2012 April 13

The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study.

Eur J Gastroenterol Hepatol Start a Discussion »

Apr 132012

The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study.

Eur J Gastroenterol Hepatol. 2012 Mar;24(3):288-93

Authors: McLaughlin C, Vine L, Chapman L, Deering P, Whittaker S, Beckly J, Fortun P, Murray IA, Hussaini SH, Michell NP, Stableforth B, Thatcher P, Hare NC, Palmer J, Dalton HR

Abstract
BACKGROUND: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.
AIM: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.
METHODS: Prospective/retrospective study of all patients presenting to a UK teaching hospital with low-risk upper gastrointestinal haemorrhage who were managed without admission to hospital over 5 years. Low risk was defined as Glasgow Blatchford Score of 2 or less, age below 70 years, no other active medical problems, not taking warfarin and suspected nonvariceal bleed. Outcome measures were the need for intervention (blood transfusion, endoscopic therapy or surgery) and death.
RESULTS: One hundred and forty-two patients fulfilled the inclusion criteria, and were managed without admission to hospital. No patients required endoscopic intervention, blood transfusion or surgery. The 28-day mortality was nil. Forty-one patients had normal endoscopic examination and 11 had significant endoscopic findings (peptic ulceration=10, oozing Mallory-Weiss tear=1) but did not require intervention.
CONCLUSION: Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.

PMID: 22189690 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia.

J Clin Microbiol Start a Discussion »

Apr 132012

Clinical impact of a real-time PCR assay for rapid identification of staphylococcal bacteremia.

J Clin Microbiol. 2012 Jan;50(1):127-33

Authors: Frye AM, Baker CA, Rustvold DL, Heath KA, Hunt J, Leggett JE, Oethinger M

Abstract
The purpose of this study was to evaluate the impact of real-time PCR reporting both on timely identification of clustered Gram-positive cocci (GPC) in blood cultures and on appropriate antibiotic treatment. This retrospective, interventional cohort study evaluated inpatients with blood cultures positive for GPC in the pre-PCR (15 January 2009 to 14 January 2010) and post-PCR (15 January 2010 to 14 January 2011) periods. Post-PCR implementation, laboratory services completed batched PCR; results other than methicillin-resistant Staphylococcus aureus (MRSA) were reported in the electronic medical record without additional interventions. The assay's sensitivity and specificity, time to identification of staphylococcal bacteremia, and clinically relevant outcomes, including time to optimal antibiotic therapy, were evaluated. Demographic information was also collected and analyzed. Sixty-eight and 58 patients with Staphylococcus aureus bacteremia from the pre- and post-PCR periods, respectively, met inclusion criteria. Similar numbers of consecutive patients with coagulase-negative staphylococci were analyzed for comparison. The time to identification was significantly reduced post-PCR implementation (mean, 13.2 h; 95% confidence interval [95% CI], 10.5 to 15.9 h; P < 0.0001). However, the time to optimal antibiotic therapy was not significantly reduced. We conclude that implementation of a PCR assay demonstrated the potential to improve appropriate antibiotic use based on clinically meaningful and statistically significant reductions in the time to microbiologic identification. However, in order to realize this potential benefit, processes must be optimized and additional interventions initiated to facilitate providers' use of the PCR result.

PMID: 22075595 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Men at risk: considering masculinity during hospital-based social work intervention.

soc work health care Start a Discussion »

Apr 132012

Men at risk: considering masculinity during hospital-based social work intervention.

Soc Work Health Care. 2012 Apr;51(4):312-26

Authors: Winnett R, Furman R, Enterline M

Abstract
The needs of hospitalized male patients are often unrecognized and unmet. Men occupy greater than half of all inpatient hospital beds and incur a broad array of illnesses and injuries at higher rates than women-yet often receive health care that pays surprisingly little attention to the concept of patient masculinity, or to masculinity's influence on the male patient's perspectives, behaviors, goals, interests, needs, and challenges. Little emphasis is placed on considering hospitalized male patients as men , understanding their need for patient-centered care within this context, and intervening in ways that regularly allow strengths to be adequately recognized and utilized. In this article, we explore how hospital social workers can reconsider masculinity as a vibrant and formative component of male patients' lives and actively view its characteristics as comprising more than just potential challenges to medical treatment-but also as untapped sources of resilience and strength.

PMID: 22489556 [PubMed - in process]

Link to Article at PubMed

Hypotension is uncommon in patients presenting to the emergency department with non-traumatic cardiac tamponade.

J Emerg Med Start a Discussion »

Apr 132012

Hypotension is uncommon in patients presenting to the emergency department with non-traumatic cardiac tamponade.

J Emerg Med. 2012 Feb;42(2):220-6

Authors: Kapoor T, Locurto M, Farina GA, Silverman R

Abstract
BACKGROUND: Cardiac tamponade is a life-threatening disease in which hypotension is believed to be a common finding. Prior inpatient studies have described normotensive or hypertensive cases of tamponade; however, because the data were not collected from the Emergency Department (ED), the hemodynamic spectrum may differ from those presenting to the ED.
OBJECTIVES: We hypothesized that hypotension is uncommon in patients presenting to the ED with non-traumatic tamponade.
METHODS: A retrospective chart review was conducted between January 2002 and December 2007 of patients presenting to our ED who were subsequently diagnosed with cardiac tamponade.
RESULTS: A total of 34 patients were identified with a diagnosis of tamponade. The mean blood pressure on ED arrival was 131/79mm Hg. Upon initial presentation to the ED, 35% (n=12) of patients were hypertensive, 50% (n=17) were normotensive, and 15% (n=5) were hypotensive. Of the 5 patients who were hypotensive on ED arrival, only 2 (6% of all patients) remained hypotensive upon admission to the hospital and before a pericardiocentesis. An average of 995mL of fluid was removed from the pericardium. The chief complaint for the majority of patients in tamponade was shortness of breath (70%); 59% were tachycardic in the ED, and 72% had cardiomegaly on chest X-ray study.
CONCLUSIONS: Hypotension is uncommon in patients presenting to the ED with non-traumatic cardiac tamponade. The majority of patients are normotensive or even hypertensive. Thus, the emergency physician should not exclude the diagnosis of tamponade even in light of normotension or hypertension.

PMID: 20800410 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Abnormal coagulation tests obtained in the emergency department are associated with mortality in patients with suspected infection.

J Emerg Med Start a Discussion »

Apr 132012

Abnormal coagulation tests obtained in the emergency department are associated with mortality in patients with suspected infection.

J Emerg Med. 2012 Feb;42(2):127-32

Authors: Fischer CM, Yano K, Aird WC, Shapiro NI

Abstract
BACKGROUND: Early recognition of acute organ dysfunction in emergency department (ED) patients with suspected infection may help select patients at increased risk of mortality. The hematologic system is often overlooked in the evaluation and management of patients with infection because it is poorly circumscribed and serves a multitude of functions.
STUDY OBJECTIVES: We examine the hypothesis that abnormalities in commonly and easily obtained markers of coagulation function (international normalized ratio [INR], partial thromboplastin time [PTT], and platelet count [PLT]) are associated with mortality in ED patients admitted to the hospital with suspected infection.
METHODS: Design: Secondary analysis of a prospective observational cohort study. Setting: Urban tertiary care university hospital with 50,000 annual ED visits. Patients: Included patients: adults (age 18 ? years) evaluated in the ED for a suspected infection, had an INR, PTT, and PLT obtained during the ED stay, admitted to the hospital. Excluded patients: on oral anticoagulant therapy, received heparin, or pre-existing severe liver disease.
RESULTS: There were 1688 patients included. The in-hospital mortality rate was 5.9%. After adjusting for elderly status, comorbid illness burden, and severity of illness, elevated INR was associated with a 2.9 (95% confidence interval [CI] 1.6-5.2) increased odds of death, and a low platelet count (< 150,000/uL) was associated with 2.0 (95% CI 1.2-3.3) increased odds of death. The C-statistic for the model was 0.80.
CONCLUSION: We found an independent association between abnormalities in the coagulation system and mortality in ED patients with suspected infection. These findings underscore the close interaction between inflammation and coagulation and provide evidence that these simple laboratory tests should be routinely considered during the early evaluation of the infected patient.

PMID: 20542399 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Managing emergency department patients with recent-onset atrial fibrillation.

J Emerg Med Start a Discussion »

Apr 132012

Managing emergency department patients with recent-onset atrial fibrillation.

J Emerg Med. 2012 Feb;42(2):139-48

Authors: Vinson DR, Hoehn T, Graber DJ, Williams TM

Abstract
BACKGROUND: The management of emergency department (ED) patients with presumed recent-onset atrial fibrillation or flutter?48h in duration varies widely.
OBJECTIVE AND METHOD: We conducted a prospective study across three affiliated community EDs within a large integrated health care delivery system to describe the management of patients with recent-onset atrial fibrillation or flutter, to determine the safety and effectiveness of ED cardioversion, and to measure the incidence of thromboembolism 30 days after discharge.
RESULTS: We enrolled 206 patients with convenience sampling between June 2005 and November 2007. Mean age was 64.0±14.4 years (range 21-96 years). Patients were grouped for analysis into four categories based on whether cardioversion was 1) spontaneous in the ED (59; 28.6%); 2) attempted with electrical or pharmacological means (115; 56.3%), with success in 110 (95.7%); 3) hoped for during a short stint of home observation (16; 7.8%, 11 of which spontaneously converted to sinus rhythm within 24h); or 4) contraindicated (16; 7.8%). Of the entire group, 183 (88.8%) patients were discharged home. Adverse events requiring ED interventions were reported in 6 (2.9%; 95% confidence interval [CI] 1.1-6.2%) patients, all of whom recovered. Two (1.0%; 95% CI 0.1-3.5%) patients were found to have an embolic event on 30-day follow-up.
CONCLUSIONS: Our approach to ED patients with presumed recent-onset atrial fibrillation or flutter seems to be safe and effective, with a high rate of cardioversion and discharge to home coupled with a low ED adverse event and 30-day thromboembolic event rate.

PMID: 20634022 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Older Entries

April 2012
M	T	W	T	F	S	S
« Mar				May »
						1
2	3	4	5	6	7	8
9	10	11	12	13	14	15
16	17	18	19	20	21	22
23	24	25	26	27	28	29
30