Recommendations to replace peripheral venous catheters every 72-96 hours: is a single reference enough?
J Hosp Infect. 2011 Jul 27;
Authors: Safdar N, McKinley LM, Davidson B, Broome C, Schenk J
PMID: 21802173 [PubMed - as supplied by publisher]
Link to Article at PubMedManagement and outcomes of patients with acute coronary syndromes in Australia and New Zealand, 2000-2007.
Med J Aust. 2011 Aug 1;195(3):116-121
Authors: Aliprandi-Costa B, Ranasinghe I, Chow V, Kapila S, Juergens C, Devlin G, Elliott J, Lefkowitz J, Brieger DB
OBJECTIVES: To describe temporal trends in the use of evidence-based medical therapies and management of patients with acute coronary syndromes (ACS) in Australia and New Zealand. DESIGN, SETTING AND PARTICIPANTS: Our analysis of the Australian and New Zealand cohort of the Global Registry of Acute Coronary Events (GRACE) included patients with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation ACS (NSTEACS) enrolled continuously between January 2000 and December 2007 from 11 metropolitan and rural centres in Australia and New Zealand. RESULTS: 5615 patients were included in this analysis (1723 with STEMI; 3892 with NSTEACS). During 2000-2007 there was an increase in the use of statin therapy, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and thienopyridines (P < 0.0001 for each). Among patients with STEMI, there was an increase in emergency revascularisation with PCI (from 11% to 27% [P < 0.0001]), and inhospital coronary angiography (from 61% to 76% [P < 0.0001]). Among patients with NSTEACS, there was an increase in revascularisation with PCI (from 20% to 25% [P = 0.004]). Heart failure rates declined substantially among STEMI and NSTEACS patients (from 21% to 12% [P = 0.0002], and from 13% to 4% [P < 0.0001], respectively) as did rates of hospital readmission for ischaemic heart disease at 6 months (from 23% to 9% [P = 0.0001], and from 24% to 15% [P = 0.0001], respectively). CONCLUSIONS: From 2000 to 2007 in Australia and New Zealand, there was a fall in inhospital events and 6-month readmissions among patients admitted with ACS. This showed an association with improved uptake of guideline-recommended medical and interventional therapies. These data suggest an overall improvement in the quality of care offered to contemporary ACS patients in Australia and New Zealand.
PMID: 21806528 [PubMed - as supplied by publisher]
Link to Article at PubMedShould adult patients be routinely tested for heritable thrombophilia after an episode of venous thromboembolism?
Med J Aust. 2011 Aug 1;195(3):139-142
Authors: Ho WK, Hankey GJ, Eikelboom JW
The clinical usefulness of laboratory testing of adult patients with venous thromboembolism (VTE) for heritable thrombophilia needs to be critically evaluated. At present, some clinicians use testing to identify patients at higher risk of recurrence (who may benefit from an extended period of anticoagulation beyond the usual 3-6 months) and their relatives at risk of a first VTE episode. As prevalence of heritable thrombophilia is related to age and ethnic origin, the pretest probability of detecting heritable thrombophilia may be low in unselected populations. Interpretation of laboratory results may not be straightforward. Apparent deficiencies of a natural anticoagulant may be due to acute thrombosis and "consumption", concomitant therapy with heparin and/or warfarin and other clinical factors. The predictive value of recurrent VTE conferred by the most common types of heritable thrombophilia (factor V Leiden and the G20210A prothrombin mutation) is limited. Risk of recurrence associated with deficiencies of a natural anticoagulant is less certain due to their rarity. Clinical risk factors (eg, the presence or otherwise of provoking factor(s) and whether or not the risk factor for VTE is reversible or permanent) appear to be the most important predictors of VTE recurrence. Duration of anticoagulation should be determined by clinical risk factors rather than the presence, or otherwise, of heritable thrombophilia. The benefit of identifying relatives who are carriers of thrombophilia is uncertain, as VTE is a multifactorial disease resulting from the interaction of various risk factors, some well recognised and others as yet unknown.
PMID: 21806532 [PubMed - as supplied by publisher]
Link to Article at PubMedLung ultrasound in critically ill patients: comparison with bedside chest radiography.
Intensive Care Med. 2011 Aug 2;
Authors: Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D
PURPOSE: To compare the diagnostic performance of lung ultrasound and bedside chest radiography (CXR) for the detection of various pathologic abnormalities in unselected critically ill patients, using thoracic computed tomography (CT) as a gold standard. METHODS: Forty-two mechanically ventilated patients scheduled for CT were prospectively studied with a modified lung ultrasound protocol. Four pathologic entities were evaluated: consolidation, interstitial syndrome, pneumothorax, and pleural effusion. Each hemithorax was evaluated for the presence or absence of each abnormality. RESULTS: Eighty-four hemithoraces were evaluated by the three imaging techniques. The sensitivity, specificity, and diagnostic accuracy of CXR were 38, 89, and 49% for consolidation, 46, 80, and 58% for interstitial syndrome, 0, 99, and 89% for pneumothorax, and 65, 81, and 69% for pleural effusion, respectively. The corresponding values for lung ultrasound were 100, 78, and 95% for consolidation, 94, 93, and 94% for interstitial syndrome, 75, 93, and 92% for pneumothorax, and 100, 100, and 100% for pleural effusion, respectively. The relatively low sensitivity of lung ultrasound for pneumothorax could be due to small number of cases (n = 8) and/or suboptimal methodology. CONCLUSIONS: In our unselected general ICU population lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT.
PMID: 21809107 [PubMed - as supplied by publisher]
Link to Article at PubMedThe effects of statin on atrial fibrillation: a meta-analysis of published data from randomized controlled trials.
Curr Med Res Opin. 2011 Aug 1;
Authors: Xu Q, Guan YQ, Zhang D, Su GH
Abstract Background: Some clinical and experimental studies have shown the use of statins could protect against AF, but there are not adequate data at present. Objectives: We performed a meta-analysis of randomized trials with statins on the endpoint of incidence of AF to estimate the impact of statin use on AF development. Methods: We searched PUBMED, EMBASE and the Cochrane controlled Trials Register (Cochrane Library Issue 4, 2010) up to November 2010 to identify studies covering the use of statins on atrial fibrillation. Results: In published data from nine short term trials (1044 patients, 421 AF), the effect of statins was significantly associated with a decreased risk of recurrence of AF (OR 0.43, 95% CI 0.25 to 0.73, P?=?0.002). The result of OR was higher when studies with Jadad score ?3 were excluded (OR 0.32, 95% CI 0.18 to 0.54, P???0.0001). Among four long term trials (12,442 patients, 618 AF), the effect of statins was associated with a decreased risk of recurrence of AF (OR 0.81, 95% CI 0.68 to 0.97, P?=?0.02). In three long term trials of more intensive versus standard statin (9130 patients, 188 AF), there was no evidence of a reduction in the risk of AF (OR 1.05, 95% CI 0.79 to 1.40, P?=?0.74). Conclusion: Our meta-analysis suggests that the use of statins may be associated with preventing AF in short term trials and long term trials, but in the long term trials of more intensive versus standard statin, there was no evidence of a reduction in the risk of AF. However, we still need large-scale randomized double blind statin trials with AF occurrence as the main endpoint in order to finally confirm the benefits of statin in AF patients.
PMID: 21806315 [PubMed - as supplied by publisher]
Link to Article at PubMedNatural history of eosinophilic gastroenteritis.
Clin Gastroenterol Hepatol. 2011 Jul 29;
Authors: Pineton de Chambrun G, Gonzalez F, Canva JY, Gonzalez S, Houssin L, Desreumaux P, Cortot A, Colombel JF
BACKGROUND & AIMS: Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disorder; little is known about its natural history. We determined the clinical features and long-term outcomes of patients with EGE. METHODS: We reviewed files from 43 patients diagnosed with EGE who were followed from January 1988 to April 2009. The diagnosis was made according to standard criteria, after other eosinophilic gastrointestinal disorders were excluded. We analyzed data on initial clinical presentation and long-term outcomes. RESULTS: EGE was classified as mucosal, subserosal, or muscular in 44%, 39%, and 12% of cases, respectively. Disease location was mostly duodenal (62%), ileal (72%), or colonic (88%); it was less frequently esophageal (30%) or gastric (38%). Blood eosinophilia (numbers >500/mm(3)) was observed in 74% of cases. Spontaneous remission occurred in 40% of patients; the majority of treated patients (74%) received oral corticosteroids, which were effective in most cases. After a median follow-up period of 13 y (0.8-29 y), we identified 3 different courses of disease progression: 18 patients (42%; 9 with subserosal disease) had an initial flare of the disease without relapse, 16 (37%) had multiple flares that were separated by periods of full remission (recurring disease), and 9 (21%) had chronic disease. CONCLUSIONS: The clinical presentation of EGE is heterogeneous and varies in histologic pattern; about 40% of patients resolve the disease spontaneously, without relapse. Approximately 50% have a more complex disease, characterized by unpredictable relapses and a chronic course.
PMID: 21806952 [PubMed - as supplied by publisher]
Link to Article at PubMed