Comments for Virtual Journal Club

Comment on Medical device related pressure ulcers in hospitalized patients. by Shelley Lancaster

Shelley Lancaster — Wed, 29 Aug 2012 19:45:00 +0000

Excellent article! I used this as a reference at a recent wound care update and gained valuable information about this topic that is not widely covered in the literature. Thank you!

Comment on Outcome of Noncardiac and Nonvascular Surgery in Patients With Mechanical Heart Valves. by Robert Mahoney

Robert Mahoney — Mon, 21 May 2012 14:00:28 +0000

This study looked at outcomes of patients with mechanical valves being “bridged” with enoxaparin. Despite practice guidelines supporting the use of enoxaparin for bridging (see http://bit.ly/enoxa), many institutions still rely on unfractionated heparin, prolonging length of stay.

How do you “bridge” your mechanical valve patients for procedures?

Comment on How long should peripherally inserted central catheterization be delayed in the context of recently documented bloodstream infection? by Robert Mahoney

Robert Mahoney — Wed, 09 May 2012 16:16:03 +0000

Most patients with bacteremia (particularly with line infections) will need to have central vascular access placed for long-term (2-6 weeks) IV antibiotics. Typically, IV antibiotics are administered initially via short-term peripheral IV in the hospital until central access can be placed, at which point the patient can be discharged if otherwise stable. There is concern that if the central access is placed too soon after bacteremia, the new access will become infected.

How long do you typically wait before placing central access after documented bacteremia?

Comment on Do timely outpatient follow-up visits decrease hospital readmission rates? by Robert Mahoney

Robert Mahoney — Mon, 07 May 2012 16:13:21 +0000

In this study out of Mayo, risk of 30d readmission was no different among patients with follow-up scheduled within 14 days of discharge, more than 14 days after discharge, or not at all. There was a slightly (not statistically but perhaps clinically significant) increased length of stay among those who followed up within 14 days, which may have negatively affected the readmission rate in the <14 day group (if length of stay is positively correlated with readmission). Furthermore, the demographics of the study population do not reflect national patterns.

Is there enough evidence to support the “discharge clinics” that are becoming so popular among hospitals to prevent early readmission?

Comment on Refusal of ICU Admission Due to a Full Unit: Impact on Mortality. by Robert Mahoney

Robert Mahoney — Thu, 23 Feb 2012 17:08:58 +0000

What is your institution’s policy on accepting or refusing ICU admissions? Do you feel that your ICU is large enough to accommodate demand?

Comment on Pre-Operative Serum Brain Natriuretic Peptide and Risk of Acute Kidney Injury after Cardiac Surgery. by Professor A. KOSSAIFY

Professor A. KOSSAIFY — Sun, 12 Feb 2012 16:43:11 +0000

The article regarding BNP post cardiac surgery is relevant with real practice : low output status related to congestion explains in fact prerenal kidney dysfunction in this setting

Comment on FAQs by Robert Mahoney

Robert Mahoney — Mon, 30 Jan 2012 16:14:46 +0000

The Virtual Journal Club collects abstracts from journals published elsewhere to allow for review and discussion. There are no original articles included. Many of the articles are from peer-reviewed journals, although that is not a requirement for inclusion in the Journal Club. All of the abstracts are aggregated from PubMed, which allows access to some of the powerful features of PubMed (including full-text links and links to similar articles).

You are welcome to post comments on any articles on the Journal Club. Comments are moderated but are not peer-reviewed; if a comment is accepted, it is not edited (but it may be moved to another place on the site). Comments can be detailed and can include references to other literature. Good luck, and thanks for asking!

Comment on FAQs by antoine KOSSAIFY

antoine KOSSAIFY — Mon, 30 Jan 2012 15:52:20 +0000

Dear Editor
Are journals peer-reviewed ? and indexed in Pubmed ?
If yes, how to proceed to submit an article ?

Best regards
AK

Comment on Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. by Mark Thoelke

Mark Thoelke — Fri, 02 Dec 2011 00:17:27 +0000

It is amazing how the how fast ‘tight control’ was promoted without evidence. There is no data to support tight control during hospitalization outside the ICU, and evidence that it is harmful in the ICU, yet it is still promoted the by Society of Hospital Medicine.

Comment on How to Access Full-text Articles by prachi shete

prachi shete — Sun, 20 Nov 2011 07:22:46 +0000

thanks

Comment on Natural history of eosinophilic gastroenteritis. by viswanath reddy

viswanath reddy — Mon, 24 Oct 2011 13:17:23 +0000

good observations
need full article

Comment on Hepatic incidentalomas. by naing naing

naing naing — Mon, 29 Aug 2011 07:08:21 +0000

very nice for online learners

Comment on Safety and Efficacy of the Oral Direct Factor Xa Inhibitor Apixaban in Japanese Patients With Non-Valvular Atrial Fibrillation. by Akul

Akul — Fri, 01 Jul 2011 19:56:25 +0000

This is a good article on apixaban. However, to fully understand why oral factor Xa inhibitors are the hottest anticoagulants it would be a good idea to check out this Presentation on Direct Factor Xa Inhibitors as Anticoagulants

Comment on Abnormal preprocedural international normalized ratio and platelet counts are not associated with increased bleeding complications after ultrasound-guided thoracentesis. by Robert Mahoney

Robert Mahoney — Wed, 29 Jun 2011 23:00:49 +0000

If you perform a thoracentesis (whether using ultrasound or not), do you have a cutoff for INR or platelet count? Does a study like this change your willingness to perform the procedure?

Comment on Antibiotics for gram-positive bacterial infection: vancomycin, teicoplanin, quinupristin/dalfopristin, oxazolidinones, daptomycin, telavancin, and ceftaroline. by Akul Mehta

Akul Mehta — Tue, 28 Jun 2011 02:06:11 +0000

This article talks about antibiotic resistance and mechanism of action. However to better understand the topic I would personally recommend the page on PharmaXChange.info for animations on antibiotic resistance.

Comment on New synthetic antithrombotic agents for venous thromboembolism: pentasaccharides, direct thrombin inhibitors, direct Xa inhibitors. by Muhammed Abbas

Muhammed Abbas — Thu, 05 May 2011 01:58:13 +0000

Excellent work done on factor Xa. Rivaroxicban for the Tx of VTA.

Comment on Terlipressin in hepatorenal syndrome: Evidence for present indications. by Thamer Abdullah

Thamer Abdullah — Thu, 28 Apr 2011 06:26:43 +0000

What are the roles of diuretics and haemodialysis in early management of HRS.
Are there any new drugs for treatment of a such syndrome?

Regards

Comment on Pleural effusion in pulmonary embolism. by Stephen Tieku

Stephen Tieku — Sat, 19 Mar 2011 16:34:06 +0000

Pleural effusion in Pulmonary embolism is not almost always an exudate! sates otherwise in your book.

Comment on Clinical Experience with Bemiparin. by mohammed almashhadany

mohammed almashhadany — Fri, 11 Mar 2011 10:57:35 +0000

im vascular surgeon mosul iraq ,alsalam hospital i did study for prophylaxis with bemiparin & enoxaparin in 50 patients the bleeding ,VTE was higher with bemiparin among moderate & high risk group

Comment on Improving diagnosis of pulmonary tuberculosis among HIV/AIDS patients: literature review and experience in a teaching hospital in Indonesia. by Bethwel m. Ng'eno

Bethwel m. Ng'eno — Tue, 15 Feb 2011 18:01:26 +0000

Is PTB prevalent among HIV/AIDs patients and do people aware about the relationship between the two?,is there any measures taken to prevent this

Comment on The Search for Effective Treatment of Clostridium difficile Infection. by Willana

Willana — Sat, 05 Feb 2011 11:23:53 +0000

We are developing a treatment for CDD using a modified faecal bacteriotherapy (MFB) procedure, employing autologous samples collected from the patients prior to their treatment. The samples will be homogenised with saline and filtered. The filtrate will be freeze-dried, placed in enteric coated capsules and used to treat the patient’s CDD. RFID tags will be employed to associate capsules with the patient and assist with sample inventory.
We have demonstrated that freeze drying faecal samples does not markedly reduce their bacterial variety or numbers. Novel plastic containers for processing faecal samples in a more aesthetic way have been produced and an RFID system has been installed.. A market research project has been carried out which concludes that MFB is potentially a safe, inexpensive and effective treatment for CDD. A website http://www.bacteriotherapy.org has been produced which describes the project and includes a copy of the market research report.
We hope to obtain further grant funding to carry out the following procedures (a) to (e) :- (a) Large scale production of plastic containers for sample processing. (b) Testing MFB on a mammalian model. (c) Carrying out a small clinical study of MFB in a hospital infectious diseases unit. (d) Carrying out a large scale comparative clinical trial of MFB.
The outcome should be a safe and inexpensive non-antibiotic medicament to renew a patient’s intestinal flora using autologous samples to prevent or treat CDD. Current therapy for CDD is restricted to only two antibiotics and a parallel allogenic based procedure, we are developing, could be employed to treat populations in the event of a pandemic caused by antibiotic resistant CDD.

Comment on Antihypertensive Efficacy of Hydrochlorothiazide as Evaluated by Ambulatory Blood Pressure Monitoring A Meta-Analysis of Randomized Trials. by Robert Mahoney

Robert Mahoney — Wed, 02 Feb 2011 17:17:21 +0000

What’s left for high blood pressure? This meta-analysis suggests we should no longer consider hydrochlorothiazide as a first-line agent for hypertension, contradicting the recommendations of JNC-7 (http://www.ncbi.nlm.nih.gov/pubmed/12748199). Recently, we were also told to avoid non-vasodilating beta-blockers (http://beckerinfo.net/JClub/2010/12/04/beta-blockers-in-hypertension/) ; a class also highly favored in JNC-7. The literature is now trending towards fixed-dose combinations as initial therapy in some populations (see, for example, http://beckerinfo.net/JClub/2010/11/17/2010-guidelines-of-the-taiwan-society-of-cardiology-for-the-management-of-hypertension/). It will be interesting to see the impact on next year’s JNC-8.

Comment on Management of ascites. by Esther Achar

Esther Achar — Thu, 09 Dec 2010 11:12:19 +0000

The information you post on your page is very important and helps in generating more ideas which are needed in patient care.
I appreciate and would like toknow more and how you operate the nutritoinal related issues in management of the same.

Thank you
nutritionist ( Mombasa Hospital- Mombasa ; Kenya)

Comment on Assessing anticoagulation knowledge in patients new to warfarin therapy. by Janet Bowers RN, BSN, FCN

Janet Bowers RN, BSN, FCN — Tue, 19 Oct 2010 17:57:39 +0000

I agree that patients lack education as inpatient. I worked in a anticoagulant clinic for several years, and there was almost no education or very little given. Nurses need to be better trained in the minute details regarding anticoagulant drugs as numerous things like lifestyle, medications, diet, etc. affect outcomes Patients do better when they are educated in a structured program after discharge, such as an anticoagulation clinic. Our stats were 80% within target range for our Warfarin patients. Hospitalization is really not the best time to educate patient on these drugs due to high anxiety, potent inpatient drugs affecting cognition, too sick, and a plethora of other reasons.

Comment on How Many Lumens Should Be Cultured in the Conservative Diagnosis of Catheter-Related Bloodstream Infections? by Robert Mahoney

Robert Mahoney — Wed, 01 Sep 2010 15:13:03 +0000

At BJH there is discussion of removing blood cultures via the catheter from the routine workup of fever in hospitalized patients. This is evidently because our laboratory does not perform quantitative blood cultures and does not track differential time to positivity.

Does your hospital offer quantitation or differential timing? Would you feel comfortable diagnosing a line infection via peripheral cultures only?