2012 June 14

Predictors of repeated emergency department visits among persons treated for addiction.

Jun 142012

Predictors of repeated emergency department visits among persons treated for addiction.

Eur Addict Res. 2012;18(2):47-53

Authors: Hansagi H, Engdahl B, Romelsjö A

Abstract

BACKGROUND/AIMS: To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use.

METHODS: Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments' specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models.

RESULTS: Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5-20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5-6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4-5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7-58.4). Drug users' EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis.

CONCLUSION: The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis. Entering regular addiction treatment does not appear to alter the pattern of ED utilization.

PMID: 22189093 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Safety and effectiveness of antithrombotic strategies in older adult patients with atrial fibrillation and non-ST elevation myocardial infarction.

Am Heart J Start a Discussion »

Jun 142012

Safety and effectiveness of antithrombotic strategies in older adult patients with atrial fibrillation and non-ST elevation myocardial infarction.

Am Heart J. 2012 Apr;163(4):720-8

Authors: Fosbol EL, Wang TY, Li S, Piccini JP, Lopes RD, Shah B, Mills RM, Klaskala W, Alexander KP, Thomas L, Roe MT, Peterson ED

Abstract

BACKGROUND: We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF).

METHODS: Using the CRUSADE registry linked to longitudinal Medicare claims data, we examined NSTEMI patients aged ? 65 years with a concomitant diagnosis of AF. Multivariable Cox analysis was used to compare risk of rehospitalization for bleeding and a major cardiac composite end point of death, readmission for myocardial infarction, or stroke, according to discharge antithrombotic strategy.

RESULTS: Among 7619 NSTEMI patients with AF, 29% were discharged on aspirin alone; 37%, on aspirin + clopidogrel; 7%, on warfarin alone; 17%, on aspirin + warfarin; and 10%, on warfarin + aspirin + clopidogrel. There was no difference in predicted stroke risk between groups. By 1 year, 12.2% of patients were rehospitalized for bleeding, and 33.1% had a major cardiac event. Relative to aspirin alone, antithrombotic intensification was associated with increased bleeding risk (aspirin + clopidogrel adjusted HR 1.22, 95% CI 1.03-1.46 and warfarin + aspirin HR 1.46, 95% CI 1.21-1.80). Patients treated with aspirin + clopidogrel + warfarin had the highest observed bleeding risk (HR 1.65, 95% CI 1.30-2.10). One-year risk of the major cardiac end point was similar between groups, although, relative to aspirin only, there was a trend toward lower risk for the warfarin + aspirin group (HR 0.88, 95% CI 0.78-1.00).

CONCLUSIONS: Older NSTEMI patients with AF are at high risk for subsequent bleeding and major cardiac events. Increased antithrombotic management was associated with increased bleeding risk. Further investigation is needed to clarify whether these risks are counterbalanced by reduced thromboembolic events in this population.

PMID: 22520540 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Dizziness and vertigo.

front neurol neurosci Start a Discussion »

Jun 142012

Dizziness and vertigo.

Front Neurol Neurosci. 2012;30:22-5

Authors: Della-Morte D, Rundek T

Abstract

Dizziness is a general, non-specific term to indicate a sense of disorientation. Vertigo is a subtype of dizziness and refers to an erroneous perception of self- or object-motion or an unpleasant distortion of static gravitational orientation that is a result of a mismatch between vestibular, visual, and somatosensory systems. Vertigo is among the most common complaints in medicine, affecting approximately 20-30% of the general population. Stroke accounts for 3-7% among all causes of vertigo. The blood perfusion to the inner ear, brainstem, and cerebellum arise from the vertebrobasilar system. Vertigo, nausea, and vomiting, along with nystagmus, represent symptoms of stroke in posterior fossa due to arterial occlusion or rupture of the vertebrobasilar system. However, the spectrum of signs and symptoms as a manifestation of stroke associated with dizziness and vertigo may be variable depending on the affected vascular territories. Stroke or transient ischemic attack should be seriously considered in patients presenting with acute vertigo in the emergency room. Differential diagnosis between vascular vertigo and other causes of vertigo can result in misclassification due to the overlapping of symptoms. Careful medical history, physical examination, neuroimaging and ear, nose, and throat studies may help to distinguish vascular vertigo from other causes.

PMID: 22377855 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study.

BMC Public Health Start a Discussion »

Jun 142012

Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study.

BMC Public Health. 2010;10:421

Authors: Izquierdo C, Oviedo M, Ruiz L, Sintes X, Vera I, Nebot M, Bayas JM, Carratalà J, Varona W, Sousa D, Celorrio JM, Salleras L, Domínguez A,

Abstract

BACKGROUND: The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship.The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population.

METHODS: A total of 651 patients aged > or =65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V)], educational level (< or = primary level or > or = secondary level) and disposable family income of the municipality or district of residence [>12,500 euro (high municipality family income) and < or =12,500 euro (low municipality family income)]. The six social groups were further categorized as upper/middle social class (groups I-IVb) and lower class (group V).Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p < 0.05.

RESULTS: 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb). Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p < 0.001).

CONCLUSIONS: We measured socioeconomic status using both individual and community data and found no association between social class, educational level or municipality family income and the variables of pneumonia outcomes. The lack of differences between social classes supports the provision of universal, equitable health care by the public health system.

PMID: 20633254 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The value of blood culture audits at peripheral hospitals.

s afr med j Start a Discussion »

Jun 142012

The value of blood culture audits at peripheral hospitals.

S Afr Med J. 2012 Apr;102(4):224-5

Authors: Kenyon CR, Fatti G, Schrueder N, Bonorchis K, Meintjes G

Abstract

Knowledge of local antibiotic sensitivities is crucial to creating appropriate empiric antibiotic guidelines. The new National Health Laboratory Service (NHLS) Data Warehouse allows clinicians to access collated spreadsheets of culture isolates and antimicrobial susceptibility patterns for their facilities. We used this service to study the trends in blood culture (BC) results at GF Jooste Hospital from 2005 to 2010. We investigated the BC contamination rate and changes in the antibiotic sensitivity profiles of selected organisms, and estimated the proportion of infections that were hospital-acquired. Over 3000 BCs were performed per year in this period. A very high contamination rate was observed (7 - 9%) in 2005 - 2007, with a gratifying reduction by 2010. Ceftriaxone resistance increased from 16% to 62% in Klebsiella pneumoniae (p<0.0001), and from 33% to 100% in Enterobacter spp. (p=0.053).

PMID: 22464502 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Use of sterile saline as a conduction agent for ultrasound visualization of central venous structures.

Emerg Med Australas Start a Discussion »

Jun 142012

Use of sterile saline as a conduction agent for ultrasound visualization of central venous structures.

Emerg Med Australas. 2010 Jun;22(3):232-5

Authors: Windish R, Ungar T, Backlund B, Haukoos JS, Kendall J

Abstract

OBJECTIVE: To determine whether sterile saline as a conduction agent provides adequate visualization of anatomic structures to attempt ultrasound-guided vascular access.

METHODS: This prospective study involved a convenience sample of adult patients (18 years and older) who presented to an urban academic ED during a 3-month study period. Each patient had three six-second ultrasound video clips obtained of the right internal jugular vein and surrounding structures utilizing three different conduction agents, water-based gel (the control), sterile saline or no conduction agent. Video clips were randomized and assigned a numeric code to blind reviewers to the conduction agent. They were then independently reviewed by two experts who determined whether anatomic structures were visualized with enough detail to perform ultrasound-guided vascular access. The reviewers also rated the overall image quality of each video clip using a 100 mm visual analogue scale (VAS).

RESULTS: Forty-seven patients were included in the final analysis. The raw agreement was 100% (95% confidence intervals [CI]: 93-100%) with a kappa of 1.0 between the two reviewers in assessing whether they would be able to perform vascular access using the images obtained using saline as a conduction agent. The median VAS for gel across both reviewers was 92 (95% CI: 90-93) and the median VAS differences for saline and no medium were -3 (95% CI: -1 to -3) and -46 (95% CI: -22 to -61), respectively.

CONCLUSIONS: The use of sterile saline as a conduction agent allows adequate visualization of anatomic structures to attempt ultrasound-guided vascular access.

PMID: 20590784 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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