2009 August 26

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations.

Aug 262009

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations.

Prim Care Respir J. 2009 Jun;18(2):106-13

Authors: Halpin D, Menjoge S, Viel K

AIM: To assess the effect of tiotropium 18 mcg once daily on chronic obstructive pulmonary disease (COPD) exacerbations and exacerbation-related hospitalisations using a patient-level pooled analysis. METHODS: All completed randomised, placebo-controlled, parallel-group tiotropium trials with a duration of >or=24 weeks were included (n=9). An exacerbation was defined in each study as >or=2 respiratory symptoms lasting >or=3 days, and requiring treatment with antibiotics and/or systemic steroids and/or hospitalisation. RESULTS: Compared with placebo (2,862 patients), tiotropium (3,309 patients) significantly reduced by 21% both the risk of COPD exacerbation (95% confidence interval [CI] 0.73-0.86; p<0.0001) and the risk of exacerbation-associated hospitalisation (95% CI 0.65-0.96; p=0.015). Time to first exacerbation and first associated hospitalisation were increased. The protective effect of tiotropium was consistent regardless of age, gender, inhaled corticosteroid use and disease severity. CONCLUSION: This analysis provides further confirmatory evidence that tiotropium reduces the risk of exacerbation and associated hospitalisation.

PMID: 19407916 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Clinical assessment of hemodynamically unstable patients.

Curr Opin Crit Care Start a Discussion »

Aug 262009

Clinical assessment of hemodynamically unstable patients.

Curr Opin Crit Care. 2009 Jun;15(3):234-8

Authors: Sevransky J

PURPOSE OF REVIEW: Clinical examination of hemodynamically unstable patients provides timely, low-risk, and potentially useful diagnostic and prognostic information. This review will examine the evidence behind the use of clinical examination findings to drive treatment decisions and predict outcomes in patients with hemodynamic instability. An additional goal of the review is to place the use of clinical examination in context of more invasive techniques to diagnose and treat hemodynamically unstable patients. RECENT FINDINGS: The development of novel diagnostic tests based on recently developed technology has focused attention on methods to determine when a test should enter routine clinical use. The widespread incorporation of pulmonary artery catheterization into clinical practice prior to formal evaluation of its ability to improve outcomes highlights the importance of properly evaluating diagnostic tests in critically ill patients. Formal evaluation of clinical examination as a diagnostic test will allow better understanding of its role in the hemodynamic evaluation of critically ill patients. SUMMARY: Clinical examination remains an important initial step in the diagnosis and risk stratification of patients. Despite limitations of current techniques, the availability, low risk, and ability to perform repetitive tests ensure that clinical examination of the hemodynamically unstable patient will continue to be a useful tool for the intensivist until more useful tests are validated in this patient population.

PMID: 19387339 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The evolving ecology of risk for hospitalized dialysis patients.

Semin Dial Start a Discussion »

Aug 262009

The evolving ecology of risk for hospitalized dialysis patients.

Semin Dial. 2009 Jan-Feb;22(1):5-8

Authors: Sandroni S

Despite an increased focus on patient safety, changes in resident work rules and contemporary hospital culture often combine to create an environment of potential hazard for the hospitalized dialysis patient. Clinical scenarios are presented to illustrate some of these risks, and suggestions are offered for the protection of patients.

PMID: 19175531 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking.

Drug Alcohol Depend Start a Discussion »

Aug 262009

Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking.

Drug Alcohol Depend. 2009 Aug 1;103(3):131-6

Authors: Oslin DW, Cary M, Slaymaker V, Colleran C, Blow FC

BACKGROUND: Both depressive symptoms and alcohol craving have been postulated as important predictors of relapse in patients with addictive disorders. The purpose of this study was to examine the course of affective symptoms and cravings for alcohol use during the initial 25 days of residential treatment for middle aged and older adults addicted to alcohol and the relationship between these symptoms and recovery outcomes. METHODS: 95 alcohol-dependent subjects were enrolled in this observational study. Participants completed a daily diary of alcohol craving, positive affect, and negative affect during residential treatment. Participants were interviewed 1 and 6 months after discharge to assess clinical symptoms of relapse and functioning. RESULTS: Latent class analysis identified three groups of individuals for each of the three daily measures. For alcohol craving, 17 subjects reported elevated cravings during the entire treatment stay, 37 subjects reported initially elevated but then a slight improvement in craving, and 41 subjects reported relatively low craving from the time of admission to the end of residential treatment. Alcohol craving class was associated with negative affect but not positive affect. Alcohol craving class but not affective class was predictive of time to relapse to any drinking in the 6 months after residential treatment (p<0.05). CONCLUSION: Results suggest that non-cue induced alcohol craving may define a subtype of alcohol dependence that is less responsive to treatment and may explain heterogeneity in treatment outcomes. These results also may suggest a role for differential treatment programming to address high states of craving for alcohol.

PMID: 19443131 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Viral loads and duration of viral shedding in adult patients hospitalized with influenza.

J Infect Dis Start a Discussion »

Aug 262009

Viral loads and duration of viral shedding in adult patients hospitalized with influenza.

J Infect Dis. 2009 Aug 15;200(4):492-500

Authors: Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW, Lui GC, Wong BC, Wong RY, Lam WY, Chu IM, Lai RW, Cockram CS, Sung JJ

BACKGROUND: The goal of this study was to characterize viral loads and factors affecting viral clearance in persons with severe influenza. METHODS: This was a 1-year prospective, observational study involving consecutive adults hospitalized with influenza. Nasal and throat swabs were collected at presentation, then daily until 1 week after symptom onset. Real-time reverse-transcriptase polymerase chain reaction to determine viral RNA concentration and virus isolation were performed. Viral RNA concentration was analyzed using multiple linear or logistic regressions or mixed-effect models. RESULTS: One hundred forty-seven inpatients with influenza A (H3N2) infection were studied (mean age+/-standard deviation, 72+/-16 years). Viral RNA concentration at presentation positively correlated with symptom scores and was significantly higher than that among time-matched outpatients (control subjects). Patients with major comorbidities had high viral RNA concentration even when presenting>2 days after symptom onset (mean+/-standard deviation, 5.06+/-1.85 vs 3.62+/-2.13 log10 copies/mL; P=.005; beta, +0.86 [95% confidence interval, +0.03 to +1.68]). Viral RNA concentration demonstrated a nonlinear decrease with time; 26% of oseltamivir-treated and 57% of untreated patients had RNA detected at 1 week after symptom onset. Oseltamivir started on or before symptom day 4 was independently associated with an accelerated decrease in viral RNA concentration (mean beta [standard error], -1.19 [0.43] and -0.68 [0.33] log10 copies/mL for patients treated on day 1 and days 2-3, respectively; P<.05) and viral RNA clearance at 1 week (odds ratio, 0.10 [95% confidence interval, 0.03-0.35] and 0.30 [0.10-0.90] for patients treated on day 1-2 and day 3-4, respectively). Conversely, major comorbidities and systemic corticosteroid use for asthma or chronic obstructive pulmonary disease exacerbations were associated with slower viral clearance. Viral RNA clearance was associated with a shorter hospital stay (7.0 vs 13.5 days; P=.001). CONCLUSION: Patients hospitalized with severe influenza have more active and prolonged viral replication. Weakened host defenses slow viral clearance, whereas antivirals started within the first 4 days of illness enhance viral clearance.

PMID: 19591575 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Curriculum for the Hospitalized Aging Medical Patient Review.

J Am Geriatr Soc Start a Discussion »

Aug 262009

Curriculum for the Hospitalized Aging Medical Patient Review.

J Am Geriatr Soc. 2009 Aug 21;

Authors: Cumbler E

Geriatricians, hospitalists, general medicine faculty, and PhD educators at the University of Chicago Pritzker School of Medicine designed the Curriculum for the Hospitalized Aging Medical Patient (CHAMP) with support from the Donald W. Reynolds Foundation. It represents a comprehensive faculty development curriculum in hospital-based geriatrics. The program comprises multiple educational modules including PowerPoint presentations, bedside teaching triggers, and workshops for faculty learners. The curriculum includes evaluation instruments, observed structured teaching exercises, and pocket teaching cards with pearls for ward-based teaching.

PMID: 19702615 [PubMed - as supplied by publisher]

Link to Article at PubMed

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