2009 September 18

Mesenteric revascularization: management and outcomes in the United States, 1988-2006.

Sep 182009

Mesenteric revascularization: management and outcomes in the United States, 1988-2006.

J Vasc Surg. 2009 Aug;50(2):341-348.e1

Authors: Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB

BACKGROUND: Recent reports have suggested that angioplasty, with and without stenting (PTA/S), may have a lower perioperative mortality rate than open surgery for revascularization of acute (AMI) and chronic mesenteric ischemia (CMI). It is unclear if there has been nationwide adoption of this methodology or whether there is actually a mortality benefit. METHODS: We identified all patients undergoing surgical (bypass, endarterectomy, or embolectomy) or PTA/S mesenteric revascularization from the Nationwide Inpatient Sample from 1988 to 2006. A diagnosis by International Classification of Diseases, 9th Revisioncoding of AMI or CMI was required for inclusion. We evaluated trends in management during this period and compared in-hospital death and complications between surgical bypass and PTA/S for the years 2000 to 2006. RESULTS: From 1988 to 2006, there were 6342 PTA/S and 16,071 open surgical repairs overall. PTA/S increased steadily, surpassing all surgery for CMI in 2002. PTA/S for AMI has also increased and surpassed bypass in 2002 but has not surpassed all surgical procedures for AMI even in 2006. The mortality rate was lower after PTA/S than after bypass for CMI (3.7% vs 13%, P < .01) and AMI (16% vs 28%, P < .01). Bowel resection was more common after bypass than PTA/S for CMI (7% vs 3%, P < .01). This subgroup showed an increased in-hospital mortality rate for both repair types (54% and 25%, respectively). CONCLUSION: PTA/S is being used with increasing frequency for revascularization of CMI and AMI. The lower in-hospital mortality rate for patients, as they are currently being selected, shows that PTA/S is appropriate therapy for selected patients with CMI. Longitudinal data are needed to determine the durability of this benefit. The greater proportion of patients undergoing bowel resection with bypass for AMI suggests a more advanced level of ischemia in this group, making comparison with PTA/S difficult. However, PTA/S may be useful in selected patients with AMI and appropriate anatomy. Further data with greater detail regarding symptomatology and anatomy will clarify appropriate patient selection.

PMID: 19372025 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Novel swine-origin influenza A virus in humans: another pandemic knocking at the door.

Med Microbiol Immunol Start a Discussion »

Sep 182009

Novel swine-origin influenza A virus in humans: another pandemic knocking at the door.

Med Microbiol Immunol. 2009 Aug;198(3):175-83

Authors: Michaelis M, Doerr HW, Cinatl J

Influenza A viruses represent a continuous pandemic threat. In April 2009, a novel influenza A virus, the so-called swine-origin influenza A (H1N1) virus (S-OIV), was identified in Mexico. Although S-OIV originates from triple-reassortant swine influenza A (H1) that has been circulating in North American pig herds since the end of the 1990s, S-OIV is readily transmitted between humans but is not epidemic in pigs. After its discovery, S-OIV rapidly spread throughout the world within few weeks. In this review, we sum up the current situation and put it into the context of the current state of knowledge of influenza and influenza pandemics. Some indications suggest that a pandemic may be mild but even "mild" pandemics can result in millions of deaths. However, no reasonable forecasts how this pandemic may develop can be made at this time. Despite stockpiling by many countries and WHO, antiviral drugs will be limited in case of pandemic and resistances may emerge. Effective vaccines are regarded to be crucial for the control of influenza pandemics. However, production capacities are restricted and development/production of a S-OIV vaccine will interfere with manufacturing of seasonal influenza vaccines. The authors are convinced that S-OIV should be taken seriously as pandemic threat and underestimation of the menace by S-OIV to be by far more dangerous than its overestimation.

PMID: 19543913 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Epidemiology and control of influenza A(H1N1)v in the Netherlands: the first 115 cases.

Euro Surveill Start a Discussion »

Sep 182009

Epidemiology and control of influenza A(H1N1)v in the Netherlands: the first 115 cases.

Euro Surveill. 2009;14(27):

Authors: Hahné S, Donker T, Meijer A, Timen A, van Steenbergen J, Osterhaus A, van der Sande M, Koopmans M, Wallinga J, Coutinho R,

Introductions of the new influenza A(H1N1) variant virus in the Netherlands led to enhanced surveillance and infection control. By 24 June 2009, 115 cases were reported, of whom 44% were indigenously acquired. Severity of disease is similar to reports elsewhere. Our point estimate of the effective reproductive number (Re) for the initial phase of the influenza A(H1N1)v epidemic in the Netherlands was below one. Given that the Re estimate is based on a small number of indigenous cases and a limited time period, it needs to be interpreted cautiously.

PMID: 19589332 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Influenza A(H1N1)v virus infections in Belgium, May-June 2009.

Euro Surveill Start a Discussion »

Sep 182009

Influenza A(H1N1)v virus infections in Belgium, May-June 2009.

Euro Surveill. 2009;14(28):

Authors:

In response to the ongoing influenza A(H1N1)v pandemic, first detected in North America in April 2009, Belgium has set up an active surveillance system for influenza-like illness among travellers returning from affected areas. This communication describes the clinical and epidemiological features of the first 43 laboratory-confirmed cases in Belgium.

PMID: 19607783 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Vaccine production capacity for seasonal and pandemic (H1N1) 2009 influenza.

Vaccine Start a Discussion »

Sep 182009

Vaccine production capacity for seasonal and pandemic (H1N1) 2009 influenza.

Vaccine. 2009 Aug 20;27(38):5184-6

Authors: Collin N, de Radiguès X,

The first influenza pandemic of the 21st century, due to a new strain of A(H1N1) virus, was declared on 11 June 2009 by the Director-General of the World Health Organization. Fortunately, the international community, including influenza vaccine manufacturers, has been increasing its preparedness for such an event, triggered by the need to stem the spread of the highly pathogenic avian influenza A(H5N1) virus over recent years. Today, the development of a pandemic influenza vaccine in the fastest possible time is a global priority. However, two major issues need to be taken into consideration: how long will it take to produce sufficient pandemic vaccine doses to immunize the global population at risk, including poor populations that have no resources to purchase the vaccine; and how will pandemic vaccine production affect availability of trivalent vaccine for the forthcoming 2009-2010 influenza season. To address these questions, WHO carried out a survey in May 2009 among influenza vaccine manufacturers on their planned seasonal and pandemic production with a view to developing recommendations on the distribution and use of pandemic influenza vaccine.

PMID: 19563891 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Evaluation of an asynchronous physician voicemail sign-out for emergency department admissions.

Ann Emerg Med Start a Discussion »

Sep 182009

Evaluation of an asynchronous physician voicemail sign-out for emergency department admissions.

Ann Emerg Med. 2009 Sep;54(3):368-78

Authors: Horwitz LI, Parwani V, Shah NR, Schuur JD, Meredith T, Jenq GY, Kulkarni RG

STUDY OBJECTIVE: Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time consuming. Taped (asynchronous) communication may be more reliable and efficient but lacks interaction. We evaluate a new asynchronous physician-physician sign-out compared with the traditional synchronous sign-out. METHODS: A voicemail-based, semistructured sign-out for routine ED admissions to internal medicine was implemented in October 2007 at an urban, academic medical center. Outcomes were obtained by pre- and postintervention surveys of ED and internal medicine house staff, physician assistants, and hospitalist attending physicians and by examination of access logs and administrative data. Outcome measures included utilization; physician perceptions of ease, accuracy, content, interaction, and errors; and rate of transfers to the ICU from the floor within 24 hours of ED admission. Results were analyzed both quantitatively and qualitatively with standard qualitative analytic techniques. RESULTS: During September to October 2008 (1 year postintervention), voicemails were recorded about 90.3% of medicine admissions; 69.7% of these were accessed at least once by admitting physicians. The median length of each sign-out was 2.6 minutes (interquartile range 1.9 to 3.5). We received 117 of 197 responses (59%) to the preintervention survey and 113 of 206 responses (55%) to the postintervention survey. A total of 73 of 101 (72%) respondents reported dictated sign-out was easier than oral sign-out and 43 of 101 (43%) reported it was more accurate. However, 70 of 101 (69%) reported that interaction among participants was worse. There was no change in the rate of ICU transfer within 24 hours of admission from the ED in April to June 2007 (65/6,147; 1.1%) versus April to June 2008 (70/6,263; 1.1%); difference of 0%, 95% confidence interval -0.4% to 0.3%. The proportion of internists reporting at least 1 perceived adverse event relating to transfer from the ED decreased a nonsignificant 10% after the intervention (95% confidence interval -27% to 6%), from 44% preintervention (32/72) to 34% postintervention (23/67). CONCLUSION: Voicemail sign-out for ED-internal medicine communication was easier than oral sign-out without any change in early ICU transfers or the perception of major adverse events. However, interaction among participants was reduced. Voicemail sign-out may be an efficient means of improving sign-out communication for stable ED admissions.

PMID: 19282064 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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