2012 March 02

Characteristics of patients who return to the emergency department within 72 hours in one community hospital.

Mar 022012

Characteristics of patients who return to the emergency department within 72 hours in one community hospital.

Adv Emerg Nurs J. 2011 Oct-Dec;33(4):344-53

Authors: White D, Kaplan L, Eddy L

Abstract
This study identifies characteristics of patients who return to the emergency department (ED) within 72 hr after an initial visit. An exploratory quantitative descriptive study was conducted to identify characteristics of patients with unscheduled 72 hr ED returns. The sample consisted of all patients with 72 hr ED return visits for the month of January 2009 at the study facility. Data were collected from electronic patient records utilizing the National Hospital Ambulatory Medical Care Survey instrument modified to eliminate patient identifiers. There were 169 individuals who had at least one 72 hr return visit to the ED for a total of 393 initial and return ED visits. The most common diagnoses were for gastrointestinal complaints. Over a third of the patients who returned had chronic health conditions. There were more emergency department return visits in individuals who lacked access to primary care.

PMID: 22075685 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Chronic obstructive pulmonary disease and associated health-care resource use – north Carolina, 2007 and 2009.

MMWR Morb Mortal Wkly Rep Start a Discussion »

Mar 022012

Chronic obstructive pulmonary disease and associated health-care resource use - north Carolina, 2007 and 2009.

MMWR Morb Mortal Wkly Rep. 2012 Mar 2;61:143-6

Authors:

Abstract
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is a progressive condition in which airflow becomes limited, making it difficult to breathe. Chronic lower respiratory diseases, primarily COPD, are the third leading cause of death in the United States, and 5.1% of U.S. adults report a diagnosis of emphysema or chronic bronchitis. Smoking is the primary cause of COPD, and at least 75% of COPD deaths are attributable to smoking in the United States. Information on state-specific prevalence of COPD is sparse, as are data on the use of COPD-related health-care resources. To understand how COPD affects adults in North Carolina and what resources are used by persons with COPD, 2007 and 2009 data from the North Carolina COPD module of the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Among 26,227 respondents, 5.7% reported ever having been told by a health professional that they had COPD. Most adults with COPD reported ever having had a diagnostic breathing test (76.4% in 2007 and 82.4% in 2009). Among adults with COPD, 43.0% reported having gone to a physician and 14.9% visited an emergency department (ED) or were admitted to a hospital (2007) for COPD-related symptoms in the previous 12 months. Only 48.1% of persons reported daily use of medications for their COPD (2007). These results indicate that many adults with COPD might not have had adequate diagnostic spirometry, and many who might benefit from daily medications, such as long-acting bronchodilators and inhaled corticosteroids, are not taking them. Continued and expanded surveillance is needed to evaluate the effectiveness of prevention and intervention programs and support efforts to educate the public and physicians about COPD symptoms, diagnosis, and treatment.

PMID: 22377845 [PubMed - in process]

Link to Article at PubMed

Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.

Crit Care Start a Discussion »

Mar 022012

Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.

Crit Care. 2012 Feb 28;16(1):R33

Authors: Egi M, Kim JY, Suh GY, Koh Y, Nishimura M

Abstract
ABSTRACT: IIntroduction: Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness. METHODS: We designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring >48 hours intensive care admitted in twenty-five ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality. RESULTS: We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, p=0.028, acetaminophen: 2.05, p=0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, p=0.15, acetaminophen: 0.58, p=0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU 36.5degreesC-37.4degreesC), MAXICU [greater than or equal to]39.5degreesC increased risk of 28-day mortality in septic patients (adjusted odds ratio 8.14, p=0.01), but not in non-septic patients (adjusted odds ratio 0.47, p=0.11). CONCLUSIONS: In non-septic patients, high fever ([greater than or equal to]39.5degreesC) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis. Trial registration: NCT00940654.

PMID: 22373120 [PubMed - as supplied by publisher]

Link to Article at PubMed

Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock.

Crit Care Start a Discussion »

Mar 022012

Fluid management and risk factors for renal dysfunction in patients with severe sepsis and/or septic shock.

Crit Care. 2012 Feb 29;16(1):R34

Authors: Muller L, Jaber S, Molinari N, Favier L, Larche J, Motte G, Lazarovici S, Jacques L, Alonso S, Leone M, Constantin JM, Allaouchiche B, Suehs C, Lefrant JY, Group A

Abstract
ABSTRACT: INTRODUCTION: The causative role of new HydroxyEthyl starch (HES 130/0.4) towards renal dysfunction frequency (a > 50% increase in serum creatinine or need of Renal Replacement Therapy (RRT)) remains debated. Using the database of a multicentre study focusing on patients with severe sepsis and septic shock, the present study aimed at identifying factors associated with the occurrence of renal dysfunction. METHODS: Among the 435 patients including in a multicenter study, patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 surviving patients after 24 hour of evolution, without history of renal failure were included. Factors associated with renal dysfunction and RRT were isolated using a multivariate analysis with logistic regression. RESULTS: Renal dysfunction was reported in 117 (33%) patients. 90 patients required RRT. Among study participants, 379 (98%) were administered fluids in the first 24 hours of management: HES 130/0.4 only (n = 39), crystalloids only (n = 63), or both HES 130/0.4 and crystalloids (n = 276). RRT was independently associated with the need for vasopressors and the baseline value of serum creatinine in the first 24 hours. Multivariate analysis indicated that male gender, SAPS II score, a surgical patient, lack of decrease in SOFA score during the first 24 hours, and the interventional period of the study were independently associated with renal dysfunction. Mortality increased in the presence of renal dysfunction (48 versus 24%, p < 0.01). CONCLUSIONS: Despite being used in more than 80% of patients with severe sepsis and/or septic shock, the administration of HES 130/0.4 in the first 24 hours of management was not associated with the occurrence of renal dysfunction.

PMID: 22377234 [PubMed - as supplied by publisher]

Link to Article at PubMed

Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease.

Aliment Pharmacol Ther Start a Discussion »

Mar 022012

Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease.

Aliment Pharmacol Ther. 2012 Feb 23;

Authors: Ananthakrishnan AN, Guzman-Perez R, Gainer V, Cai T, Churchill S, Kohane I, Plenge RM, Murphy S

Abstract
BACKGROUND: The increasing incidence of Clostridium difficile (C. difficile) infection (CDI) among patients with inflammatory bowel disease is well recognised. However, most studies have focused on demonstrating that CDI is associated with adverse outcomes in IBD patients. Few have attempted to identify predictors of severe outcomes associated with CDI among IBD patients. AIM: To identify clinical and laboratory factors that predict severe outcomes associated with CDI in IBD patients. METHODS: From a multi-institution EMR database, we identified all hospitalised patients with at least one diagnosis code for C. difficile from among those with a diagnosis of Crohn's disease or ulcerative colitis. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Cox proportional hazards models were used to identify predictors of the primary outcome from among demographic, disease-related, laboratory and medication variables. RESULTS: A total of 294 patients with CDI-IBD were included in our study. Of these, 58 patients (20%) met our primary outcome (45 deaths, 13 colectomy) at a median of 31 days. On multivariate analysis, serum albumin <3 g/dL (HR 5.75, 95% CI 1.34-24.56), haemoglobin below 9 g/dL (HR 5.29, 95% CI 1.58-17.69) and creatinine above 1.5 mg/dL (HR 1.98, 95% CI 1.04-3.79) were independent predictors of our primary outcome. Examining laboratory parameters as continuous variables or shortening our primary outcome to include events within 90 days yielded similar results. CONCLUSION: Serum albumin below 3 g/dL, haemoglobin below 9 g/dL and serum creatinine above 1.5 mg/dL were independent predictors of severe outcomes in hospitalised IBD patients with Clostridium difficile infection.

PMID: 22360370 [PubMed - as supplied by publisher]

Link to Article at PubMed

Randomised clinical trial: high-dose vs. standard-dose proton pump inhibitors for the prevention of recurrent haemorrhage after combined endoscopic haemostasis of bleeding peptic ulcers.

Aliment Pharmacol Ther Start a Discussion »

Mar 022012

Randomised clinical trial: high-dose vs. standard-dose proton pump inhibitors for the prevention of recurrent haemorrhage after combined endoscopic haemostasis of bleeding peptic ulcers.

Aliment Pharmacol Ther. 2012 Feb 28;

Authors: Chen CC, Lee JY, Fang YJ, Hsu SJ, Han ML, Tseng PH, Liou JM, Hu FC, Lin TL, Wu MS, Wang HP, Lin JT

Abstract
BACKGROUND: The optimal dosage of intravenous proton pump inhibitors (PPIs) for the prevention of peptic ulcer rebleeding remains unclear. AIM: To compare the rebleeding rate of high-dose and standard-dose PPI use after endoscopic haemostasis. METHODS: A total of 201 patients with bleeding ulcers undergoing endoscopic treatment with epinephrine injection and heater probe thermocoagulation were randomised to receive a high-dose regimen (80 mg bolus, followed by pantoprazole 8 mg/h infusion, n = 100) or a standard-dose regimen (pantoprazole 40 mg bolus daily, n = 101). After 72 h, all patients were given 40 mg pantoprazole daily orally for 27 days. RESULTS: There were no statistical differences in mean units of blood transfused, length of hospitalisation ?5 days, surgical or radiological interventions and mortality within 30 days between two groups. Bleeding recurred within 30 days in six patients [6.2%, 95% confidence interval (CI) 1.3-11.1%] in the high-dose group, as compared to five patients (5.2%, 95% CI 0.6-9.7%) in the standard-dose group (P = 0.77). The stepwise Cox regression analysis showed end-stage renal disease, haematemesis, chronic obstructive pulmonary disease (hazard ratio: 37.15, 10.07, 9.12, 95% CI: 6.76-204.14, 2.07-49.01, 1.66-50.00 respectively) were independent risk factors for rebleeding and Helicobacter pylori infection was associated with lower risk of rebleeding (hazard ratio: 0.20, 95% CI: 0.04-0.94). CONCLUSIONS: Following combined endoscopic haemostasis of bleeding ulcers, co-morbidities, haematemesis and H. pylori Status, but not PPI dosage, are associated with rebleeding (http://www.Clinical Trials.gov.ID: NCT00709046).

PMID: 22369682 [PubMed - as supplied by publisher]

Link to Article at PubMed

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