrane distribution. In addition, obestatin decreases the APQ2 plasma membrane distribution probably by promoting the endocytosis of AQP2. 相似文献7.
Antonia Scobie Sanch Kanagarajah Ross J. Harris Lisa Byrne Corinne Amar Kathie Grant Gauri Godbole 《The Journal of infection》2019,78(3):208-214
Listeriosis
is a foodborne illness that can result in septicaemia, Central Nervous System (CNS) disease, foetal loss and death in high risk patients.Objectives
To analyse the demographic trends, clinical features and treatment of non-perinatal listeriosis cases over a ten year period and identify mortality-associated risk factors.Methods
Reported laboratory-confirmed non-pregnancy associated cases of listeriosis between 2006 and 2015 in England were included and retrospectively analysed. Multivariate logistic regression analysis was performed to determine independent risk factors for mortality.Results
1357/1683 reported cases met the inclusion criteria. Overall all-cause mortality was 28.7%; however, mortality rates declined from 42.1% to 20.2%. Septicaemia was the most common presentation 69.5%, followed by CNS involvement 22.4%. CNS presentations were significantly associated with age?<?50 years, and septicaemia with older age. Age?>?80 years (OR 3.32 95% CI 1.92–5.74), solid-organ malignancy (OR 3.42 95% CI 2.29-5.11), cardiovascular disease (OR 3.30 95% CI 1.64–6.63), liver disease (OR 4.61 95% CI 2.47–8.61), immunosuppression (OR 2.12 95% CI 1.40-3.21) and septicaemia (OR 1.60 95% CI 1.17–2.20) were identified as independent mortality risk factors.Conclusions
High risk groups identified in this study should be the priority focus of future public health strategies aimed at reducing listeriosis incidence and mortality. 相似文献8.
Juan Jiang Chengping Hu Yuanyuan Li Pinhua Pan Xiaoli Su Pengbo Deng Junpu Wang Xiaoying Wu 《The American journal of the medical sciences》2019,357(4):289-295
Background
Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated.Materials and Methods
A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected. Nonbacterial infectious agents detected by TEM in bronchoalveolar lavage fluid (BALF) and serological tests were summarized. The detection rates were further compared between TEM and serological tests.Results
BALF examination under the transmission electron microscope revealed 24 viruses, 16 mycoplasmas, 18 chlamydia, 2 fungi and 74 bacteria in 99 samples, among which 61 samples were mixed infections. The combined use of serological tests and TEM significantly improved the detection rate of nonbacterial infectious agents in patients with severe pneumonia.Conclusions
Our data support that implementation of TEM could improve the sensitivity for detecting viruses, atypical pathogens and mixed infections in BALF from patient of severe pneumonia. Therefore, TEM may be used as an auxiliary diagnostic method of other microbiological tests in severe pneumonia. 相似文献9.
Xin-yue Zhang Dong-mei Gu Jing-jing Guo Qing-qing Su Yan-bin Chen 《The American journal of the medical sciences》2019,357(4):316-322
Background
The objective of this study was to improve the understanding of primary pulmonary lymphoma (PPL) for clinicians.Methods
We enrolled 27 patients diagnosed with PPL in the First Affiliated Hospital of Soochow University from January 2000 to December 2016. The clinical manifestations, imaging findings, pathologic features, treatments and prognosis of the patients were collected.Results
The male to female ratio was 1.5:1 and the average age was 54.6 ± 15.7 years old. Nine patients were asymptomatic. The main manifestations were cough, expectoration, bloody sputum and fever. The imaging findings presented as nodule, mass, pneumonia or consolidation. There were 2 cases of Hodgkin's lymphoma, 18 cases of non–Hodgkin's lymphoma and 7 cases of undifferentiated lymphoma. Non–Hodgkin's lymphoma cases were divided into T-cell lymphoma (n?=?2), mucosa-associated lymphoid tissue lymphoma (MALT) (n?=?11), diffuse large B-cell lymphoma (n?=?3), small B-cell lymphoma (n?=?1) and plasmacytoid B-cell lymphoma (n?=?1). Ten MALT cases survived and 1 diffuse large B-cell lymphoma case has been in stable condition for 71 months after surgery and chemotherapy. The international prognostic index was related to the prognosis of PPL.Conclusions
The clinical manifestations and imaging findings of PPL were nonspecific. The prognosis of MALT was better than other types of PPL. The International prognostic index can be used for predicting the prognosis of PPL. 相似文献10.
Ravinder Kang Samuel T. Kunkel Jesse A. Columbo Philip P. Goodney Sandra L. Wong 《The American journal of medicine》2019,132(4):530-534.e1
Background
Employee satisfaction is thought to impact performance. However, which aspects of employee satisfaction matter most is unknown. We utilized data from the Veterans Affairs Medical Centers(VAMC) via their Strategic Analytics for Improvement and Learning program to examine the association between organizational satisfaction as well as job-specific satisfaction with measures of patient safety, patient satisfaction, and hospital rating.Methods
The correlation between employee satisfaction with their organization and with their specific job were examined across indicators of patient care using Pearson and Spearman's correlation. Employee satisfaction data were obtained from the All Employee Survey.Results
We found that employee job-specific satisfaction does not correlate with patient outcomes, whereas higher satisfaction with the organization is associated with improved patient safety (ρ?=??0.19, P < .05) and correlates with all aspects of patient satisfaction (“top box” ratings of hospital [r?=?0.30, P < 0.005], primary care [r?=?0.25, P < 0.005], and specialty care [r?=?0.14, P < 0.005]). Further, employees are more satisfied with their job and organization when they work at a VAMC with a higher Star rating.Conclusion
Employee organizational satisfaction and job-specific satisfaction are distinct metrics, and it is higher organizational satisfaction that is associated with improved patient care. 相似文献11.
Benjamin J. Tarrant Caitlin Le Maitre Lorena Romero Ranjana Steward Brenda M. Button Bruce R. Thompson Anne E. Holland 《Heart & lung : the journal of critical care》2019,48(2):141-147
Background and objectives
Inhaled mucoactive agents are used to enhance airway clearance, however efficacy and safety are unclear in adults with acute respiratory conditions.Methods
We systematically reviewed randomized controlled trials assessing respiratory function; safety; length of stay (LOS); mucus; radiology; and oxygenation.Results
No adverse events were reported for dornase alfa (n?=?63), N-acetylcysteine (NAC, n?=?50), ambroxol (n?=?140), hypertonic saline (n?=?33), heparin (n?=?384), mannitol (n?=?20) or isotonic saline. During invasive ventilation, NAC, dornase alfa and saline had no effect on mucus. Postoperatively, mucus characteristics improved with NAC (n?=?10). Ambroxol lowered LOS (mean difference 4 days) and halved complications following lung carcinoma resection (n?=?140). Heparin improved ventilator-free days (n?=?130, mean difference 3.9–4.6) and intensive care LOS (n?=?223, 3.2 days), but not ventilator-acquired pneumonia.Conclusion
Dornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness. 相似文献12.
Hester Groenewegen Wouter F.W. Bierman Konstantina Delli Pieter U. Dijkstra Willem Nesse Arjan Vissink Frederik K.L. Spijkervet 《The Journal of infection》2019,78(3):171-177
Objective
To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.Design
cross-sectional controlled study.Methods
We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.Results
Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p?=?0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.Conclusions
Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients. 相似文献13.
Yanhong Ren Junke Qiu Zelin Li Cheng Li 《Heart & lung : the journal of critical care》2019,48(2):155-158
Objectives
The purpose of this study is to explore the value of P-wave terminal force in lead V1 (PTFV1) in the clinical diagnosis of tuberculous constrictive pericarditis (TCP).Methods
A total of 53 patients with TCP and 64 patients with tuberculous exudative pericarditis were enrolled in this retrospective study. The demographic and clinical characteristics were collected, including gender, age, the course of disease and New York Heart Association (NYHA) classification. Besides, echocardiography data also were obtained, including left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction. In addition, the parameters of electrocardiogram (ECG) were obtained, such as heart rate, the time from the corrected ORS wave origin to T-wave terminal, atrial fibrillation, right bundle branch block, atrial premature beat, and PTFV1 value.Results
No significant differences were found in age, gender, the course of disease, echocardiography results, ECG parameters (in addition to PTFV1) between patients with TCP and patients with tuberculous exudative pericarditis. The percentage of patients located in NYHA class IV in the patients with TCP was significantly higher than those of patients with tuberculous exudative pericarditis (p?=?0.041). Moreover, the incidence rate of abnormal PTFV1 (≤?-0.04 mm·s) was obviously higher in patients with TCP than those of patients with tuberculous exudative pericarditis (64.2% vs 9.4%, p?<?0.001).Conclusions
Abnormal PTFV1 (≤?-0.04 mm·s) is associated with TCP, and PTFV1 may be a potential novel diagnostic indicator for TCP diagnosis. 相似文献14.
Teresa Daniels Melissa Earlywine Vicki Breeding 《American journal of infection control》2019,47(4):400-405.e1
Background
Healthcare–associated Clostridium difficile infection (CDI) can result from organisms found on hospital environmental surfaces. Without proper cleaning of hospital environmental surfaces, cross-contamination can occur, resulting in a healthcare–associated infection. In 2011, an environmental services (EVS) model was developed in Hospital A that resulted in a reduction in healthcare–associated CDI. The purpose of this study was to determine if implementing Hospital A's EVS model in Hospital B would decrease healthcare–associated CDI incidence.Methods
A quasi-experimental design was used. The study was conducted in Hospital B, a 53-bed acute care community-based hospital, between January 2013 and December 2017. A retrospective review of all CDI LabID A/B toxin enzyme immunoassay events was performed using the National Healthcare Safety Network surveillance definitions. The data were calculated based on incidence rates per 1,000 patient days and the National Healthcare Safety Network standard infection ratio formula. No new disinfectants, antibiotic restrictions, or new isolation techniques were instituted during this time period.Results
There was a 100% reduction in healthcare–associated CDI in Hospital B from 2013’s baseline rate of 0.48 per 1,000 patient days to 0.00 per 1,000 patient days (0.48, 0.00, P?=?0.020).Conclusions
This study highlights the importance of EVS education and accountability as well as recognition of the role played by EVS in reducing healthcare–associated CDI within healthcare facilities. 相似文献15.
Anna M. Nordenskjöld Bo Lagerqvist Tomasz Baron Tomas Jernberg Nermin Hadziosmanovic Harmony R. Reynolds Per Tornvall Bertil Lindahl 《The American journal of medicine》2019,132(3):335-346
Background
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.Methods
In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.Results
The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P?=?.54).Conclusions
About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD. 相似文献16.
Quan M. Bui Oscar O. Braun Michela Brambatti Yan K. Gernhofer Holly Hernandez Victor Pretorius Eric Adler 《Heart & lung : the journal of critical care》2019,48(2):85-89
Background
The Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population.Objective
We evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure.Methods
This retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017. Patients were split into two groups based on SIPAT score, separating a “excellent”/“good” from a “minimally acceptable”/“poor” candidate. Poisson regression, using SIPAT as both a categorical and continuous variable, was used to compare the incidence rates of the primary outcome of cumulative re-admissions and secondary outcomes of LVAD complications.Results
The patient cohort was predominantly male 93.5% vs 89.4% (p = 0.629) with a median age of 67.0 vs 58.0 years (p = 0.037), planned destination therapy 48.4% vs 68.4% (p = 0.242) and median LVAD follow-up time of 241 vs 379 days (p = 0.10) in the low- and high- SIPAT groups, respectively. SIPAT was not a significant predictor for cumulative re-admissions, but there was an association between higher SIPAT scores and major bleeding.Conclusion
In this single-center retrospective study, SIPAT did not predict cumulative re-admissions. Further study is required to validate SIPAT before clinical implementation. 相似文献17.
Babak Hooshmand Minna Rusanen Tiia Ngandu Jaana Leiviskä Shireen Sindi Christine A.F. von Arnim Peter Falkai Hilkka Soininen Jaakko Tuomilehto Miia Kivipelto 《The American journal of medicine》2019,132(3):367-373
Purpose
The aim of this study was to examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning 7 years later in a longitudinal population-based study of Finnish older adults.Methods
Serum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years, from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). Participants were reexamined 7 years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed, both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors.Results
In the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA-IR values were related to worse performance in global cognition (β [standard error (SE)] -.050 [0.02]; P?=?.043) and psychomotor speed (β [SE] -.064 [.03]; P?=?[.043]) 7 years later. Raised serum insulin levels were associated with lower scores on global cognition (β [SE] -.054 [.03]; P?=?.045) and tended to relate to poorer performance in psychomotor speed (β [SE] -.061 [.03]; P?=?.070).Conclusions
Serum insulin and insulin resistance may be independent predictors of cognitive performance 7 years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue. 相似文献18.
Zachary Boivin Mario F. Perez Nkiruka C. Atuegwu Antonio Anzueto Eric M. Mortensen 《The American journal of the medical sciences》2019,357(4):296-301
Background
Prior research has demonstrated high mortality rates in patients with cirrhosis who contract bacterial infections. The purpose of our study was to explore clinical outcomes such as 90-day mortality, rehospitalization, and intensive care unit (ICU) admission in older veterans with pneumonia and cirrhosis.Methods
We conducted a retrospective cohort study of hospitalized patients with community-acquired pneumonia at any Departments of Veterans Affairs (VA) hospital over a 10-year period. We included patients 65 years or older who consistently received VA care and who were diagnosed with community-acquired pneumonia. There were 103,997 patients who met the inclusion criteria, and 1,246 patients with cirrhosis. We used multilevel regression models to examine the association between cirrhosis and the outcomes of interest after controlling for potential confounders.Results
Cirrhosis was associated with significantly increased odds of 90-day mortality (odds ratio 1.79, 95% confidence interval, 1.57-2.04). There were also significantly increased odds of rehospitalization within 90-days (1.30, 1.16-1.47). No significant association was found with ICU admission (1.00, 0.83-1.19).Conclusions
We found an association between cirrhosis and 90-day mortality and rehospitalization in older patients with pneumonia. We suggest that physicians should carefully monitor patients with cirrhosis who develop pneumonia. 相似文献19.
Kevin Bryan Lo Hafeez Ul Hassan Virk Vladimir Lakhter Pradhum Ram Carlos Gongora Gregg Pressman Vincent Figueredo 《The American journal of medicine》2019,132(4):505-509
Background
Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes.Methods
Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model.Results
Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate.Conclusion
This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use. 相似文献20.
E.L. Hamblion A. Burkitt M.K. Lalor L.F. Anderson H.L. Thomas I. Abubakar S. Morton H. Maguire S.R. Anderson 《The Journal of infection》2019,78(4):269-274
