Q: Should I order an anti-CCP antibody test to diagnose rheumatoid arthritis?
Cleve Clin J Med. 2012 Apr;79(4):249-52
Authors: Bose N, Calabrese LH
PMID: 22473722 [PubMed - in process]
Link to Article at PubMedApr 052012
Apr 052012
Factor V Leiden: How great is the risk of venous thromboembolism?
Cleve Clin J Med. 2012 Apr;79(4):265-72
Authors: Shaheen K, Alraies MC, Alraiyes AH, Christie R
Abstract
The factor V Leiden mutation, the most common inherited cause of thrombophilia, causes a mild hypercoagulable state. We describe a 29-year-old man, heterozygous for factor V Leiden, who developed extensive pulmonary emboli with concomitant bilateral deep venous thrombosis, likely provoked by prolonged immobility during a car trip. We then review the diagnosis, therapy, screening, and prognosis of venous thromboembolism related to factor V Leiden.
PMID: 22473726 [PubMed - in process]
Link to Article at PubMedApr 052012
Barriers to End-of-Life Care in the Intensive Care Unit: Perceptions Vary by Level of Training, Discipline, and Institution.
J Palliat Med. 2012 Apr 2;
Authors: Friedenberg AS, Levy MM, Ross S, Evans LE
Abstract
Abstract Purpose: Barriers to providing quality end-of-life (EOL) care in the intensive care unit (ICU) are common, but little is known about how these barriers vary by level of training or discipline. Methods: Medical residents and ICU fellows, attendings, and nurses at two teaching hospitals were surveyed about barriers to EOL care in the ICU. The survey consisted of questions about possible barriers in four domains: patient-family factors, clinician factors, institutional factors, and education-training factors. Results: There were significant differences in reported barriers to EOL care by level of training, discipline, and institution, particularly in the education-training domain. Insufficient resident training in EOL care was reported as a large or huge barrier by a smaller proportion of residents (20%) than attendings (62%), fellows (55%) or nurses (36%) (p=0.001). Nurses' perceptions of barriers to EOL care varied between institutions. Barriers that varied significantly between nurses included difficulty communicating due to language (p=0.008), and inadequate training in recognition of pain and anxiety (p=0.001). Conclusions: We found that perceived barriers to EOL care differed significantly by level of training, discipline and institution, suggesting the interventions to improve EOL care may need to be locally targeted and specific to level of training and discipline.
PMID: 22468773 [PubMed - as supplied by publisher]
Link to Article at PubMedApr 052012
Saccharomyces boulardii for the Prevention of Antibiotic-Associated Diarrhea in Adult Hospitalized Patients: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Trial.
Am J Gastroenterol. 2012 Apr 3;
Authors: Pozzoni P, Riva A, Bellatorre AG, Amigoni M, Redaelli E, Ronchetti A, Stefani M, Tironi R, Molteni EE, Conte D, Casazza G, Colli A
Abstract
OBJECTIVES:Antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) are common complications of antibiotic use. Probiotics were effective in preventing AAD and CDAD in several randomized controlled trials. This study was aimed at testing the effect of Saccharomyces boulardii on the occurrence of AAD and CDAD in hospitalized patients.METHODS:A single-center, randomized, double-blind, placebo-controlled, parallel-group trial was performed. Patients being prescribed antibiotics or on antibiotic therapy for <48?h were eligible. Exclusion criteria were ongoing diarrhea, recent assumption of probiotics, lack of informed consent, inability to ingest capsules, and severe pancreatitis. Patients received a capsule containing S. boulardii or an indistinguishable placebo twice daily within 48?h of beginning antibiotic therapy, continued treatment for 7 days after antibiotic withdrawal, and were followed for 12 weeks after ending antibiotic treatment.RESULTS:Of 562 consecutive eligible patients, 275 patients aged 79.2±9.8 years (134 on placebo) were randomized and 204 aged 78.4±10.0 years (98 on placebo) completed the follow-up. AAD developed in 13.3% (13/98) of the patients receiving placebo and in 15.1% (16/106) of those receiving S. boulardii (odds ratio for S. boulardii vs. placebo, 1.16; 95% confidence interval (CI), 0.53-2.56). Five cases of CDAD occurred, 2 in the placebo group (2.0%) and 3 in the probiotic group (2.8%; odds ratio for S. boulardii vs. placebo, 1.40; 95% CI, 0.23-8.55). There was no difference in mortality rates (12.7% vs. 15.6%, P=0.60).CONCLUSIONS:In elderly hospitalized patients, S. boulardii was not effective in preventing the development of AAD.Am J Gastroenterol advance online publication, 3 April 2012; doi:10.1038/ajg.2012.56.
PMID: 22472744 [PubMed - as supplied by publisher]
Link to Article at PubMedApr 052012
Comparison of Additional Versus No Additional Heparin During Therapeutic Oral Anticoagulation in Patients Undergoing Percutaneous Coronary Intervention.
Am J Cardiol. 2012 Mar 29;
Authors: Kiviniemi T, Karjalainen P, Pietilä M, Ylitalo A, Niemelä M, Vikman S, Puurunen M, Biancari F, Airaksinen KE
Abstract
Uninterrupted oral anticoagulation (OAC) therapy can be the preferred strategy in patients with atrial fibrillation at moderate to high risk of thromboembolism undergoing percutaneous coronary intervention (PCI). To evaluate the need for additional heparins in addition to therapeutic peri-PCI OAC, we assessed bleeding complications and major adverse cardiac and cerebrovascular events in 414 consecutive patients undergoing PCI during therapeutic (international normalized ratio 2 to 3.5) periprocedural OAC. Patients were divided into those with no (n = 196) and with (n = 218) additional use of periprocedural heparins. No differences in major adverse cardiac and cerebrovascular events (4.1% vs 3.2%, p = 0.79) or major bleeding (1.0% vs 3.7%, p = 0.11) were detected, but access site complications (5.1% vs 11.0%, p = 0.032) were less frequent in those without additional heparins. When adjusted for propensity score, patients with additional heparins had a higher risk of access site complications (odds ratio 2.6, 95% confidence interval 1.1 to 6.1, p = 0.022) without any increased risk of any other adverse event. Analysis of 1-to-1 propensity-matched pairs showed a significantly higher risk of access site complication in patients receiving additional AC (13.1% vs 5.7%, p = 0.049). In conclusion, therapeutic warfarin treatment seems to provide sufficient AC for PCI. Additional heparins are not needed and may increase access site complications.
PMID: 22464216 [PubMed - as supplied by publisher]
Link to Article at PubMed