Escaping the EHR trap--the future of health IT.
N Engl J Med. 2012 Jun 14;366(24):2240-2
Authors: Mandl KD, Kohane IS
PMID: 22693995 [PubMed - in process]
Link to Article at PubMedJun 152012
Jun 152012
Guillain-Barré syndrome.
N Engl J Med. 2012 Jun 14;366(24):2294-304
Authors: Yuki N, Hartung HP
PMID: 22694000 [PubMed - in process]
Link to Article at PubMedJun 152012
Cardio-renal syndrome: new perspective in diagnostics.
Semin Nephrol. 2012 Jan;32(1):3-17
Authors: Iyngkaran P, Schneider H, Devarajan P, Anavekar N, Krum H, Ronco C
Abstract
Chronic heart failure and chronic renal failure are at epidemic proportions. These patients have significantly altered cardiac, renal, and all-cause outcomes. Much of the current research has focused on treating these individual organs in isolation. Although there are positive data on outcomes with neurohormonal modulation, they, however, remain underused. At present, data lacks for novel treatment options, while evidence continues to point at significantly worsened prognosis. Current diagnostic tools that detect acute changes in renal function or renal injury appear retrospective, which often hinder meaningful diagnostic and therapeutic decisions. This review is aimed at exploring the importance of accurate assessment of renal function for the heart failure patient by providing a synopsis on cardio-renal physiology and establishing the possibility of novel approaches in bridging the divide.
PMID: 22365157 [PubMed - indexed for MEDLINE]
Link to Article at PubMedJun 152012
Role of biomarkers in the diagnosis and management of cardio-renal syndromes.
Semin Nephrol. 2012 Jan;32(1):79-92
Authors: Cruz DN, Fard A, Clementi A, Ronco C, Maisel A
Abstract
The complex interaction between heart and kidney disease has been increasingly recognized over the recent years. Pathologies within these two organs frequently coexist and, due to organ cross-talk, dysfunction in one often leads to problems in the other. The classification of the various forms of cardio-renal syndrome has made these interactions clearer. To aid in the diagnosis, management and prognosis of these conditions, many novel cardiac and renal biomarkers have emerged to supplement traditional markers which have limited specificity and sensitivity. In this review we will summarize the literature on novel renal behind these and other biomarkers and discuss their potential relevance to the clinical scenarios of cardio-renal syndrome.
PMID: 22365166 [PubMed - indexed for MEDLINE]
Link to Article at PubMedJun 152012
Surgical risk in patients with cirrhosis.
J Gastroenterol Hepatol. 2012 Jun 13;
Authors: Nicoll A
Abstract
Surgery in the patient with cirrhosis is problematic, as encephalopathy, ascites, sepsis and bleeding are common in the post-operative period. Accurate pre-operative assessment and planning, and careful post-operative management has the potential to reduce the frequency and severity of such complications, and reduce the length of hospital stay, but there is little literature evidence to prove this. Operative mortality and other risks correlate with the severity of the liver disease, co-morbidities and the type of surgery. The Child-Turcott-Pugh (CTP) score or model for end-stage liver disease (MELD) score may be used to determine the severity of the liver disease, but must also take into account recent changes in the patient's condition. Surgery that does not involve opening the peritoneum may have slightly better outcomes, as the risk of ascitic leak, sepsis and difficult fluid management are reduced. Mortality rates range from 10% in CTP-A patients to 82% in CTP-C patients. The presence of portal hypertension is an important negative predictor, especially in abdominal surgery, as refractory ascites may occur. Careful monitoring in the post-operative period and early intervention of complications are essential. Hepatic resections in cirrhosis are associated with other considerations such as leaving sufficient liver tissue to prevent liver failure, and are beyond the scope of this review. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
PMID: 22694313 [PubMed - as supplied by publisher]
Link to Article at PubMedJun 152012
Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home.
J Am Geriatr Soc. 2012 Jun 13;
Authors: Rosenberg T
Abstract
OBJECTIVES: To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home (PIECH) on acute hospital use and mortality in a frail elderly population. DESIGN: Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period (May 1, 2010-April 30, 2011, postentry) for active and discharged patients. SETTING: Community. PARTICIPANTS: All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia. INTERVENTION: Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes. MEASUREMENTS: Acute hospital admissions, emergency department (ED) contacts that did not lead to admission, reason for leaving practice, and site of death. RESULTS: There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home. CONCLUSION: Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.
PMID: 22694020 [PubMed - as supplied by publisher]
Link to Article at PubMed