2009 June 19

Usefulness of B-type natriuretic peptide levels in predicting hemodynamic and clinical decompensation.

Jun 192009

Usefulness of B-type natriuretic peptide levels in predicting hemodynamic and clinical decompensation.

Heart Fail Clin. 2009 Apr;5(2):169-75

Authors: Taub PR, Daniels LB, Maisel AS

Pulmonary congestion can be challenging to diagnose because of nonspecific symptoms and the blunt nature of physical examination and radiographic findings. Assessing for euvolemia following treatment of congestion also can be difficult but can improve both the inpatient and outpatient care of patients who have heart failure. Tools such as the natriuretic peptides are important adjuncts to the physical examination and chest radiographs and often obviate the need for invasive hemodynamic assessment.

PMID: 19249686 [PubMed - indexed for MEDLINE]

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Telephone follow-up improves patients satisfaction following hospital discharge.

Eur J Intern Med Start a Discussion »

Jun 192009

Telephone follow-up improves patients satisfaction following hospital discharge.

Eur J Intern Med. 2009 Mar;20(2):221-5

Authors: Braun E, Baidusi A, Alroy G, Azzam ZS

BACKGROUND: Many patients encounter problems in the first weeks after discharge from hospital. Telephone follow-up (TFU) is reputed to be a good tool for providing medical advice, managing symptoms, identifying complications and giving reassurance after discharge. Therefore, we aimed to study whether tight TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate. METHODS: The study population included 400 patients, hospitalized in an Internal Medicine Department, randomly divided into two groups; TFU and control. TFU took place one week and one month after discharge. Three months later, members of both groups were contacted by telephone. RESULTS: Satisfaction was increased in the TFU group compared with control group by 6-12% in most fields. Notably, 87% of patients in the TFU group indicated that earlier telephone contact increased their satisfaction. In addition, 78.2% of the patients in the control group reported that they performed the tests that were recommended at discharge and 86.5% reported that they received explanations regarding their medications. In the TFU group, this percentage was increased significantly to 86.9% (P=0.02) and 96.7% (P<0.0001), respectively. As to treatment results, 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P=0.062). CONCLUSIONS: TFU can improve medical treatment by increasing satisfaction and compliance. A trend towards decreased readmission rates was observed, which may lead to a reduction in the burden on the medical system.

PMID: 19327616 [PubMed - indexed for MEDLINE]

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The impact of early hypoglycemia and blood glucose variability on outcome in critical illness.

Crit Care Start a Discussion »

Jun 192009

The impact of early hypoglycemia and blood glucose variability on outcome in critical illness.

Crit Care. 2009 Jun 17;13(3):R91

Authors: Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C, Anzics Core Management Committee T

ABSTRACT: INTRODUCTION: In critical illness, the association of hypoglycemia, blood glucose (BG) variability and outcome are not well understood. We describe the incidence, clinical factors and outcomes associated with an early hypoglycemia and BG variability in critically ill patients. METHODS: Retrospective interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database on 66184 adult admissions to 24 intensive care units (ICUs) from January 1st 2000 to December 31st 2005. Primary exposure was hypoglycemia (BG <4.5mmol/L) and BG variability (BG <4.5 and [greater than or equal to]12.0 mmol/L) within 24 hours of admission. Primary outcome was all-cause mortality. RESULTS: The cumulative incidence of hypoglycemia and BG variability were 13.8% (95% confidence interval [CI], 13.5 - 14.0; n = 9122) and 2.9% (95%CI, 2.8 - 3.0, n = 1913), respectively. Several clinical factors were associated with both hypoglycemia and BG variability including: co-morbid disease (P <0.001), non-elective admissions (P <0.001), higher illness severity (P <0.001) and primary septic diagnosis (P <0.001). Hypoglycemia was associated with greater odds of adjusted ICU (odds ratio [OR] 1.41, 95% CI, 1.31 - 1.54) and hospital death (OR 1.36, 95% CI, 1.27 - 1.46). Hypoglycemia severity was associated with "dose-response" increases in mortality. BG variability was associated with greater odds of adjusted ICU (1.5, 95% CI, 1.4-1.6) and hospital (1.4, 95% CI, 1.3-1.5) mortality, when compared with either hypoglycemia only or neither. CONCLUSIONS: In critically ill patients, both early hypoglycemia and early variability in BG are relatively common, and independently portend an increased risk for mortality.

PMID: 19534781 [PubMed - as supplied by publisher]

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