2012 June 09

The Role of Asymptomatic Bacteriuria in Young Women with Recurrent Urinary Tract Infections: to Treat or Not to Treat?

Jun 092012

The Role of Asymptomatic Bacteriuria in Young Women with Recurrent Urinary Tract Infections: to Treat or Not to Treat?

Clin Infect Dis. 2012 Jun 7;

Authors: Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, D'Elia C, Malossini G, Boddi V, Bartoletti R

Abstract
Background.?Little is known about the role of asymptomatic bacteriuria (AB) treatment in young women affected by recurrent UTI. We aimed to evaluate the impact of AB treatment in recurrence rate among young women affected by recurrent UTI.Methods.?673 consecutive asymptomatic young women with demonstrated bacteriuria from January 2005 and December 2009, were prospectively enrolled. All patients were split into two groups: Group A - not treated, Group B - treated. Microbiological and clinical evaluations were performed at 3, 6 and 12 months. Quality of life was also measured. Recurrence-free rate at the end of the entire study period was the main outcome measure.Results.?312 were assigned to Group A while 361 to Group B. At the baseline, the two most commonly isolated pathogens were Escherichia coli (Group A 38.4%; Group B 39.3%) and Enterococcus faecalis (Group A 32.7%; Group B 33.2%). At the first follow-up visit, there was no difference between the two Groups (RR 1.05;95%CI, 1.01-1.10), while after 6 months, 23 (7.6%) in Group A and 98 (29.7%) in Group B showed recurrence with a statistically significant difference (RR 1.31; 95%CI, 1.21-1.42;p<0.0001). At the last follow-up, 41 (13.1%) in Group A and 169 (46.8%) in Group B showed recurrence (RR 3.17;95%CI, 2.55-3.90;p<0.0001). 1 patient in Group A and 2 patients in Group B were found to be affected by pyelonephritis.Conclusions.?This study shows that AB should not be treated when found in young women affected by UTI, hypothesizing its protective role in preventing symptomatic recurrence.

PMID: 22677710 [PubMed - as supplied by publisher]

Link to Article at PubMed

Diuretics and ultrafiltration in acute decompensated heart failure.

J Am Coll Cardiol Start a Discussion »

Jun 092012

Diuretics and ultrafiltration in acute decompensated heart failure.

J Am Coll Cardiol. 2012 Jun 12;59(24):2145-53

Authors: Felker GM, Mentz RJ

Abstract
Congestion and volume overload are the hallmarks of acute decompensated heart failure (ADHF), and loop diuretics have historically been the cornerstone of treatment. The demonstrated efficacy of loop diuretics in managing congestion is balanced by the recognized limitations of diuretic resistance, neurohormonal activation, and worsening renal function. However, the recently published DOSE (Diuretic Optimization Strategies Evaluation) trial suggests that previous concerns about the safety of high-dose diuretics may not be valid. There has been a growing interest in alternative strategies to manage volume retention in ADHF with improved efficacy and safety profiles. Peripheral venovenous ultrafiltration (UF) represents a potentially promising approach to volume management in ADHF. Small studies suggest that UF may allow for more effective fluid removal compared with diuretics, with improved quality of life and reduced rehospitalization rates. However, further investigation is needed to completely define the role of UF in patients with ADHF. This review summarizes available data on the use of both diuretics and UF in ADHF patients and identifies challenges and unresolved questions for each approach.

PMID: 22676934 [PubMed - in process]

Link to Article at PubMed

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China.

Clin Microbiol Infect Start a Discussion »

Jun 092012

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China.

Clin Microbiol Infect. 2012 May 15;

Authors: Tian LT, Yao K, Zhang XY, Zhang ZD, Liang YJ, Yin DL, Lee L, Jiang HC, Liu LX

Abstract
Clin Microbiol Infect ABSTRACT: In China, there are four types of liver abscesses (LAs) that meet the clinical criteria. Pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs) are two of the most common types of abscesses, followed by fungal liver abscesses (FLAs) and hydatid secondary liver abscesses (HsLAs). Diabetes mellitus (DM) is associated with the development of PLAs. However, there is a lack of population-based studies that have evaluated the underlying relationship between LAs (mainly PLAs and FLAs) and DM. We conducted a retrospective study based on a large population to identify the potential differences and factors that affect the mortality of PLA patients in DM and non-DM groups. Our results revealed that the prevalence of DM is 44.3% (158/357) in PLA patients and 35.3% (18/51) in FLA patients. Compared with the non-DM patients, statistically significant differences were found in DM patients according to symptomatology, clinical manifestations, laboratory findings, microbiological characteristics, antimicrobial resistance, clinical treatments and outcomes in relation to mortality. In addition, the status of antibiotic resistance to E. coli and K. pneumoniae, which were isolated from the patient samples, is severe in the area in which the study was conducted. Regarding the treatment of PLAs, our study indicated that broad-spectrum antimicrobial therapy and drug combinations should be recommended and initiated before the pathogens are cultured and identified. In the clinic, therapies that combine percutaneous drainage with antibiotics and surgery with antibiotics are the two most useful strategies for treating an LA. These two combined treatments resulted in satisfactory cure rates. In the DM and non-DM groups, the cure rates for percutaneous drainage with antibiotics were 90.3% and 92.0%, respectively, and the cure rates for surgery with antibiotics were 93.9% and 95.2%, respectively.

PMID: 22676078 [PubMed - as supplied by publisher]

Link to Article at PubMed

Development of a Clinical Prediction Rule for Risk Stratification of Recurrent Venous Thromboembolism in Patients with Cancer: Associated Venous Thromboembolism.

Circulation Start a Discussion »

Jun 092012

Development of a Clinical Prediction Rule for Risk Stratification of Recurrent Venous Thromboembolism in Patients with Cancer: Associated Venous Thromboembolism.

Circulation. 2012 Jun 7;

Authors: Louzada ML, Carrier M, Lazo-Langner A, Dao V, Kovacs MJ, Ramsay TO, Rodger MA, Zhang J, Lee AY, Meyer G, Wells PS

Abstract
BACKGROUND: Long-term low molecular weight heparin (LMWH) is the current standard for treatment of venous thromboembolism (VTE) in cancer patients. Whether treatment strategies should vary according to individual risk of VTE recurrence remains unknown. We performed a retrospective cohort study and a validation study in patients with cancer-associated VTE to derive a clinical prediction rule that stratifies VTE recurrence risk. METHODS AND RESULTS: The cohort study of 543 patients determined the model with the best classification performance included 4 independent predictors (sex, primary tumor site, stage and prior VTE.) with 100% sensitivity, a wide separation of recurrence rates, 98.1% negative predictive value and a negative likelihood ratio of 0.16. In this model, the score sum ranged between -3 and +3 score points. Patients with a score ? 0 had low risk (?4.5%) for recurrence and patients with a score above 1 had a high risk (?19%) for VTE recurrence. Subsequently, we applied and validated the rule in an independent set of 819 patients from 2 randomized controlled trials comparing LMWH to coumarin treatment in cancer patients. CONCLUSIONS: By identifying VTE recurrence risk in cancer patients with VTE we may be able to tailor treatment, improving clinical outcomes while minimizing costs.

PMID: 22679142 [PubMed - as supplied by publisher]

Link to Article at PubMed

Communication and collaboration: it’s about the pharmacists, as well as the physicians and nurses.

Qual Saf Health Care Start a Discussion »

Jun 092012

Communication and collaboration: it's about the pharmacists, as well as the physicians and nurses.

Qual Saf Health Care. 2010 Jun;19(3):169-72

Authors: Holden LM, Watts DD, Walker PH

Abstract
OBJECTIVE: Collaboration and communication as dimensions of patient safety climate have been measured in acute care hospital units, and discrepant viewpoints have been documented between different professional groups, particularly between physicians and nurses. In the ambulatory care setting, these groups often work more closely together throughout the day than in acute care settings, thereby enhancing effective collaboration and communication. This study sought to determine if the communication differences that are known to impact patient safety, which are found in acute care, also exist in ambulatory care.
METHODS: The Safety Attitudes Questionnaire, a 77-item survey of collaboration, communication and safety attitudes, was administered to the primary care staff at four Midwestern military ambulatory care clinics.
RESULTS: There were 107 participants consisting of nurses (n=46), nurse practitioners (n=12), pharmacists (n=10) and physicians (n=39), yielding an overall response rate of 65%. All groups rated their peer group higher than other professional groups. The ratings of nurses and physicians were very similar: 85.0% of nurses rated physicians, and 85.7% of physicians rated nurses as high or very high in communication and collaboration. Pharmacists were rated the lowest by each of the other professional groups. Only 60% of pharmacists rated physicians as high or very high.
CONCLUSIONS: Collaboration and communication ratings among physicians and nurses appear to be higher in the ambulatory care setting than in the acute care. However, interactions with pharmacists are more problematic, perceived as adversarial. Teamwork training that focuses on specific interactions among professional groups should target these concerns.

PMID: 20123760 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Patterns of nurse-physician communication and agreement on the plan of care.

Qual Saf Health Care Start a Discussion »

Jun 092012

Patterns of nurse-physician communication and agreement on the plan of care.

Qual Saf Health Care. 2010 Jun;19(3):195-9

Authors: O'Leary KJ, Thompson JA, Landler MP, Kulkarni N, Haviley C, Hahn K, Jeon J, Wayne DB, Baker DW, Williams MV

Abstract
BACKGROUND: Interdisciplinary communication is critically important to provide safe and effective care, yet it has been inadequately studied for hospitalised medical patients. Our objective was to characterise nurse-physician communication and their agreement on patients' plan of care.
METHODS: During a one-month period, randomly selected hospitalised patients, their nurses and their physicians were interviewed. Nurses and physicians were asked to identify one another, whether communication had occurred, and about six aspects of the plan of care. Two internists rated nurse-physician agreement on aspects of the plan of care as none, partial or complete agreement. Measures included the percentage of nurses and physicians able to identify one another and reporting communication and the percentage of nurse-physician pairs in agreement on aspects of the plan of care.
RESULTS: 310 (91%) and 301 (88%) of 342 eligible nurses and physicians completed interviews. Nurses correctly identified patients' physicians 71% of the time and reported communicating with them 50% of the time. Physicians correctly identified the patients' nurses 36% of the time and reported communicating with them 62% of the time. Physicians and nurses showed no agreement on aspects of the plan of care ranging from 11% for planned procedures to 42% for medication changes.
CONCLUSIONS: Nurses and physicians did not reliably communicate with one another and were often not in agreement on the plan of care for hospitalised medical patients.

PMID: 20430931 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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