Mar 082011
 

End of the "see one, do one, teach one" era: the next generation of invasive bedside procedural instruction.

J Am Osteopath Assoc. 2010 Jun;110(6):340-6

Authors: Lenchus JD

Traditionally, an apprenticeship model has been used for the instruction of invasive bedside procedures. Because this approach is subject to nonuniform application, a new model was established to determine the impact of a standardized curriculum on medical students' and residents' medical knowledge and technical skills.

PMID: 20606241 [PubMed - indexed for MEDLINE]

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Mar 082011
 

National fluid shifts: fifteen-year trends in paracentesis and thoracentesis procedures.

J Am Coll Radiol. 2010 Nov;7(11):859-64

Authors: Duszak R, Chatterjee AR, Schneider DA

The aim of this study was to evaluate national trends in paracentesis and thoracentesis procedures and the relative roles of specialty groups providing these services.

PMID: 21040867 [PubMed - indexed for MEDLINE]

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Mar 082011
 

Ceftaroline: A new broad-spectrum cephalosporin.

Am J Health Syst Pharm. 2011 Mar 15;68(6):491-8

Authors: Lim L, Sutton E, Brown J

Purpose The pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of ceftaroline are reviewed. Summary Ceftaroline, a new broad- spectrum antibiotic, is approved for the treatment of complicated skin and skin structure infections (cSSSIs) and community- acquired pneumonia (CAP). This ?-lactam antibiotic has extended activity against gram-positive organisms and has activity against common gram-negative organisms. The drug's spectrum of activity includes both methicillin-resistant Staphylococcus aureus and multidrug-resistant Streptococcus pneumoniae. However, its activity against extended-spectrum ?-lactamase-producing bacteria is limited. These bacteria, particularly those that express AmpC ?-lactamase, greatly reduce the activity of ceftaroline. The prodrug of ceftaroline (ceftaroline fosamil) is rapidly converted to its active form (ceftaroline) in plasma. This dose-linear drug has been found to be pharmacodynamically best correlated with the percentage of time that free drug concentrations remain above the minimum inhibitory concentration. Ceftaroline's safety profile is similar to that of the other cephalosporins, with minimal adverse drug reactions, most of which are considered mild. Currently available pharmacokinetic, animal, and clinical studies have found that ceftaroline has reasonable efficacy and tolerability but have also revealed that dosing regimen modifications may be needed in patients with moderate-to-severe renal impairment. The recommended dosage of ceftaroline for the treatment of cSSSIs and CAP is 600 mg infused intravenously over 60 minutes every 12 hours. The recommended duration of therapy is 5-14 and 5-7 days for cSSSIs and CAP, respectively. Additional Phase III studies are currently underway. Conclusion Ceftaroline is a new broad-spectrum cephalosporin indicated for the treatment of cSSSIs and CAP caused by susceptible gram-positive and gram-negative organisms.

PMID: 21378297 [PubMed - in process]

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Mar 082011
 

Hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in the United States--September-October 2009.

Clin Infect Dis. 2011 Jan 1;52 Suppl 1:S50-9

Authors: Skarbinski J, Jain S, Bramley A, Lee EJ, Huang J, Kirschke D, Stone A, Wedlake T, Richards SM, Page S, Ragan P, Bullion L, Neises D, Williams RM, Petruccelli BP, Vandermeer M, Lofy KH, Gindler J, Finelli L,

Given the potential worsening clinical severity of 2009 pandemic influenza A (H1N1) virus (pH1N1) infection from spring to fall 2009, we conducted a clinical case series among patients hospitalized with pH1N1 infection from September through October 2009. A case patient was defined as a hospitalized person who had test results positive for pH1N1 virus by real-time reverse-transcription polymerase chain reaction. Among 255 hospitalized patients, 34% were admitted to an intensive care unit and 8% died. Thirty-four percent of patients were children <18 years of age, 8% were adults ? 65 years of age, and 67% had an underlying medical condition. Chest radiographs obtained at hospital admission that had findings that were consistent with pneumonia were noted in 103 (46%) of 255 patients. Among 255 hospitalized patients, 208 (82%) received neuraminidase inhibitors, but only 47% had treatment started ? 2 days after illness onset. Overall, characteristics of hospitalized patients with pH1N1 infection in fall 2009 were similar to characteristics of patients hospitalized with pH1N1 infection in spring 2009, which suggests that clinical severity did not change substantially over this period.

PMID: 21342900 [PubMed - in process]

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Mar 082011
 

Chronic Pancreatitis and Persistent Steatorrhea: What is the Correct Dose of Enzymes?

Clin Gastroenterol Hepatol. 2011 Mar 3;

Authors: Domínguez-Muñoz JE

Exocrine pancreatic insufficiency with steatorrhea is a major consequence of chronic pancreatitis. Recognition of this entity is highly relevant to avoid malnutrition-related morbidity and mortality. Nutritional counseling and oral pancreatic enzyme replacement are the basis of the therapy of exocrine pancreatic insufficiency. Aim of enzyme therapy is not only to avoid symptoms but also to normalize digestion. With this aim, oral administration of pancreatic enzymes in form of enteric-coated minimicrospheres is the therapy of choice. This enzyme preparation avoids acid-mediated lipase inactivation and ensures gastric emptying of enzymes in parallel with nutrients. Despite that, factors like an acidic intestinal pH and bacterial overgrowth may prevent normalization of fat digestion even in compliant patients. The present article reviews the current evidence on therapy of exocrine pancreatic insufficiency in chronic pancreatitis patients, with special attention to different potential endpoints to select the optimal enzyme dose for individual patients.

PMID: 21377551 [PubMed - as supplied by publisher]

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