2012 April

Language barriers and understanding of hospital discharge instructions.

Apr 282012

Language barriers and understanding of hospital discharge instructions.

Med Care. 2012 Apr;50(4):283-9

Authors: Karliner LS, Auerbach A, Nápoles A, Schillinger D, Nickleach D, Pérez-Stable EJ

Abstract
BACKGROUND: Effective communication at hospital discharge is necessary for an optimal transition and to avoid adverse events. We investigated the association of a language barrier with patient understanding of discharge instructions.
METHODS: Spanish-speaking, Chinese-speaking, and English-speaking patients admitted to 2 urban hospitals between 2005 and 2008, comparing patient understanding of follow-up appointment type, and medication category and purpose between limited English-proficient (LEP) and English-proficient patients.
RESULTS: Of the 308 patients, 203 were LEP. Rates of understanding were low overall for follow-up appointment type (56%) and the 3 medication outcomes (category 48%, purpose 55%, both 41%). In unadjusted analysis, LEP patients were less likely than English-proficient patients to know appointment type (50% vs. 66%; P=0.01), medication category (45% vs. 54%; P=0.05), and medication category and purpose combined (38% vs. 47%; P=0.04), but equally likely to know medication purpose alone. These results persisted in the adjusted models for medication outcomes: LEP patients had lower odds of understanding medication category (odds ratio 0.63; 95% confidence interval, 0.42-0.95); and category/purpose (odds ratio 0.59; 95% confidence interval, 0.39-0.89).
CONCLUSIONS: Understanding of appointment type and medications after discharge was low, with LEP patients demonstrating worse understanding of medications. System interventions to improve communication at hospital discharge for all patients, and especially those with LEP, are needed.

PMID: 22411441 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Combination Biomarkers to Diagnose Sepsis in the Critically Ill Patient.

Am J Respir Crit Care Med Start a Discussion »

Apr 282012

Combination Biomarkers to Diagnose Sepsis in the Critically Ill Patient.

Am J Respir Crit Care Med. 2012 Apr 26;

Authors: Gibot S, Béné MC, Noel R, Massin F, Guy J, Cravoisy A, Barraud D, De Carvalho Bittencourt M, Quenot JP, Bollaert PE, Faure G, Charles PE

Abstract
RationaleAlthough the outcome of sepsis benefits from the prompt administration of appropriate antibiotics upon correct diagnosis, the assessment of infection in critically ill patients is often a challenge for clinicians. In this setting, simple biomarkers, especially when used in combination, could prove useful.ObjectiveTo determine the usefulness of combination biomarkers to diagnose sepsisMethodsThree-hundred consecutive patients were enrolled to construct a biological score that was next validated in an independent prospective cohort of 79 critically ill patients from another center.Measurement and main resultsPlasma concentrations of soluble Triggering Receptor Expressed on Myeloid cells-1 (sTREM-1) and procalcitonin (PCT) were assayed, and the expression of the high affinity immunoglobulin-Fc fragment receptor I (Fc?RI) CD64 on neutrophils (PMN CD64 index) in flow cytometry was measured. A "Bioscore" combining these biomarkers was constructed. Serum concentrations of PCT and sTREM-1 as well as the PMN CD64 index were higher in septic patients compared to all others (p<0.001 for the three markers). These biomarkers were all independent predictors of infection, the best ROC curve being obtained for the PMN CD64 index. The performance of the Bioscore, better than that of each individual biomarker was externally confirmed in the validation cohort. ConclusionThis prospective study, including both inceptive and validation cohorts of unselected ICU patients demonstrates the high performance of a Bioscore combining the PMN CD64 index together with PCT and sTREM-1 serum levels in diagnosing sepsis in the critically ill patient.

PMID: 22538802 [PubMed - as supplied by publisher]

Link to Article at PubMed

Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation.

Am J Cardiol Start a Discussion »

Apr 282012

Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation.

Am J Cardiol. 2012 Apr 24;

Authors: Miller CS, Grandi SM, Shimony A, Filion KB, Eisenberg MJ

Abstract
New oral anticoagulants, including apixaban, dabigatran, and rivaroxaban, have been developed as alternatives to warfarin, the standard oral anticoagulation therapy for patients with atrial fibrillation (AF). A systematic review and meta-analysis of randomized controlled trials was performed to compare the efficacy and safety of new oral anticoagulants to those of warfarin in patients with AF. The published research was systematically searched for randomized controlled trials of >1 year in duration that compared new oral anticoagulants to warfarin in patients with AF. Random-effects models were used to pool efficacy and safety data across randomized controlled trials. Three studies, including 44,563 patients, were identified. Patients randomized to new oral anticoagulants had a decreased risk for all-cause stroke and systemic embolism (relative risk [RR] 0.78, 95% confidence interval [CI] 0.67 to 0.92), ischemic and unidentified stroke (RR 0.87, 95% CI 0.77 to 0.99), hemorrhagic stroke (RR 0.45, 95% CI 0.31 to 0.68), all-cause mortality (RR 0.88, 95% CI 0.82 to 0.95), and vascular mortality (RR 0.87, 95% CI 0.77 to 0.98). Randomization to a new oral anticoagulant was associated with a lower risk for intracranial bleeding (RR 0.49, 95% CI 0.36 to 0.66). Data regarding the risks for major bleeding (RR 0.88, 95% CI 0.71 to 1.09) and gastrointestinal bleeding (RR 1.25, 95% CI 0.91 to 1.72) were inconclusive. In conclusion, the new oral anticoagulants are more efficacious than warfarin for the prevention of stroke and systemic embolism in patients with AF. With a decreased risk for intracranial bleeding, they appear to have a favorable safety profile, making them promising alternatives to warfarin.

PMID: 22537354 [PubMed - as supplied by publisher]

Link to Article at PubMed

Chest radiography in the ICU: Part 2, Evaluation of cardiovascular lines and other devices.

AJR Am J Roentgenol Start a Discussion »

Apr 282012

Chest radiography in the ICU: Part 2, Evaluation of cardiovascular lines and other devices.

AJR Am J Roentgenol. 2012 Mar;198(3):572-81

Authors: Godoy MC, Leitman BS, de Groot PM, Vlahos I, Naidich DP

Abstract
OBJECTIVE: In this pictorial essay, we discuss and illustrate normal and aberrant positioning of the cardiovascular support and monitoring devices frequently used in critically ill patients, including central venous catheters, pulmonary artery catheters, left atrial catheters, transvenous pacemakers, automatic implantable cardioverter defibrillators, intraaortic counterpulsation balloon pump, and ventricular assist devices, as well as their inherent complications. CONCLUSION: The radiographic evaluation of the support and monitoring devices used in patients in the ICU is important, because the potentially serious complications arising from their introduction and use are often not clinically apparent. Familiarity with normal and abnormal radiographic findings is critical for the detection of these complications.

PMID: 22357995 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain.

Emerg Radiol Start a Discussion »

Apr 282012

Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain.

Emerg Radiol. 2012 Jan;19(1):19-26

Authors: Ham H, McInnes MD, Woo M, Lemonde S

Abstract
The purpose of this study is to calculate the negative predictive value (NPV) CT of the abdomen in patients presenting to the emergency department (ED) with undifferentiated upper abdominal pain. Approved by the hospital research ethics board, this retrospective study examined consecutive patients presenting to the ED with undifferentiated upper abdominal pain whose intravenous contrast-enhanced CT of the abdomen was reported as "normal" from June 2006-August 2010. Exclusion criteria included active malignancy, trauma, and known inflammatory bowel disease. True-negative (TN) vs. false-negative (FN) cases were categorized by consensus opinion of radiologist and emergency physician using a composite reference standard including clinical, laboratory, imaging, surgery, pathology, and patient self-reporting via phone questionnaire. The NPV was calculated with confidence intervals of 95%. The TN and FN groups were compared based on gender, age, site of pain, oral contrast use, and laboratory values. One hundred twenty-seven patients were included for analysis. The NPV was 64% (95% CI 55-72). The FN group had a higher proportion of patients with epigastric pain (p?=?0.02) and a lower proportion of patients with left upper quadrant pain (p?=?0.02). The WBC, lipase, and ALT were all higher in the FN group compared with the TN group. The most commonly missed pathologies were inflammatory conditions of the biliary tract and upper gastrointestinal systems. The NPV of CT for evaluation of undifferentiated upper abdominal pain in the ED was low at 64%. Physicians should consider this limitation and the commonly missed pathology when discharging patients with a "normal" CT report.

PMID: 22072086 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis.

Emerg Radiol Start a Discussion »

Apr 282012

Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis.

Emerg Radiol. 2012 Jan;19(1):61-73

Authors: Heller MT, Hattoum A

Abstract
Evaluation of acute right lower quadrant pain remains a common and challenging clinical scenario for emergency medicine physicians due to frequent nonspecific signs, symptoms, and physical examination findings. Therefore, imaging has evolved to play a pivotal role in the emergency setting. While appendicitis is a common cause for acute pain, there are numerous other important differential considerations with which the radiologist must be aware. The purpose of this review is to list an anatomy-based, encompassing differential diagnosis in addition to acute appendicitis for right lower quadrant pain; demonstrate the key imaging findings of numerous differential considerations; and describe helpful imaging and clinical features useful in narrowing the differential diagnosis.

PMID: 22072087 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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