2012 June 01

Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding.

J Gastroenterol Hepatol Start a Discussion »

Jun 012012

Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding.

J Gastroenterol Hepatol. 2012 May 31;

Authors: Liu N, Liu L, Zhang H, Cp G, Zhang D, Yao L, Yang Y, Wu K, Ding J, Fan D

Abstract
Background and Aim:? The most effective schedule of PPI administration and the optimal timing of endoscopy in acute peptic ulcer bleeding remain uncertain. The aim of this study is to determine the most efficient PPI regimen and optimal timing of endoscopy. Methods:? Consecutive patients with suspected bleeding peptic ulcers were enrolled and randomized to receive either a standard regimen or a high-dose intensive IV regimen. Only patients with bleeding peptic ulcers diagnosed at initial endoscopy continued the study. High-risk patients received endoscopic hemostasis. The primary outcome measure of recurrent bleeding was compared between the two dosage regimens and between early and late endoscopy. Secondary outcome measures compared included need for endoscopic treatment, blood transfusion, hospital stay, surgery and mortality. Results:? A total of 875 patients completed the study. Recurrent bleeding occurred in 11.0% in the standard regimen group, statistically higher than that in the intensive regimen group (6.4%, P=0.02). Mean units of blood transfused and duration of hospital stay were also higher in the standard regimen group (P<0.001 for each compared to intensive regimen group). However, no significant differences were noted between the two groups in the need for endoscopic hemostasis, need for surgery, and mortality. Recurrence of bleeding was similar between the early and late endoscopy. Units of blood transfused and length of hospital stay were both significantly reduced with early endoscopy. Discussion:? High-dose PPI infusion is more efficacious in reducing rebleeding rate, blood transfusion requirements and hospital stay. Early endoscopy is safe and more effective than late endoscopy. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

PMID: 22646140 [PubMed - as supplied by publisher]

Link to Article at PubMed

Management of febrile neutropenia in an acute oncology service.

QJM Start a Discussion »

Jun 012012

Management of febrile neutropenia in an acute oncology service.

QJM. 2012 Apr;105(4):327-36

Authors: Sammut SJ, Mazhar D

Abstract
BACKGROUND: Neutropenic fever in patients receiving chemotherapy is a medical emergency and should be treated promptly within 1 h with antibiotics as specified within the 2009 NCAG report on chemotherapy services. AIM: To determine door-to-assessment, door-to-treatment and door-to-investigation intervals for patients with febrile neutropenia who presented to the inpatient Oncology Ward, the outpatient Oncology Day Unit and the Emergency Department in Addenbrooke's Hospital, Cambridge. DESIGN: Retrospective observational audit. METHODS: Thirty-two patients on treatment for solid cancers who were admitted with febrile neutropenia between January and December 2010 were identified, and paper and electronic medical records were analysed to determine door to: assessment, treatment and investigation intervals. Results and conclusions: Patients in this series were assessed quicker and received the first dose of antibiotics faster when they presented to an oncology ward rather than the emergency department. However, imaging was performed faster and blood results issued quicker if performed in the emergency department due to a better infrastructure that has been tailored to comply with national targets. Nonetheless, compliance with optimum standards of care was poor, with only 9% of sampled patients getting antibiotics within 1 h of presenting to hospital, and 53% within 1 h of being assessed by a clinician.

PMID: 22080099 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Health-related quality of life and anemia in hospitalized patients with heart failure.

Int J Cardiol Start a Discussion »

Jun 012012

Health-related quality of life and anemia in hospitalized patients with heart failure.

Int J Cardiol. 2012 May 28;

Authors: Kraai IH, Luttik ML, Johansson P, De Jong RM, Van Veldhuisen DJ, Hillege HL, Jaarsma T

Abstract
BACKGROUND: Anemia is a serious and highly prevalent co-morbidity in chronic heart failure (HF) patients. Its influence on health-related quality of life (HR-QoL) has rarely been studied, and no data is available regarding the role it plays in hospitalized HF patients. METHODS: Baseline data from the COACH study (Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure) were used. HR-QoL was assessed by means of generic and disease-specific questionnaires. Analyses were performed using ANOVA and ANCOVA, with covariates of age, gender, eGFR, diabetes, and NYHA class. RESULTS: In total, 1013 hospitalized patients with a mean age of 71 (SD 11) years were included; 70% of these patients had no anemia (n=712), 14% had mild anemia (n=141), and 16% had moderate-to-severe anemia (n=160). Independent associations were found between anemia and physical functioning (p=0.019), anemia and role limitations due to physical functioning (p=0.002), anemia and general health (p=0.024), and anemia and global well-being (p=0.003). CONCLUSION: In addition to the burden of HF itself, anemia is an important factor which influences HR-QoL in hospitalized HF patients, and one that is most pronounced in the domain related to physical functioning and general health.

PMID: 22647414 [PubMed - as supplied by publisher]

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Inherited and acquired risk factors for venous thromboembolism.

Semin Respir Crit Care Med Start a Discussion »

Jun 012012

Inherited and acquired risk factors for venous thromboembolism.

Semin Respir Crit Care Med. 2012 Apr;33(2):127-37

Authors: Baglin T

Abstract
Venous thrombosis, or venous thromboembolism, comprises deep vein thrombosis with or without symptomatic pulmonary embolus. The development of symptomatic venous thrombosis is highly dependent on gene-environment interaction. In most instances this interaction results in hypercoagulability (the intermediate phenotype) sufficient to result in intraluminal clot formation (the disease phenotype). The genetic framework underlying venous thrombosis is complex, and there is a large material contribution from disease and interaction with environmental factors. For example, venous thrombosis is related to recent hospitalization in approximately half of all adult cases. After a first episode of venous thrombosis patients are 40 times more likely to suffer a further event compared with previously unaffected individuals. However, the risk differs between patients. Duration of anticoagulation (lifelong or not) should be made with reference to whether an episode of thrombosis was provoked and the presence of other risk factors. The results of testing for heritable thrombophilia rarely influence duration of treatment.

PMID: 22648484 [PubMed - in process]

Link to Article at PubMed

New Anticoagulants in the Treatment of VTE.

Semin Respir Crit Care Med Start a Discussion »

Jun 012012

New Anticoagulants in the Treatment of VTE.

Semin Respir Crit Care Med. 2012 Apr;33(2):191-8

Authors: Le Gal G, Mottier D

Abstract
Low molecular weight heparins (LMWHs) and vitamin K antagonists make up the cornerstone of therapy for patients with venous thromboembolism (VTE) but have drawbacks making their use difficult in daily practice. Current research focuses on the development of new anticoagulant drugs that could be administered orally at a fixed dose, with fewer food and drug interactions and no need for monitoring or dose adjustment. Several new drugs are tested in noninferiority trials, either as a single-drug approach treatment (e.g., rivaroxaban or apixaban), or after an initial course of LMWH (e.g., dabigatran or edoxaban). Published clinical trials demonstrate that rivaroxaban and dabigatran are noninferior to conventional treatment in patients with VTE. Several issues remain challenging for physicians, such as the lack of antidote and of routinely available monitoring tests. To what extent new anticoagulant drugs will change clinical practice is not yet well defined. They may facilitate outpatient management of VTE. They might also improve the risk-benefit balance of prolonged anticoagulation and therefore modify the optimal duration of anticoagulation in VTE patients.

PMID: 22648492 [PubMed - in process]

Link to Article at PubMed

Imaging tests in the diagnosis of pulmonary embolism.

Semin Respir Crit Care Med Start a Discussion »

Jun 012012

Imaging tests in the diagnosis of pulmonary embolism.

Semin Respir Crit Care Med. 2012 Apr;33(2):138-43

Authors: Mos IC, Klok FA, Kroft LJ, de Roos A, Huisman MV

Abstract
Imaging modalities play an essential role in diagnosing pulmonary embolism (PE). Clinical outcome studies demonstrated that PE can be safely ruled out in patients with unlikely clinical probability in combination with a normal D-dimer test result; in all other patients additional imaging is needed. The aim is to accurately confirm or rule out the diagnosis of PE, after which, if indicated, anticoagulant treatment can be initiated. Various diagnostic tests are available, and this article reviews the different imaging techniques in patients with suspected PE. Computed tomographic pulmonary angiography (CTPA) is the imaging test of choice because of its high sensitivity and specificity. Compression ultrasonography and ventilation perfusion scintigraphy are reserved for patients with concomitant suspicion of deep vein thrombosis or contraindication for CTPA. Furthermore the diagnostic process in patients with clinically suspected recurrent PE, PE during pregnancy, and PE in the elderly and in patients with malignancy are discussed.

PMID: 22648485 [PubMed - in process]

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