2009 August 05

Identifying low-risk patients for bacterial meningitis in adult patients with acute meningitis.

Aug 052009

Identifying low-risk patients for bacterial meningitis in adult patients with acute meningitis.

Intern Med. 2009;48(7):537-43

Authors: Tokuda Y, Koizumi M, Stein GH, Birrer RB

OBJECTIVE: To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients. METHODS: We developed the model using the derivation cohort in a community rural hospital in Okinawa and assessed its performance using the validation cohort in a metropolitan urban hospital in Tokyo. There were 66 (39.5%) and 5 (17.9%) adult patients with BM among the derivation (n=167) and the validation cohort (n=28), respectively. Recursive partitioning analysis was used to determine the important classification variables and to develop a sensitive model to safely exclude BM. RESULTS: The model produced high- and low-risk groups based on the following: 1) Gram stain, 2) CSF neutrophil percent < or =15%, 3) CSF neutrophil count < or =150 cells/mm(3), and, 4) mental status change. Among the derivation cohort, there were 65 patients with BM in the high-risk group (n=76), while only one patient with BM was noted (sensitivity, 99%) in the low-risk group (n=91). Among the validation cohort, there were 5 patients with BM in the high-risk group (n=7), while no patient was classified with BM (sensitivity, 100%) in the low-risk group (n=21). CONCLUSION: This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.

PMID: 19336955 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Predicting the onset of delirium in the post-operative patient.

Age Ageing Start a Discussion »

Aug 052009

Predicting the onset of delirium in the post-operative patient.

Age Ageing. 2009 Jul;38(4):368-73

Authors: Noimark D

The number of people over 65 is increasing and those over 65 requiring surgery will likewise increase. Post-operative delirium (POD) affects up to 47% of patients undergoing surgery and is more prevalent in older people. Importantly, POD is associated with increased morbidity, mortality, length of stay and care home placement. There is evidence that specialist geriatrician input reduces POD but to be cost effective, needs to target patients with increased risk for POD. Many factors have been associated with increased risk of POD, including age, cognitive impairment, gender, depression, alcohol, drug use, smoking, co-morbidity, functional status, ASA score and pre-operative biochemical and haematological abnormalities. This article reviews the literature associated with the above factors, considers frailty as a factor and also suggests that POD may be associated with rapidity of onset and severity of the insult to the patient.

PMID: 19297372 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial.

Diabetes Care Start a Discussion »

Aug 052009

Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial.

Diabetes Care. 2009 Apr;32(4):594-6

Authors: Korytkowski MT, Salata RJ, Koerbel GL, Selzer F, Karslioglu E, Idriss AM, Lee KK, Moser AJ, Toledo FG

OBJECTIVE: To compare two subcutaneous insulin strategies for glycemic management of hyperglycemia in non-critically ill hospitalized patients with diabetes during enteral nutrition therapy (ENT). RESEARCH DESIGN AND METHODS: Fifty inpatients were prospectively randomized to receive sliding-scale regular insulin (SSRI) alone (n = 25) or in combination with insulin glargine (n = 25). NPH insulin was added for persistent hyperglycemia in the SSRI group (glucose >10 mmol/l). RESULTS: Glycemic control was similar in the SSRI and glargine groups (mean +/- SD study glucose 8.9 +/- 1.6 vs. 9.2 +/- 1.6 mmol/l, respectively; P = 0.71). NPH insulin was added in 48% of the SSRI group subjects. There were no group differences in frequency of hypoglycemia (1.3 +/- 4.1 vs. 1.1 +/- 1.8%; P = 0.35), total adverse events, or length of stay. CONCLUSIONS: Both insulin strategies (SSRI with the addition of NPH for persistent hyperglycemia and glargine) demonstrated similar efficacy and safety in non-critically ill hospitalized patients with type 2 diabetes during ENT.

PMID: 19336639 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Inflammatory bowel disease patients who leave hospital against medical advice: predictors and temporal trends.

Inflamm Bowel Dis Start a Discussion »

Aug 052009

Inflammatory bowel disease patients who leave hospital against medical advice: predictors and temporal trends.

Inflamm Bowel Dis. 2009 Jun;15(6):845-51

Authors: Kaplan GG, Panaccione R, Hubbard JN, Nguyen GC, Shaheen AA, Ma C, Devlin SM, Leung Y, Myers RP

BACKGROUND: Leaving hospital against medical advice (AMA) may have consequences with respect to health-related outcomes; however, inflammatory bowel disease (IBD) patients have been inadequately studied. Thus, we determined the prevalence of self-discharge, assessed predictors of AMA status, and evaluated time trends. METHODS: We analyzed the 1995-2005 Nationwide Inpatient Sample (NIS) to identify 93,678 discharges with a primary diagnosis of IBD admitted to the hospital emergently and did not undergo surgery. We described the proportion of IBD patients who left AMA. Predictors of AMA status were evaluated using a multivariate logistic regression model and temporal trend analyses were performed with Poisson regression models. RESULTS: Between 1995 and 2005, 1.31% of IBD patients left hospitals AMA. Crohn's disease (CD) patients were more likely to leave AMA (adjusted odds ratio [aOR], 1.53; 95% confidence intervals [CI]: 1.30-1.79). Characteristics associated with leaving AMA included: ages 18-34 (aOR, 7.77, 95% CI: 4.34-13.89); male (aOR, 1.75; 95% CI: 1.55-1.99); Medicaid (aOR, 4.55; 95% CI: 3.81-5.43) compared to private insurance; African Americans (aOR, 1.34; 95% CI: 1.09-1.64) compared to white; substance abuse (aOR, 2.75; 95% CI: 2.14-3.54); and psychosis (aOR, 1.55; 95% CI: 1.13-2.14). The incidence rates of self-discharge for CD patients were stable (P > 0.05) between 1995 and 1999, while they significantly (P < 0.0001) increased after 1999. In contrast, AMA rates for UC patients remained stable during the study period. CONCLUSIONS: Approximately 1 in 76 IBD patients admitted emergently for medical management leave the hospital AMA. These were primarily disenfranchised patients who may lack adequate outpatient follow-up.

PMID: 19130616 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems.

Eur J Echocardiogr Start a Discussion »

Aug 052009

Improved workflow, sonographer productivity, and cost-effectiveness of echocardiographic service for inpatients by using miniaturized systems.

Eur J Echocardiogr. 2009 Jun;10(4):537-42

Authors: Badano LP, Nucifora G, Stacul S, Gianfagna P, Pericoli M, Del Mestre L, Buiese S, Compassi R, Tonutti G, Di Benedetto L, Fioretti PM

AIMS: The aim of this study was to assess the cost-effectiveness of using certified sonographers and miniaturized echocardiography systems to perform echocardiograms at bedside in comparison to moving inpatients from the admission department to the echocardiography laboratory (echo-lab). METHODS AND RESULTS: From 26 September 2005 to 27 October 2005, 112 patients admitted in six hospital wards connected through a 100 Mbit LAN to the echo-lab were scanned within the admission ward by sonographers using a miniaturized echo system. Logistical data were collected and results were compared with those obtained from 194 consecutive patients coming from the same wards and studied in the echo-lab with high-end machines between 8 March 2005 and 15 April 2005. Performing echocardiograms in the admission department avoided long waiting time of the inpatients in the echo-lab before and after the study, increased the percentage of patients studied within 3 and 5 days from request (88 vs. 77% and 100 vs. 95%, respectively; P = 0.03), increased both sonographer (by 33.9%; P < 0.001) and echo-lab productivity (by 41%; P < 0.001), and reduced costs of echocardiograms by 29%. CONCLUSION: Implementation of digital echocardiography, certified sonographers, and a miniaturized echo system allowed improvement of the cost-effectiveness of the service provided by the echo-lab for inpatients, and avoided patients' discomfort derived from prolonged waiting time before and after the exam.

PMID: 19252189 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Predictors of “worsening renal function” in patients hospitalized in internal medicine department.

Curr Drug Saf Start a Discussion »

Aug 052009

Predictors of "worsening renal function" in patients hospitalized in internal medicine department.

Curr Drug Saf. 2009 May;4(2):113-8

Authors: Sweileh WM, Sawalha AF, Jayousi HM, Zyoud SH, Al-Jabi SW

AIM: The aim of this study was to identify predictors of worsening renal function (WRF) among hospitalized patients in the internal medicine department. SETTINGS AND DESIGN: A one-year, hospital-based prospective study. METHODS AND MATERIAL: This study was carried out at the internal medicine department of Al-Watani governmental hospital, Palestine. Inclusion criteria were: hospitalization for at least 48 hours and availability of at least three serum creatinine (Scr) measurements. WRF was defined, per hospital stay, as an elevation in Scr of > or = 0.5 mg/dL from baseline value if baseline Scr value was < 3 mg/ dL and 1 mg/dL if the baseline value was > or = 3 mg/dL. Baseline measurements were made at hospital admission. STATISTICAl ANALYSIS: Regression analysis (enter method) was carried out on two sets of variables: non-medication variables (Model I) and medication variables (Model II). Statistics was performed using SPSS version 15. RESULTS: Three hundred and sixty one patients were included in this study. The prevalence of WRF among those who met the inclusion criteria was 40.2%. In the majority of cases, WRF started within the first 48 hrs of admission. Analysis of data indicated that eight variables were significantly associated with WRF: renal dysfunction (P< 0.0001), diabetes mellitus (P= 0.005), hypertension (HTN) (P< 0.0001), congestive heart failure (CHF) (P= 0.021), elderly (being > 65 years) (P= 0.003), number of diagnosis (P< 0.001), furosemide (P = 0.001) and calcium channel blockers (P= 0.01) administration at admission. Regression analysis indicated that HTN (P =0.033) and renal dysfunction (P= 0.007) were predictors of WRF in model I, while furosemide administration (P= 0.01) was the only predictor of WRF in model II. CONCLUSION: Hypertension, renal dysfunction and furosemide administration at hospital admission are predictors of WRF among hospitalized patients. Clinical characteristics available at hospital admission can be used to identify patients at increased risk for WRF. Patients receiving certain medications, especially loop diuretics, require close observation for potential development of WRF.

PMID: 19442103 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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