2010 January 06

Lying obliquely–a clinical sign of cognitive impairment: cross sectional observational study.

Jan 062010

Lying obliquely--a clinical sign of cognitive impairment: cross sectional observational study.

BMJ. 2009;339:b5273

Authors: Kraft P, Gadeholt O, Wieser MJ, Jennings J, Classen J

OBJECTIVE: To determine if failure to spontaneously orient the body along the longitudinal axis of a hospital bed when asked to lie down is associated with cognitive impairment in older patients. DESIGN: Cross sectional observational study. SETTING: Neurology department of a university hospital in Germany. PARTICIPANTS: Convenience sample of 110 older (>or=60 years) inpatients with neurological conditions and 23 staff neurologists. MAIN OUTCOME MEASURES: The main outcome measure was the association between the angle of the body axis and the results of three cognitive screening tests (mini-mental state examination, DemTect, and clock drawing test). Staff doctors were shown photographs of a model taken at a natural viewing able to determine their subjective perspective of what constitutes oblique. RESULTS: 110 neurological inpatients (mean age 70.9 (SD 6.8) years) were included after exclusions. Evidence of cognitive impairment was found in 34, with scores indicating dementia in eight, according to the mini-mental state examination, and in 11 according to the DemTect. Across all patients, the mean angular deviation of the body axis from the longitudinal axis of the bed (range 0-23 degrees ) correlated linearly with the mini-mental state examination (r=-0.480), DemTect (r=-0.527), and the clock drawing test (r=-0.552) scores (P<0.001 for all), even after removing age as a covariate. Overall, 90% of staff neurologists considered a minimal body angle of 7 degrees to be oblique. Angular deviation of at least 7 degrees predicted cognitive impairment according to the three different tests, with specificities between 89% and 96% and sensitivities between 27% and 50%. CONCLUSION: Clinicians might suspect cognitive impairment in mobile older inpatients with neurological disorders who spontaneously position themselves obliquely when asked to lie on a bed.

PMID: 20015907 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The patient panel conference experience: what patients can teach our residents about competency issues.

Acad Med Start a Discussion »

Jan 062010

The patient panel conference experience: what patients can teach our residents about competency issues.

Acad Med. 2009 Dec;84(12):1833-9

Authors: Colbert CY, Mirkes C, Cable CT, Sibbitt SJ, VanZyl GO, Ogden PE

PURPOSE: In 2007, the Scott & White/Texas A&M HSC College of Medicine began requiring all internal medicine residents to attend quarterly patient panel conferences, during which former Scott & White patients speak frankly about their inpatient and outpatient experiences. The main purpose of this mixed-methods pilot study was to determine whether residents' competency education could be enhanced via the conferences. METHOD: Of the 54 internal medicine residents in the residency program, 31, 39, and 41 participated in three patient panel conferences, respectively, between December 2007 and August 2008. Each resident completed an assessment that included a reflection on his or her own practice and the identification of competency issues highlighted by patients' oral narratives. Content analyses of responses to open-ended questions were performed. Consensus on themes was reached. Descriptive statistics were run on quantitative data. RESULTS: Six themes were identified: improve communication with patients/families, improve patient care, improve professional behaviors, empathize with patients/families, display sensitivity to patients'/families' needs/concerns, and recognize system issues. When asked if the conference highlighted competency problems, residents answered "agree" or "strongly agree" as follows: 82% for professionalism, 82.9% for systems-based practice, 85.2% for interpersonal and communication skills, and 84.4% for patient care. The majority were able to provide examples of competency issues. CONCLUSIONS: The patient panel conference experience was a powerful mechanism for enhancing competency education. The conferences were an effective means of presenting real-life examples of systems issues in the context of a hospital system.

PMID: 19940596 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Swine flu and antibiotics.

J Antimicrob Chemother Start a Discussion »

Jan 062010

Swine flu and antibiotics.

J Antimicrob Chemother. 2009 Nov;64(5):889-94

Authors: Barlow GD,

Health services worldwide are likely to be hard-pressed by swine flu-related illness in the months ahead. Secondary infections with Streptococcus pneumoniae, other streptococci (e.g. Streptococcus pyogenes), Haemophilus influenzae and Staphylococcus aureus are likely to be important causes of morbidity and mortality. The UK Department of Health recently published clinical pathways for the management of swine flu. Suggested severity criteria have not been validated in respiratory infection and are different from those previously published. Antibiotics are recommended for all patients assessed at hospital, regardless of severity of illness; cephalosporins or quinolones are suggested for inpatients with pneumonia. These recommendations will jeopardize recent decreases in Clostridium difficile-associated diarrhoea (CDAD) and methicillin-resistant S. aureus (MRSA) in UK hospitals. This article, written on behalf of the BSAC Council, considers these recommendations and provides alternative antibiotic regimens for a range of clinical scenarios.

PMID: 19740909 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Trends in US hospital admissions for skin and soft tissue infections.

Emerg Infect Dis Start a Discussion »

Jan 062010

Trends in US hospital admissions for skin and soft tissue infections.

Emerg Infect Dis. 2009 Sep;15(9):1516-8

Authors: Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G

Using data from the 2000-2004 US Healthcare Cost and Utilization Project National Inpatient Sample, we found that total hospital admissions for skin and soft tissue infections increased by 29% during 2000-2004; admissions for pneumonia were largely unchanged. These results are consistent with recent reported increases in community-associated methicillin-resistant Staphylococcus aureus infections.

PMID: 19788830 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting.

Eur J Intern Med Start a Discussion »

Jan 062010

Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting.

Eur J Intern Med. 2009 Nov;20(7):690-4

Authors: Monte R, Rabuñal R, Casariego E, Bal M, Pértega S

BACKGROUND: The clinical expressions of alcohol withdrawal syndrome (AWS) may vary and the factors determining these variations are not well-known. It would be useful to have a set of clinical tools capable of predicting which patients are likely to develop the more severe forms of the syndrome. AIM: To analyse the clinical variables associated with the development of delirium tremens (DTs) in patients who were admitted to a general hospital with AWS. METHODS: Cohort study of AWS patients admitted to the Xeral Hospital in Lugo, Spain, between 1987 and 2003. The characteristics of patients with the syndrome who did not develop delirium tremens were contrasted with those who did. Cases presenting with DTs at diagnosis were excluded. The different clinical, epidemiological and biochemical variables reflective of alcohol consumption habits, basal health status and presentation features of syndrome were all recorded. RESULTS: Data from 156 episodes of AWS that coursed without DTs were compared with 147 cases that coursed with it. Three independent variables for development of DTs were identified in a multivariate logistic regression model: number of seizures [1 or 2: OR 2.2 (CI 95% 1.2-3.8), p=0.005; 3 or more: OR 2.6 (CI 95% 1.04-6.8), p=0.04]; systolic blood pressure >150 mm Hg [OR 1.9 (CI 95% 1.1-3.8), p=0.03] and axillary temperature >38 degrees C [OR 1.9 (CI 95% 1.05-3.5), p=0.01]. ROC analysis revealed an area under the curve of 0.679. CONCLUSION: Three clinical findings (seizures, blood pressure and temperature) can aid in identifying patients with AWS who are likely to develop DTs. The model's predictive capacity is not high.

PMID: 19818288 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Technical mistakes during the acquisition of the electrocardiogram.

Ann Noninvasive Electrocardiol Start a Discussion »

Jan 062010

Technical mistakes during the acquisition of the electrocardiogram.

Ann Noninvasive Electrocardiol. 2009 Oct;14(4):389-403

Authors: García-Niebla J, Llontop-García P, Valle-Racero JI, Serra-Autonell G, Batchvarov VN, de Luna AB

In addition to knowledge of normal and pathological patterns, the correct interpretation of electrocardiographic (ECG) recordings requires the use of acquisition procedures according to approved standards. Most manuals on standard electrocardiography devote little attention to inadequate ECG recordings. In this article, we present the most frequent ECG patterns resulting from errors in limb and precordial lead placement, artifacts in 12-lead ECG as well as inadequate filter application; we also review alternative systems to the standard ECG, which may help minimize errors.

PMID: 19804517 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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