2011 August 21

Modified insertion of a peripherally inserted central catheter: taking the chest radiograph earlier.

Aug 212011

Modified insertion of a peripherally inserted central catheter: taking the chest radiograph earlier.

Crit Care Nurse. 2011 Apr;31(2):64-9

Authors: Tian G, Chen B, Qi L, Zhu Y

Abstract
Placement of the tip of a peripherally inserted central catheter in the lower third of the superior vena cava is essential to minimize the risk of complications. Sometimes, however, the catheter tip cannot be localized clearly on the chest radiograph, and repositioning a catheter at bedside is difficult, sometimes impossible. A chest radiograph obtained just after the catheter is inserted, before the guidewire is removed, can be helpful. With the guidewire in the catheter, the catheter and its tip can be seen clearly on the radiograph. If the catheter was inserted via the wrong route or the tip is not at the appropriate location, the catheter can be repositioned easily with the guidewire in it. Between January 1, 2007, and May 31, 2009, 225 catheters were placed by using this method in our department. Of these, 33 tips (14.7%) were initially malpositioned. The tips of all these catheters were repositioned in the lower third of the superior vena cava by using this method. No catheter was exchanged or removed. The infection rate for catheter placement did not increase when this method was used. This modification facilitates accurate location of the catheter tip on the chest radiograph, making it easy to correct any malposition (by withdrawing, advancing, or even reinserting the catheter after withdrawal).

PMID: 21459865 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Jump-start to the wards: a hospitalist model.

Clin Teach Start a Discussion »

Aug 212011

Jump-start to the wards: a hospitalist model.

Clin Teach. 2011 Sep;8(3):164-7

Authors: Martinez JM, Hembre KM, Ebright AB, Newman JS

Abstract
Background:? In recent years, pursuing a second degree during medical school has become an increasingly attractive option. Interested students choose to leave medical school for one or several years, and then return to finish their clinical rotations. However, they often have minimal clinical exposure while completing these degree programmes, and may have difficulty adapting to the clinical environment when returning for their third or fourth year of medical school. Context:? Whereas MD and PhD students tend to have clinical re-entry courses at their medical schools, there are no formal reintegration programmes for medical students who choose to pursue 1- or 2-year degrees. Innovation:? We designed a 5-day reintegration course based on a hospital service model, with physician assistants or nurse practitioners to aid in student transition to clinical rotations, and describe the experience of a dual-degree medical student participating in this re-entry model. Implications:? This model provides the student with both didactic and patient care training, as well as the experience of working with professionals from different backgrounds. As the demand for dual-degree opportunities increases, the implementation of formal re-entry programmes should be considered to ensure students returning to medical school are prepared to begin clinical rotations.

PMID: 21851562 [PubMed - in process]

Link to Article at PubMed

Patient acuity rating: Quantifying clinical judgment regarding inpatient stability.

J Hosp Med Start a Discussion »

Aug 212011

Patient acuity rating: Quantifying clinical judgment regarding inpatient stability.

J Hosp Med. 2011 Aug 18;

Authors: Edelson DP, Retzer E, Weidman EK, Woodruff J, Davis AM, Minsky BD, Meadow W, Hoek TL, Meltzer DO

Abstract
BACKGROUND: New resident work-hour restrictions are expected to result in further increases in the number of handoffs between inpatient care providers, a known risk factor for poor outcomes. Strategies for improving the accuracy and efficiency of provider sign-outs are needed. OBJECTIVE: To develop and test a judgment-based scale for conveying the risk of clinical deterioration. DESIGN: Prospective observational study. SETTING: University teaching hospital. SUBJECTS: Internal medicine clinicians and patients. MEASUREMENTS: The Patient Acuity Rating (PAR), a 7-point Likert score representing the likelihood of a patient experiencing a cardiac arrest or intensive care unit (ICU) transfer within the next 24 hours, was obtained from physicians and midlevel practitioners at the time of sign-out. Cross-covering physicians were blinded to the results, which were subsequently correlated with outcomes. RESULTS: Forty eligible clinicians consented to participate, providing 6034 individual scores on 3419 patient-days. Seventy-four patient-days resulted in cardiac arrest or ICU transfer within 24 hours. The average PAR was 3 ± 1 and yielded an area under the receiver operator characteristics curve (AUROC) of 0.82. Provider-specific AUROC values ranged from 0.69 for residents to 0.85 for attendings (P = 0.01). Interns and midlevels did not differ significantly from the other groups. A PAR of 4 or higher corresponded to a sensitivity of 82% and a specificity of 68% for predicting cardiac arrest or ICU transfer in the next 24 hours. CONCLUSIONS: Clinical judgment regarding patient stability can be reliably quantified in a simple score with the potential for efficiently conveying complex assessments of at-risk patients during handoffs between healthcare members. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

PMID: 21853529 [PubMed - as supplied by publisher]

Link to Article at PubMed

The impact of multidrug resistance in healthcare-associated and nosocomial Gram-negative bacteraemia on mortality and length of stay: cohort study.

Clin Microbiol Infect Start a Discussion »

Aug 212011

The impact of multidrug resistance in healthcare-associated and nosocomial Gram-negative bacteraemia on mortality and length of stay: cohort study.

Clin Microbiol Infect. 2011 Jun 20;

Authors: Lye DC, Earnest A, Ling ML, Lee TE, Yong HC, Fisher DA, Krishnan P, Hsu LY

Abstract
Clin Microbiol Infect ABSTRACT: Multidrug-resistant Gram-negative bacteria (MDR-GNB) are an emerging public health threat. Accurate estimates of their clinical impact are vital for justifying interventions directed towards preventing or managing infections caused by these pathogens. A retrospective observational cohort study was conducted between 1 January 2007 and 31 July 2009, involving subjects with healthcare-associated and nosocomial Gram-negative bacteraemia at two large Singaporean hospitals. Outcomes studied were mortality and length of stay post-onset of bacteraemia in survivors (LOS). There were 675 subjects (301 with MDR-GNB) matching study inclusion criteria. On multivariate analysis, multidrug resistance was not associated with 30-day mortality, but it was independently associated with longer LOS in survivors (coefficient, 0.34; 95% CI, 0.21-0.48; p?<?0.001). The excess LOS attributable to multidrug resistance after adjustment for confounders was 6.1?days. Other independent risk factors for higher mortality included male gender, higher APACHE II score, higher Charlson comorbidity index, intensive care unit stay and presence of concomitant pneumonia. Concomitant urinary tract infection and admission to a surgical discipline were associated with lower risk of mortality. Appropriate empirical antibiotic therapy was neither associated with 30-day mortality nor LOS, although the study was not powered to assess this covariate adequately. Our study adds to existing evidence that multidrug resistance per se is not associated with higher mortality when effective antibiotics are used for definitive therapy. However, its association with longer hospitalization justifies the use of control efforts.

PMID: 21851482 [PubMed - as supplied by publisher]

Link to Article at PubMed

Contemporary unconventional clinical use of co-trimoxazole.

Clin Microbiol Infect Start a Discussion »

Aug 212011

Contemporary unconventional clinical use of co-trimoxazole.

Clin Microbiol Infect. 2011 Jun 24;

Authors: Goldberg E, Bishara J

Abstract
Clin Microbiol Infect ABSTRACT: In the late 1960s, the combination of trimethoprim and sulphamethoxazole (co-trimoxazole) was introduced into clinical practice and used to treat many infectious diseases, such as urinary tract infections, respiratory infections, sexually transmitted diseases, Gram-negative sepsis, enteric infections and typhoid fever. Subsequently, co-trimoxazole was reported to be effective against numerous bacterial, fungal and protozoal pathogens, including Nocardia, Listeria monocytogenes, Brucella, Stenotrophomonas maltophilia, Burkholderia, Coxiella burnetii, Tropheryma whipplei, atypical mycobacteria, and Pneumocystis jirovecii. Among protozoal infections, in addition to toxoplasmosis, co-trimoxazole has been used to treat susceptible Plasmodium falciparum, Cyclospora and Isospora infections. Several retrospective and prospective studies have demonstrated good clinical outcome with co-trimoxazole in treating invasive methicillin-resistant Staphylococcus aureus infections. We summarize herein the accumulated evidence in the literature on the new, 'unconventional' clinical use of co-trimoxazole during the last three decades. In the era of widespread antibiotic resistance and shortage of new antibiotic options, large-scale, well-designed studies are needed to explore the tremendous potential concealed in this well-established drug.

PMID: 21851485 [PubMed - as supplied by publisher]

Link to Article at PubMed

August 2011
M	T	W	T	F	S	S
« Jul				Sep »
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	31