2012 March 28

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of COPD: a Randomized Placebo Controlled Trial.

Am J Respir Crit Care Med Start a Discussion »

Mar 282012

Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of COPD: a Randomized Placebo Controlled Trial.

Am J Respir Crit Care Med. 2012 Mar 23;

Authors: Bafadhel M, McKenna S, Terry S, Mistry V, Pancholi M, Venge P, Lomas DA, Barer MR, Johnston SL, Pavord ID, Brightling CE

Abstract
RATIONALE: Exacerbations of chronic obstructive pulmonary disease (COPD) and responses to treatment are heterogeneous. OBJECTIVES: Investigate the utility of blood eosinophils to direct corticosteroid therapy during exacerbations. METHODS: Subjects with COPD exacerbations were entered into a randomized biomarker-directed double-blind corticosteroid versus standard therapy study. Subjects in the standard arm received prednisolone for 2 weeks, whilst in the biomarker-directed arm, prednisolone or matching placebo was given according to the blood eosinophil count biomarker. Both study groups received antibiotics. Blood eosinophils were measured in the biomarker-directed and standard therapy arms to define biomarker-positive and -negative exacerbations (blood eosinophil count > and ? 2% respectively). The primary outcome was to determine non-inferiority in health status using the chronic respiratory questionnaire (CRQ) and in the proportion of exacerbations associated with a treatment failure between subjects allocated to the biomarker-directed and standard therapy arm. MEASUREMENTS AND MAIN RESULTS: There were 86 and 80 exacerbations in the biomarker-directed and standard treatment group. In the biomarker-directed group 49% of the exacerbations were not treated with prednisolone. CRQ improvement following treatment in the standard and biomarker-directed therapy group was similar (0.8 vs. 1.1, mean difference 0.3, 95% CI 0.0 to 0.6, p=0.05). There was a greater improvement in CRQ in biomarker-negative exacerbations given placebo compared to those given prednisolone (mean difference 0.45; 95% CI 0.01 to 0.90; p=0.04). In biomarker-negative exacerbations, treatment failures occurred in 15% given prednisolone and 2% of those given placebo (p=0.04). CONCLUSION: The peripheral blood eosinophil count is a promising biomarker to direct corticosteroid therapy during COPD exacerbations, but larger studies are required.Clinical trial registration available at www.controlled-trials.com/ISRCTN92422949.

PMID: 22447964 [PubMed - as supplied by publisher]

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Automated external defibrillators and in-hospital cardiac arrest: patient survival and device performance at an Australian teaching hospital.

Resuscitation Start a Discussion »

Mar 282012

Automated external defibrillators and in-hospital cardiac arrest: patient survival and device performance at an Australian teaching hospital.

Resuscitation. 2011 Dec;82(12):1537-42

Authors: Smith RJ, Hickey BB, Santamaria JD

Abstract
AIMS: To evaluate the effect of automated external defibrillators (AEDs) on patient survival and to describe the performance of AEDs after in-hospital cardiac arrest.
METHODS: Prospectively collected data were analysed for cardiac arrests in the general patient care areas of a teaching hospital during the 3 years before and the 3 years after the deployment of AEDs. The association between availability of an AED and survival to hospital discharge was assessed using multivariate logistic regression. AED performance during automated management of the initial rhythms was assessed using information captured by the AEDs.
RESULTS: There were 84 cardiac arrests in the AED period and 82 in the pre-AED period. Patient and event characteristics were similar in each period. The initial rhythm was shockable in 16% of cases. Return of spontaneous circulation was higher in the AED period (54% vs. 35%, P=0.02) but the proportion of hospital survivors in each period was similar (22% vs. 19%, P=0.56). The adjusted odds ratio for hospital survival when an AED was available was 1.22 (95% CI 0.53-2.84, P=0.64). An AED was applied in 77/84 (92%) possible cases. Median interruption to chest compressions was 12s (inter-quartile range 12-13). An automated shock was delivered in 8/13 (62%) possible cases.
CONCLUSIONS: Availability of AEDs was not independently associated with hospital survival. Shockable presenting rhythms were not common and, in keeping with the manufacturer's specifications, the AEDs did not shock all potentially shockable rhythms. The hands-off time associated with automated rhythm management was considerable.

PMID: 21741431 [PubMed - indexed for MEDLINE]

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Improving patient satisfaction in hospital care settings.

Health Serv Manage Res Start a Discussion »

Mar 282012

Improving patient satisfaction in hospital care settings.

Health Serv Manage Res. 2011 Nov;24(4):163-9

Authors: Otani K, Herrmann PA, Kurz RS

Abstract
Health-care managers have to address many aspects of the organization, and patient satisfaction is clearly one of the critical aspects for managers. To respond to the need of health-care managers, there have been many patient satisfaction studies. However, these studies focus on which attributes (factors such as nursing care and physician care) are more influential; they do not provide specific aspects for each attribute. In order to develop an effective intervention programme to improve patient satisfaction, more specific research outcomes are needed. This study utilized data collected between January 2007 and June 2008 from 32 hospitals representing a large, national private not-for-profit hospital system. The patient satisfaction survey included the Consumer Assessment of Healthcare Providers and Systems, Hospital version questionnaire items, and there are 31,471 cases. Two-stage multiple linear regression analyses were conducted with control variables (age, gender, perceived health, education and race). It was found that patients' highest priority is to be treated with courtesy and respect by nurses and physicians. An effective intervention programme to improve patient satisfaction would include a training programme, where care providers understand that patients want them to show courtesy and respect. Then, well-trained and empathetic nurses and staff members can comfort patients, and consequently improve patient satisfaction.

PMID: 22040943 [PubMed - indexed for MEDLINE]

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Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting.

PLoS ONE Start a Discussion »

Mar 282012

Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting.

PLoS One. 2011;6(11):e26790

Authors: Shiramizo SC, Marra AR, Durão MS, Paes ÂT, Edmond MB, Pavão dos Santos OF

Abstract
BACKGROUND: The Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality.
MATERIALS AND METHODS: A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize SS and SSh shock patients' clinical outcomes were performed by applying sepsis bundles (6- and 24-hour) in May 2006. We compared bundle compliance and patient outcomes before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions.
RESULTS: A total of 564 SS and SSh patients were identified. Prior to the intervention, compliance with the 6 hour-sepsis resuscitation bundle was only 6%. After the intervention, compliance was as follows: 8.2% from May to December 2006, 9.3% in 2007, 21.1% in 2008 and 13.7% in 2009. For the 24 hour-management bundle, baseline compliance was 15.0%. After the intervention, compliance was 15.1% from May to December 2006, 21.4% in 2007, 27.8% in 2008 and 44.4% in 2009. The in-hospital mortality was 54.0% from July 2005 to April 2006, 41.1% from May to December 2006, 39.3% in 2007, 41.4% in 2008 and 16.2% in 2009.
CONCLUSION: These results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions.

PMID: 22073193 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Heparin Bridging vs. Uninterrupted Oral Anticoagulation in Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting.

Circ J Start a Discussion »

Mar 282012

Heparin Bridging vs. Uninterrupted Oral Anticoagulation in Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting.

Circ J. 2012 Mar 9;

Authors: Lahtela H, Rubboli A, Schlitt A, Karjalainen PP, Niemelä M, Vikman S, Puurunen M, Weber M, Valencia J, Biancari F, Lip GY, Airaksinen KE,

Abstract
Background: The anti-thrombotic strategy during coronary stenting is challenging in patients on long-term oral anticoagulation (OAC) because of atrial fibrillation (AF). Uninterrupted OAC (UAC) is increasingly used, but bridging therapy (BT) is still in common use. Methods and Results: Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) is a prospective multicenter European registry that recruited 963 patients with AF undergoing coronary stenting. To compare the safety of UAC and BT, bleeding complications and major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, target vessel revascularization, stent thrombosis and stroke) were assessed in 290 patients treated with UAC and 161 patients with BT during a 30-day follow-up period. In the BT group, OAC was interrupted for a median of 5 days. Overall bleeding complications tended to be more common in the BT group (18.6% vs. 12.1%, P=0.07), with no significant difference in the rate of major bleeding (2.5% vs. 1.4%) or MACCE (6.2% vs. 3.8%). After adjustment for propensity score, BT was not associated with bleeding complications (odds ratio [OR], 1.38; 95% confidence interval [CI]: 0.77-2.48, P=0.28) or MACCE (OR, 1.16; 95%CI: 0.44-3.05, P=0.76). Periprocedural international normalized ratio was not associated with bleeding or MACCE. Conclusions: UAC does not increase perioperative complications during coronary stenting and is a simple and cost-effective alternative to conventional heparin bridging.

PMID: 22447005 [PubMed - as supplied by publisher]

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Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure.

Circ J Start a Discussion »

Mar 282012

Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure.

Circ J. 2012;76(4):833-42

Authors: Masuyama T, Tsujino T, Origasa H, Yamamoto K, Akasaka T, Hirano Y, Ohte N, Daimon T, Nakatani S, Ito H

Abstract
Background: Diuretics are the most prescribed drug in heart failure (HF) patients. However, clinical evidence about their long-term effects is lacking. The purpose of this study was to compare the therapeutic effects of furosemide and azosemide, a short- and long-acting loop diuretic, respectively, in patients with chronic heart failure (CHF). Methods and Results: In this multicenter, prospective, randomized, open, blinded endpoint trial, we compared the effects of azosemide and furosemide in patients with CHF and New York Heart Association class II or III symptoms. 320 patients (160 patients in each group, mean age 71 years) were followed up for a minimum of 2 years. The primary endpoint was a composite of cardiovascular death or unplanned admission to hospital for congestive HF. During a median follow-up of 35.2 months, the primary endpoint occurred in 23 patients in the azosemide group and in 34 patients in the furosemide group (hazard ratio [HR], 0.55, 95% confidence interval [CI] 0.32-0.95: P=0.03). Among the secondary endpoints, unplanned admission to hospital for congestive HF or a need for modification of the treatment for HF were also reduced in the azosemide group compared with the furosemide group (HR, 0.60, 95%CI 0.36-0.99: P=0.048). Conclusions: Azosemide, compared with furosemide, reduced the risk of cardiovascular death or unplanned admission to hospital for congestive HF. (Circ J 2012; 76: 833-842).

PMID: 22451450 [PubMed - in process]

Link to Article at PubMed

March 2012
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