2011 September 07

Non-invasive ventilation in severe asthma attack, its possibilities and problems.

Sep 072011

Non-invasive ventilation in severe asthma attack, its possibilities and problems.

Panminerva Med. 2011 Jun;53(2):87-96

Authors: Murase K, Tomii K, Chin K, Niimi A, Ishihara K, Mishima M

Abstract
Asthma attack is characterized by episodic attacks of cough, dyspnea and wheeze occurring due to bronchoconstriction, airway hyperresponsiveness and mucous hypersecretion. Although nationwide clinical guidelines have been published to establish the standard care of asthma, choices in the treatment of fatal asthma attacks remain of clinical significance. Especially, in a severe asthma attack, despite the application of conventional medical treatment, respiratory management is critical. Even though non-invasive ventilation (NIV) has been shown to be effective in a wide variety of clinical settings, reports of NIV in asthmatic patients are scarce. According to a few prospective clinical trials reporting promising results in favour of the use of NIV in a severe asthma attack, a trial of NIV prior to invasive mechanical ventilation seems acceptable and may benefit patients by decreasing the need for intubation and by supporting pharmaceutical treatments. Although selecting the appropriate patients for NIV use is a key factor in successful NIV application, how to distinguish such patients is quite controversial. Larger high quality clinical trails are urgently required to confirm the benefits of NIV to patients with severe asthma attack. In this article, we focus on the body of evidence supporting the use of NIV in asthma attacks and discuss its advantages as well its problems.

PMID: 21659974 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Prescriber adherence to pharmacokinetic monitoring service recommendations for aminoglycoside dosing and the risk of acute kidney injury.

Int J Clin Pharmacol Ther Start a Discussion »

Sep 072011

Prescriber adherence to pharmacokinetic monitoring service recommendations for aminoglycoside dosing and the risk of acute kidney injury.

Int J Clin Pharmacol Ther. 2011 Sep;49(9):536-544

Authors: Hennessy S, Leonard CE, Localio AR, Cohen A, Yang W, Cheung L, Strom BL, Herlim M, Feldman HI

Abstract
Objective: The importance of adherence to aminoglycoside dosing recommendations by a pharmacokinetic monitoring service for preventing acute kidney injury (AKI) is unknown. We aimed to examine the association between AKI and discordance in aminoglycoside dosing between physician orders and recommendations by a pharmacokinetic monitoring service. Materials: We utilized 2000 - 2003 data from a large quaternary care academic medical center, including: hand-written pharmacokinetic monitoring service recommendations; computerized physician order entry inpatient medication orders; and electronic inpatient laboratory orders and results. Methods: We conducted a case-control study, nested within users of intravenous aminoglycosides. Outcomes of interest were cases of AKI, as determined by changes in serum creatinine. Exposures of interest were discordances between pharmacokinetic monitoring service recommendations and physician orders in the past 2 days with regard to total daily aminoglycoside dose. Results: Most patients received once-daily or less frequent aminoglycoside dosing. In 1,414 evaluable aminoglycoside courses, 220 patients developed AKI, for a cumulative incidence of 15.6%. We identified 690 controls, matched these to 220 cases, and found adjusted odds ratios of 0.72 (95% CI: 0.37 - 1.39) for overdose discordance and of 0.83 (0.51 - 1.34) for underdose discordance, suggesting that discordance in dosing is not associated with AKI. Conclusion: Non-adherence to dosing recommendations for aminoglycosides was not associated with risk of AKI in a setting primarily of once-daily aminoglycoside administration.

PMID: 21888866 [PubMed - as supplied by publisher]

Link to Article at PubMed

No Place Like the Hospital.

J Pain Symptom Manage Start a Discussion »

Sep 072011

No Place Like the Hospital.

J Pain Symptom Manage. 2011 Aug 31;

Authors: Gillick MR, Sabin JE

Abstract
The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.

PMID: 21889294 [PubMed - as supplied by publisher]

Link to Article at PubMed

Antimicrobial susceptibility of 15,644 pathogens from Canadian hospitals: results of the CANWARD 2007-2009 study.

Diagn Microbiol Infect Dis Start a Discussion »

Sep 072011

Antimicrobial susceptibility of 15,644 pathogens from Canadian hospitals: results of the CANWARD 2007-2009 study.

Diagn Microbiol Infect Dis. 2011 Mar;69(3):291-306

Authors: Zhanel GG, Adam HJ, Low DE, Blondeau J, Decorby M, Karlowsky JA, Weshnoweski B, Vashisht R, Wierzbowski A, Hoban DJ,

Abstract
The CANWARD study (Canadian Ward Surveillance Study) assessed the antimicrobial susceptibility of a variety of available agents against 15 644 pathogens isolated from patients in Canadian hospitals between 2007 and 2009. The most active (based on MIC data) agents against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci were daptomycin, linezolid, tigecycline, and vancomycin (MRSA only) with MIC(90)'s (?g/mL) of 0.25 and 2, 2 and 2, 0.5 and 0.12, and 1, respectively. The most active agents against extended-spectrum ?-lactamase-producing Escherichia coli were colistin (polymyxin E), doripenem, ertapenem, meropenem, and tigecycline with MIC(90)'s (?g/mL) of 1, ? 0.12, 0.25, ? 0.12, and 1, respectively. The most active agents against Pseudomonas aeruginosa were amikacin, cefepime, ceftazidime, colistin, doripenem, meropenem, and piperacillin-tazobactam with MIC(90)'s (?g/mL) of 32, 16, 32, 2, 4, 8, and 64, respectively. Overall, the most active agents versus Gram-positive cocci from Canadian hospitals were vancomycin, linezolid, daptomycin, and tigecycline and versus Gram-negative bacilli were amikacin, cefepime, doripenem, ertapenem (excluding Pseudomonas aeruginosa), meropenem, piperacillin-tazobactam, and tigecycline (excluding Pseudomonas aeruginosa).

PMID: 21353957 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

In vitro activity of dalbavancin and telavancin against staphylococci and streptococci isolated from patients in Canadian hospitals: results of the CANWARD 2007-2009 study.

Diagn Microbiol Infect Dis Start a Discussion »

Sep 072011

In vitro activity of dalbavancin and telavancin against staphylococci and streptococci isolated from patients in Canadian hospitals: results of the CANWARD 2007-2009 study.

Diagn Microbiol Infect Dis. 2011 Mar;69(3):342-7

Authors: Karlowsky JA, Adam HJ, Poutanen SM, Hoban DJ, Zhanel GG,

Abstract
Two novel lipoglycopeptides, dalbavancin and telavancin, and relevant comparative agents were tested for in vitro activity against clinical isolates of staphylococci and streptococci collected in the cross-Canada surveillance study, CANWARD, in 2007-2009. The rank order of potency (based on MIC(90) [?g/mL], i.e., the concentration of antimicrobial agent required to inhibit the growth of 90% of isolates tested) of glycopeptides against both Staphylococcus aureus and Staphylococcus epidermidis was dalbavancin (0.06 ?g/mL) >telavancin (0.5 ?g/mL) > vancomycin (1-2 ?g/mL); concurrent susceptibility or resistance to oxacillin in staphylococci did not affect potency of glycopeptides. Dalbavancin and telavancin also demonstrated potent activity against Streptococcus pneumoniae, including penicillin-resistant isolates (MIC(90), ? 0.03 ?g/mL; ? 0.06 ?g/mL), and Streptococcus pyogenes (? 0.03 ?g/mL; 0.06 ?g/mL). Based on their robust in vitro activities, dalbavancin and telavancin have the potential to treat Gram-positive infections caused by methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae.

PMID: 21353963 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure.

Ann Clin Biochem Start a Discussion »

Sep 072011

Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure.

Ann Clin Biochem. 2011 May;48(Pt 3):212-7

Authors: Robaei D, Koe L, Bais R, Gould I, Stewart T, Tofler GH

Abstract
BACKGROUND: Difficulty in distinguishing congestive heart failure (HF) from other causes of dyspnoea in the emergency department (ED) may result in delay in appropriate treatment and referral. Although the diagnostic value of serum amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is well documented, the impact on diagnostic certainty of providing these results to ED physicians is not well studied. We sought to determine the effect of providing NT-proBNP results on diagnostic certainty of physicians managing patients presenting to the ED with suspected HF.
METHODS: A randomized controlled study was conducted in 68 patients presenting to the ED with dyspnoea. ED clinicians initially rated the probability of HF as the cause of dyspnoea without the knowledge of the result. A scale of 1-7 was used, with 1 representing a high degree of certainty of a diagnosis other than HF and 7 representing a high degree of certainty of HF being the cause of dyspnoea. In 38 patients, the ED physician then reassessed the probability of HF as the cause of dyspnoea after receiving the NT-proBNP result. A cardiologist blinded to the NT-proBNP result determined the final diagnosis after review of medical records and investigations.
RESULTS: Providing the NT-proBNP result reduced diagnostic uncertainty, defined as a test score of 3-5, from 66% of cases to 18% of cases (P < 0.0001) and improved diagnostic accuracy from 53% to 71% (P = 0.016).
CONCLUSION: Measurement of NT-proBNP concentrations reduces diagnostic uncertainty and improves diagnostic accuracy in patients presenting to the ED with dyspnoea and possible HF.

PMID: 21398433 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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