Mechanical Thrombectomy for Patients with In-Hospital Ischemic Stroke: A Case-Control Study.
Aged; Humans; Male; Female; Middle Aged; Treatment Outcome; Time Factors; Feasibility Studies; Incidence; Retrospective Studies; thrombectomy; Inpatients; Thrombectomy/adverse effects; Acute ischemic stroke; Brain Ischemia/diagnostic imaging/epidemiology/physiopathology/therapy; in-hospital stroke; Intracranial Thrombosis/diagnostic imaging/epidemiology/physiopathology/therapy; large vessel occlusion; Stroke/diagnostic imaging/epidemiology/physiopathology/therapy
BACKGROUND AND AIM: Patients with in-hospital acute ischemic stroke (AIS) have, in general, worse outcomes compared to those presenting from the community, partly attributed to the numerous contraindications to intravenous thrombolysis. We aimed to identify and analyze a group of patients with in-hospital AIS who remain suitable candidates for acute endovascular therapies. METHODS: A retrospective 6-year data analysis was conducted in patients evaluated through the in-hospital stroke alert protocol in a single tertiary care university hospital to identify those with in-hospital AIS due to acute intracranial large vessel occlusion (ILVO). Feasibility and safety of mechanical thrombectomy for in-hospital AIS was assessed in a case-control study comparing inpatients to those presenting from the community. RESULTS: From 1460 in-hospital stroke alert activations, 11% had a final diagnosis of AIS (n = 167). One hundred and two patients with in-hospital AIS had emergent intracranial vessel imaging and were included in our cohort. Acute ILVO was identified in 27 patients within this cohort. Patients were younger in the ILVO group and had more severe neurologic deficit on presentation. Compared to a matched (1:2) control group of patients presenting from the community, inpatients who underwent mechanical thrombectomy achieved equivalent technical success, safety, and clinical outcomes. CONCLUSIONS: The incidence of acute ILVO in patients with in-hospital AIS who underwent emergent vessel imaging is similar to the reported incidence of ILVO in patients presenting with community-onset AIS. Among patients with in-hospital AIS secondary to ILVO, mechanical thrombectomy is a feasible and safe therapy associated with favorable outcomes.
Bulwa Z; Del Brutto VJ; Loggini A; Ammar FE; Martinez RC; Christoforidis G; Brorson JR; Ardelt AA; Goldenberg FD
Journal of Stroke and Cerebrovascular Diseases
2020
2020-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104692" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2020.104692</a>
Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Relation of concomitant heart failure to outcomes in patients hospitalized with influenza.
Female; Humans; Male; Aged; Middle Aged; Retrospective Studies; United States/epidemiology; Incidence; Comorbidity; Follow-Up Studies; Survival Rate/trends; Hospitalization/statistics & numerical data; Inpatients; Length of Stay/trends; Heart Failure/epidemiology; Hospital Mortality/trends; Influenza Human/epidemiology
Influenza is a major public health challenge. Patients hospitalized with influenza who also have heart failure (HF) may be at risk for worse outcomes compared with patients without HF. There is a lack of large studies examining this issue. We queried the 2013 to 2014 National Inpatient Sample for all adult patients (aged ≥ 18 years) admitted with influenza with and without concomitant HF. Using propensity score matching, patients were matched across demographics, discharge weights, and comorbidities. Outcomes included in-hospital mortality, complications, length of stay, and average hospital costs. Of 218,540 influenza hospitalizations, 45,460 (20.8%) had concomitant HF. Patients with HF had higher in-hospital mortality (6.1% vs 3.8%, adjusted odds ratio [aOR] 1.66 [95% confidence interval [CI] 1.44 to 1.91]; p <0.001), acute kidney injury (29.5% vs 22.2%, aOR 1.47 [95% CI 1.37 to 1.57]; p <0.001), acute kidney injury requiring dialysis (2.0% vs 1.0%, aOR 2.08 [1.62 to 2.67], acute respiratory failure (36.2% vs 23.5%, aOR 1.85 [1.73 to 1.97]; p <0.001), and acute respiratory failure requiring mechanical ventilation (17.1% vs 9.3%, OR 2.01 [1.84 to 2.21]; p <0.001), longer length of stay (5.70 ± 0.02 days vs 4.60 ± 0.01 days, p <0.001) and higher average hospital costs ($11,609 ± $52 vs $9,003 ± $38, p <0.001). In conclusion, in patients hospitalized with influenza, HF is associated with increased risk of in-hospital mortality and complications. Our results highlight a need for early recognition and aggressive treatment of HF in these patients to try to improve outcomes.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
The American journal of cardiology
2019
2019-05-01
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2019.01.046" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.01.046</a>
PMID: 30819433
233. The Epidemiology, Genomics, and Evolution of Staphylococcus aureus in Northeast Ohio.
mortality; epidemiology; prevention; Community; OHIO; inpatients; morbidity; infection; OHIO; genomics; institutional review board; risk reduction; METHICILLIN-resistant staphylococcus aureus; genomics; epidemiology; staphylococcus aureus; AKRON (Ohio); CLEVELAND Clinic Foundation; databases; disclosure; FOOD poisoning; HUMAN ecology; meca gene; methicillin; METHICILLIN-resistant staphylococcus aureus; MICROCOCCACEAE; polymerase chain reaction; staphylococcal protein a; staphylococcus; staphylococcus aureus
Background Infections due to S. aureus result in significant morbidity, mortality, and healthcare expense. We sought to identify the strains of S. aureus causing infections in hospitalized patients in Northeast Ohio and determine whether they are reflective of the S. aureus strains present in the surrounding environment. Methods The study was approved by the Institutional Review Board at Cleveland Clinic Akron General. Clinical S. aureus isolates (n = 300) were cultured and PCR was used to amplify the staphylococcus protein A (spa), Panton–Valentine Leukocidin (PVL), and mecA genes. The clinical spa types were compared with ones from our data base of S. aureus strains previously collected and sequenced from the community and environment in Northeast Ohio. Results A total of 51 spa types were detected from 129 S. aureus clinical isolates (discriminatory index, 0.876; 95% confidence interval [CI], 0.827–0.925; Table 1). The most common spa types were t008 (42/129, 32.6%), t002 (16/129, 12.4%), and t334 (6/129, 4.7%). In comparison, the most frequently detected spa types from the environmental samples were t189 (40/257, 15.6%), t002 (16/257, 6.2%), and t008 (11/257, 4.3%). Among the S. aureus isolates (n = 146), 45 were PVL-positive (30.8%) and 94 (66.7%) carried mecA. Of the 42 t008 (ST8/USA300; a common community-associated strain) isolates, 35 (83.3%) were methicillin-resistant S. aureus (MRSA) (based on the presence of the mecA gene) and 25 (59.5%) were PVL-positive. Thirteen of the sixteen (81.2%) t002 (ST5/USA100; a common hospital-associated strain) were MRSA and only one (6.2%) was PVL-positive. Conclusion There is considerable overlap of S. aureus strains present in clinical samples with those found in the environment. This finding should draw attention to the need for more effective prevention strategies to reduce the risk of transmission of S. aureus, including MRSA, in the environment to humans. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]
Watkins Richard R; Thapaliya Dipendra; Savri Rami; Smith Tara
Open Forum Infectious Diseases
2019
2019-10-02
Journal Article
<a href="http://doi.org/10.1093/ofid/ofz360.308" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofz360.308</a>
The relationship between psychiatric medication and course of hospital stay among intoxicated trauma patients
acute; brain-injury; chronic alcohol-abuse; comorbidity; cost; disorders; Emergency Medicine; ethanolism; general hospitals; hospitalization; inpatients; intoxication; Length of Stay; pneumonia; prevalence; Psychiatry; trauma
Introduction The purpose of this study was to determine whether trauma patients requiring psychiatric medication who were admitted with positive alcohol or drug screen require more pain medications or sedation resulting in longer length of stay. Methods Data were retrospectively collected from 1997 through 2003 on patients with positive alcohol or drug screen who also received psychiatric medication during their hospital stay in a trauma center. Patients were matched by age, injury severity score, and injury to controls who had negative alcohol and toxicology screens and no psychiatric medication. An additional group consisted of positive alcohol or drug-screen trauma patients without psychiatric medication during hospitalization. Each group had 25 patients. Results No significant differences between the three groups regarding comorbidities or pain-medication doses given per day were found. The patients with positive alcohol and with psychiatric medication were more likely to have respiratory complications such as pneumonia or respiratory failure requiring ventilator support (36 versus 4%, P=0.005), to develop other infections (8 versus 0%), or other complications (26 versus 4%, P=0.0007) compared with the controls. A significant difference in hospital length of stay between the group with positive toxicity and psychiatric medication and that with negative toxicity and psychiatric medication (mean: 12.8 and 5.5 days, respectively; P=0.01) was found. Conclusion Psychiatric medication and positive drug or alcohol screens are associated with longer length of stay and increased respiratory complications. Factors influencing these outcomes need more clarification and prospective studies.
Muakkassa F F; Marley R A; Dolinak J; Salvator A E; Workman M C
European Journal of Emergency Medicine
2008
2008-02
Journal Article
<a href="http://doi.org/10.1097/MEJ.0b013e3280b17ea0" target="_blank" rel="noreferrer noopener">10.1097/MEJ.0b013e3280b17ea0</a>
Pharmacists' role in glycemic management in the inpatient setting: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy.
Diabetes Mellitus; hyperglycemia; hypoglycemia; inpatients; pharmacists
The objective of this opinion paper was to identify and describe the role of pharmacists in ensuring safe and optimal management of patients with glycemic excursions in the inpatient setting. The role of the pharmacist includes involvement in admission medication history and reconciliation, formulary management of glucose‐lowering medications and devices, individual patient medication management, discharge transition of care, and interprofessional collaboration with other health care providers. Recommendations are based on review of published guidelines and literature focusing on the management of patients with hypo‐ and hyperglycemia in the hospital as well as during the time of transition to and from the inpatient setting. [ABSTRACT FROM AUTHOR]
Donihi Amy C; Moorman John M; Abla Alicia; Hanania Raja; Carneal Dustin; MacMaster Heidemarie Windham
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-04
<a href="http://doi.org/10.1002/jac5.1041" target="_blank" rel="noreferrer noopener">10.1002/jac5.1041</a>
International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.
Antibiotics; Outpatients; Risk Assessment; Methicillin Resistance; Inpatients; Clinical Trials; Practice Guidelines; Drug Resistance; Microbial; Nonexperimental Studies; Pneumonia – Drug Therapy; Community-Acquired Infections – Drug Therapy; Pneumonia – Etiology; Macrolide – Therapeutic Use; Streptococcal Infections – Drug Therapy; Community-Acquired Infections – Etiology; Immune System – Drug Effects; Macrolide – Pharmacodynamics
The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance.
File T M Jr; Tan J S
Drugs
2003
2003-01-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">10.2165/00003495-200363020-00005</a>
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Renal vascular disease: a look at two options that can preserve renal function.
Female; Male; Aged; Outpatients; Inpatients; Hypertension; Middle Age; Renal – Etiology; Renal Artery Obstruction – Surgery
Percutaneous transluminal angioplasty and renal artery bypass surgery are the most effective means of treating renal vascular disease and the hypertension it causes. Selection of the most appropriate treatment depends on the nature of the underlying stenotic lesion. This is readily determined from the patient's history, character of associated hypertension, physical and laboratory findings, and arteriography. Though specialists usually provide definitive therapy, primary care physicians must be prepared to explain the advantages and disadvantages of each kind of treatment.
Rutecki G W; Whittier F C
Consultant (00107069)
1994
1994-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Drug-induced acute renal failure: recognizing and treating prerenal, postrenal, and pseudorenal injury.
Female; Male; Aged; Risk Factors; Hemodynamics; Physical Examination; Inpatients; Middle Age; Kidney Function Tests; Kidney Failure; Nephrotoxicity; Antiinflammatory Agents; Acute – Etiology; Angiotensin-Converting Enzyme Inhibitors – Adverse Effects; Antineoplastic Agents – Adverse Effects; Non-Steroidal – Adverse Effects; Acute – Chemically Induced; Acute – Diagnosis; Acute – Therapy; Enzyme Inhibitors – Adverse Effects; Renal Circulation – Drug Effects
Angiotensin-converting enzyme (ACE) inhibitors and NSAIDs are among the drugs most commonly associated with acute renal failure (ARF). Patients at risk for ACE inhibitor-induced ARF include those with congestive heart failure (CHF) or compromised left ventricular (IV) function and those receiving diuretics. In these settings, discontinue the ACE inhibitor and direct therapy toward correcting volume or improving the ineffective circulation (by appropriately reducing afterload, by ensuring adequate IV filling pressures, and by treating ischemia). Risk factors for NSAID-included ARF include CHI, poor renal perfusion, and recent hospitalization. Postrenal ARF may be precipitated by drugs that are highly insoluble in addic urine, such as antineoplastic agents and HmG-CoA reductase inhibitors. Alkalinization of urine and hydration are the cornerstones of management of this type of ARF.
Frazee L A; Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Decision points in hypocalcemia: is emergent therapy required? Complications may include tetany, seizures, and arrhythmias.
Inpatients; Diagnosis; Laboratory; Hypocalcemia – Diagnosis; Hypocalcemia – Symptoms; Hypocalcemia – Therapy; Hypoparathyroidism – Complications; Magnesium – Administration and Dosage; Pancreatitis – Complications
When a patient's total serum calcium level drops below 8.9 mg/dL, first determine whether the hypocalcemia is real. Measure the serum level of ionized calcium or (because 40% of calcium is bound to protein) adjust the total serum calcium level for changes in serum protein concentrations. This helps determine whether the calcium imbalance is severe and whether emergent treatment (with infusions of elemental calcium) is required. Symptoms and signs of neuromuscular irritability, such as Chvostek's sign and Trousseau's sign, point to true hypocalcemia. Hypomagnesemia often accompanies–and even may cause–hypocalcemia; when the serum magnesium level falls below the normal limit, the ability of the parathyroid hormone to stimulate osteoclast growth and activity can be diminished.
Rutecki G W; Whittier F C
Journal of Critical Illness
1998
1998-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Acid-base interpretation: part 1: applying five rules in everyday cases.
Female; Male; Aged; Outpatients; Reference Values; Blood Gas Analysis; Inpatients; Middle Age; Cations; Anions; Acid-Base Imbalance – Diagnosis; Acidosis – Diagnosis; Alkalosis – Diagnosis; Acid-Base Equilibrium – Physiology; Carbon Dioxide – Analysis; Hydrogen-Ion Concentration – Evaluation
The interpretation of acid-base data can be greatly facilitated by applying five rules: (1) use the blood gas to identify acidemia or alkalemia, (2) determine whether the underlying cause of acidemia or alkalemia is respiratory or metabolic, (3) calculate the anion gap, (4) check for the degree of compensation, and (5) assess the relationship between anions (there should be a 1:1 relationship of acid to base). Alkalemia has an underlying respiratory cause if the partial pressure of carbon dioxide (PCO2) is substantially less than 40 min Hg. It has a metabolic cause if the bicarbonate content is greater than 25 mEq/L Acidemia has a respiratory cause if the PC02 is greater than 40/min Hg. It has a metabolic cause if the bicarbonate content is less than 25 mEq/L.Calculating the acidbase ratio may reveal a metabolic alkalosis not detected by rules 1 through 4.
Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. Health System.
Aged; United States; Outpatients; Emergency Medicine; Health Services Needs and Demand; Health Policy; Nursing Homes; Disaster Planning; Inpatients; Drugs; Health Care Delivery; Institute of Medicine (U.S.); Subacute Care; Prehospital Care; 80 and Over; Emergency Care – Trends – In Old Age; Emergency Service – Trends; Health Services for the Aged – Trends
Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
Wilber S T; Gerson L W; Terrell KM; Carpenter CR; Shah MN; Heard K; Hwang U
Academic Emergency Medicine
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.09.050" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.09.050</a>
Combination Therapy for Carbapenemase-Producing Klebsiella pneumoniae Bacteremia Reduces Mortality.
Time Factors; Mortality; Inpatients; Human; Multicenter Studies; Drug Resistance; Severity of Illness; Greece; Drug Combinations – Therapeutic Use; Confidence Intervals – Utilization; Carbapenems – Therapeutic Use; Enzymes – Adverse Effects; Klebsiella Infections – Drug Therapy; Medical Records – Utilization; Odds Ratio – Utilization; Retrospective Design – Utilization
Watkins Richard R
Infectious Disease Alert
2014
2014-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Hospital Wards with Higher Rates of Antibiotic Prescribing Are Associated with Increased Risk for C. difficile Infection.
Adult; Multivariate Analysis; Prospective Studies; Inpatients; Human; Retrospective Design; Physiologic; Monitoring; Record Review; Clostridium Difficile; Antibiotics – Therapeutic Use; Clostridium Infections – Epidemiology; Clostridium Infections – Risk Factors
Watkins Richard R
Infectious Disease Alert
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reported Beta-lactam Allergy Is Associated with More Adverse Events Among Inpatients.
Inpatients; Hypersensitivity; Adverse Drug Event; Centers for Disease Control and Prevention (U.S.); Adverse Health Care Event; Drug Reaction With Eosinophilia and System Symptoms Syndrome
Watkins Richard R
Hospital Medicine Alert
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cranberry Capsules Are Not Effective in Preventing Bacteriuria with Pyuria in Elderly Women in Nursing Homes.
Female; Aged; Hospitalization; Odds Ratio; Mortality; Drug Utilization; Confidence Intervals; Inpatients; Women's Health; Descriptive Statistics; Drug Resistance; Microbial; Treatment Outcomes; Randomized Controlled Trials; Double-Blind Studies; Fluid Intake; Gerontologic Care; Long Term Care; Nursing Home Patients; 80 and Over; Antibiotics – Therapeutic Use; Capsules – Administration and Dosage – In Old Age; Cranberry – Therapeutic Use – In Old Age; Plant Extracts – Therapeutic Use – In Old Age; Urinary Tract Infections – Prevention and Control – In Old Age
A randomized, double-blind, placebo-controlled trial found that giving cranberry capsules to elderly women residing in nursing homes did not result in any significant benefits, including no reduction in symptomatic urinary tract infections.
Watkins Richard R
Internal Medicine Alert
2016
2016-12-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.
Adult; Humans; Microbial Sensitivity Tests; Anti-Infective Agents/*therapeutic use; Outpatients; Practice Guidelines as Topic; Clinical Trials as Topic; Community-Acquired Infections/drug therapy/microbiology; Treatment Failure; Inpatients; Macrolides/pharmacology/*therapeutic use; Drug Resistance; Pneumonia; Bacterial; Bacterial/*drug therapy/microbiology; Adjuvants; Immunologic/pharmacology/therapeutic use
The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance.
File Thomas M Jr; Tan James S
Drugs
2003
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">10.2165/00003495-200363020-00005</a>
Patient Awareness and Expectations of Pharmacist Services During Hospital Stay.
*Anticipation; *Awareness; *Health Knowledge; 80 and over; Adolescent; Adult; Aged; Attitudes; Descriptive Statistics; Female; Health Services Accessibility; hospital; Hospital/methods/*statistics & numerical data; Human; Humans; Inpatients; Inpatients/*psychology; Male; marketing; Marketing/methods; Middle Aged; Patient Attitudes; patient awareness; Patient Education; patient expectations; Pharmacists/*statistics & numerical data; Pharmacy Service; pharmacy services; Practice; Pretest-Posttest Design; Professional Role; Professional-Patient Relations; Psychological; Social Marketing; Summated Rating Scaling; Surveys; Surveys and Questionnaires; United States; Young Adult
BACKGROUND: There are insufficient data in the United States regarding patient awareness and expectations of hospital pharmacist availability and services. OBJECTIVE: The objective of this research is to assess patient awareness and expectations of hospital pharmacist services and to determine whether a marketing campaign for pharmacist services increases patient awareness and expectations. METHODS: Eligible inpatients were surveyed before and after implementation of a hospital-wide pharmacist services marketing campaign (12 items; Likert scale of 1 [strongly disagree] to 4 [strongly agree]; maximum total score of 48) regarding awareness of pharmacist services. The primary outcome was the change in median total survey scores from baseline. Other outcomes included the frequency of patient requests for pharmacists. RESULTS: Similar numbers of patients completed the survey before and after the campaign (intervention, n = 140, vs control, n = 147). Awareness of pharmacist availability and services was increased (41 [interquartile ranges, IQRs: 36-46] vs 37 [IQR 31-43]; P \textless .001). Patients were 7 times more likely to request a pharmacist following the marketing campaign implementation. CONCLUSION: Awareness among inpatients of pharmacist services is low. Marketing pharmacist availability and services to patients in the hospital improves awareness and expectations for pharmacist-provided care and increases the frequency of patient-initiated interaction between pharmacists and patients. This could improve patient outcomes as pharmacists become more integrally involved in direct patient care.
King Philip K; Martin Steven J; Betka Eric M
Journal of pharmacy practice
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0897190016665541" target="_blank" rel="noreferrer noopener">10.1177/0897190016665541</a>
Outcomes of Patients With Syncope and Suspected Dementia.
80 and Over; Aged; Dementia – Diagnosis – In Old Age; Dementia – Risk Factors; Dementia – Therapy; Emergency; Human; Iatrogenic Disease; Inpatients; Interviews; Length of Stay; Middle Age; Office Visits; Outcome Assessment; Outcomes (Health Care); Patient Assessment; Patient Discharge; Physicians; Prospective Studies; Surveys; Syncope – Diagnosis; Syncope – In Old Age; Syncope – Mortality
OBJECTIVES: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
Holden Timothy R; Shah Manish N; Gibson Tommy A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/acem.13414" target="_blank" rel="noreferrer noopener">10.1111/acem.13414</a>