VanSuch M, et al. Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care? Qual Saf Health Care. 2006;15(6):414-17.
Retrospective study of 1121 randomly selected patients admitted to a hospital for heart failure. See Figures 1 and 2 for data on hospital readmission. See Figure 3 for survival data.
5/19/08
5/16/08
What is the incidence of hepatocellular carcinoma metastasizing to the lungs?
PMID: 10966697
Retrospective study of 403 patients diagnosed with HCC. 148 identified (by CT scans) as having extra-hepatic metastases, with 39% (58) of the first detectable metastases being in the lung and 55% (81) of the patients having metastases to the lung. It was the most common metastatic site.
Retrospective study of 403 patients diagnosed with HCC. 148 identified (by CT scans) as having extra-hepatic metastases, with 39% (58) of the first detectable metastases being in the lung and 55% (81) of the patients having metastases to the lung. It was the most common metastatic site.
5/15/08
How well does the fact that nitroglycerin relieves a patient's chest pain predict coronary artery disease?
These studies indicate that relief of chest pain by nitroglycerin is not a predictor of coronary artery disease.
Study (N): Henrikson; PMID 14678917 (459 pts given nitroglycerin in ED because of chest pain)
Measures: Pain relief by increase/decrease of self-reported pain 5 min. after admin. of nitroglycerin; CAD by elevated serum enzyme levels, coronary angiography demonstrating a 70% or greater stenosis, or a positive exercise test result
Results: nitroglycerin relieved pain of 35% of pts w/CAD and 41% of pts without CAD
Study: Diercks; PMID 15940087 (664 pts given nitroglycerin in ED because of chest pain)
Measures: Pain relief by 11-point numeric descriptive scale for chest pain recorded before & after initial dose ; Cardiac-related pain by discharge diagnosis of myocardial infarction or the diagnosis of coronary artery disease based on a positive diagnostic study
Results: Relief of pain following nitroglycerin administration was not significantly different between the cardiac diagnosis group and the non-cardiac diagnosis group.
Study (N): Henrikson; PMID 14678917 (459 pts given nitroglycerin in ED because of chest pain)
Measures: Pain relief by increase/decrease of self-reported pain 5 min. after admin. of nitroglycerin; CAD by elevated serum enzyme levels, coronary angiography demonstrating a 70% or greater stenosis, or a positive exercise test result
Results: nitroglycerin relieved pain of 35% of pts w/CAD and 41% of pts without CAD
Study: Diercks; PMID 15940087 (664 pts given nitroglycerin in ED because of chest pain)
Measures: Pain relief by 11-point numeric descriptive scale for chest pain recorded before & after initial dose ; Cardiac-related pain by discharge diagnosis of myocardial infarction or the diagnosis of coronary artery disease based on a positive diagnostic study
Results: Relief of pain following nitroglycerin administration was not significantly different between the cardiac diagnosis group and the non-cardiac diagnosis group.
5/14/08
What is the evidence concerning GCSF prophylaxis for cancer patients receiving chemotherapy?
From UptoDate:
2006 guidelines from both the American Society of Clinical Oncology (ASCO) and the European Organization for Research and Treatment of Cancer (EORTC) recommend prophylaxis when "the anticipated incidence of febrile neutropenia is approximately 20 percent or more."
UptoDate recommends GCSF prophylaxis for
-patients who are receiving therapies where there is a likelihood of dose-limiting neutropenia
-certain high-risk patients
-patients receiving radiation therapy involving large fields
For more read "Prophylaxis of infection during chemotherapy-induced neutropenia" in UptoDate (on campus only)
2006 guidelines from both the American Society of Clinical Oncology (ASCO) and the European Organization for Research and Treatment of Cancer (EORTC) recommend prophylaxis when "the anticipated incidence of febrile neutropenia is approximately 20 percent or more."
UptoDate recommends GCSF prophylaxis for
-patients who are receiving therapies where there is a likelihood of dose-limiting neutropenia
-certain high-risk patients
-patients receiving radiation therapy involving large fields
For more read "Prophylaxis of infection during chemotherapy-induced neutropenia" in UptoDate (on campus only)
What is the prognosis for erythema nodosum?
According to "Erythema nodosum" in UptoDate (on campus only) and Current Medical Diagnosis and Treatment 2008, the lesions usually disappear in about 6 weeks, but may recur unless any underlying causes are treated.
What is the incidence of PCP in patients with cancer?
Sepkowitz KA. Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome. Clin Infect Dis. 2002 Apr 15;34(8):1098-107. Epub 2002 Mar 21.
Table 1 summarizes incidence of PCP in cancer patients - data taken from 3 studies
1.3% of patients with solid tumors while receiving glucocorticosteroids
Also, a Cochrane Review, Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients (2007), states that the incidence of PCP in non-HIV patients is increasing, naming cancer patients treated with corticosteroids as one of the at risk groups. (See Background section of the review)
Table 1 summarizes incidence of PCP in cancer patients - data taken from 3 studies
1.3% of patients with solid tumors while receiving glucocorticosteroids
Also, a Cochrane Review, Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients (2007), states that the incidence of PCP in non-HIV patients is increasing, naming cancer patients treated with corticosteroids as one of the at risk groups. (See Background section of the review)
5/12/08
Is rifaximin effective for prophylaxis against spontaneous bacterial peritonitis?
No RCTs identified in Pubmed or EMBASE
How do rifaximin & lactulose compare for hepatic encephalopathy
3 RCTs identified in Pubmed - Rifaximin & lactulose appear to be similar in efficacy
Comparison of rifaximin and lactulose for the treatment of hepatic encephalopathy: a prospective randomized study.
Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial.
Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy
Comparison of rifaximin and lactulose for the treatment of hepatic encephalopathy: a prospective randomized study.
Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial.
Double-blind, double-dummy comparison between treatment with rifaximin and lactulose in patients with medium to severe degree hepatic encephalopathy
5/9/08
What is the prognosis for tick-borne diseases common to the southeastern US?
Ehrlichiosis
Bakken JS, Dumler JS. Human granulocytic ehrlichiosis. Clin Infect Dis. 2000 Aug;31(2):554-60. Epub 2000 Sep 14.
Review article puts mortality at <1%; style="color: rgb(204, 0, 0);">
Rocky Mountain spotted fever
Kirkland KB, Wilkinson WE, Sexton DJ. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis. 1995 May;20(5):1118-21.
Retrospective study of patients at a university hospital with RMSF. Patients who received therapy within 5 days of the onset of symptoms were significantly less likely to die than were those who received treatment after the 5th day of illness (6.5% vs. 22.9%, respectively; P < .03) [from Pubmed abstract]
Tularemia
UptoDate: Overall mortality associated with tularemia is 2 to 4 percent
Bakken JS, Dumler JS. Human granulocytic ehrlichiosis. Clin Infect Dis. 2000 Aug;31(2):554-60. Epub 2000 Sep 14.
Review article puts mortality at <1%; style="color: rgb(204, 0, 0);">
Rocky Mountain spotted fever
Kirkland KB, Wilkinson WE, Sexton DJ. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis. 1995 May;20(5):1118-21.
Retrospective study of patients at a university hospital with RMSF. Patients who received therapy within 5 days of the onset of symptoms were significantly less likely to die than were those who received treatment after the 5th day of illness (6.5% vs. 22.9%, respectively; P < .03) [from Pubmed abstract]
Tularemia
UptoDate: Overall mortality associated with tularemia is 2 to 4 percent
What is the comparative value of the various tests for cytomegalvirus?
Pubmed search
(cytomegalovirus infection) AND specificity AND (cohort studies OR meta-analysis) AND predictive value
LIMITS: human, English
Ø cohort studies of immunocompetent patients comparing methods
UptoDate
Led to this review article, which summarizes diagnostic methods:
Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation,and emerging treatments. Lancet Infect Dis. 2004 Dec;4(12):725-38.
(cytomegalovirus infection) AND specificity AND (cohort studies OR meta-analysis) AND predictive value
LIMITS: human, English
Ø cohort studies of immunocompetent patients comparing methods
UptoDate
Led to this review article, which summarizes diagnostic methods:
Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation,and emerging treatments. Lancet Infect Dis. 2004 Dec;4(12):725-38.
5/5/08
Why is methamphetamine use associated with poor oral health?
Donaldson M, Goodchild JH. Oral health of the methamphetamine abuser.
Am J Health Syst Pharm. 2006 Nov 1;63(21):2078-82. Erratum in: Am J Health Syst
Pharm. 2006 Nov 15;63(22):2180.
This review in the American Journal of Health-System Pharmacy identifies 3 conditions associated with methamphetamine use that can contribute to poor oral health:
1. xerostomia
2. grinding of teeth from drug-induced hyperactivity
3. acids used in manufacturing the methamphetamine
Read more...
Am J Health Syst Pharm. 2006 Nov 1;63(21):2078-82. Erratum in: Am J Health Syst
Pharm. 2006 Nov 15;63(22):2180.
This review in the American Journal of Health-System Pharmacy identifies 3 conditions associated with methamphetamine use that can contribute to poor oral health:
1. xerostomia
2. grinding of teeth from drug-induced hyperactivity
3. acids used in manufacturing the methamphetamine
Read more...
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