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Hospital Practice (Minneapolis)

Amar Salam, Kadhim Sulaiman, Ibrahim Al-Zakwani, Alawi Alsheikh-Ali, Mohammed Aljaraallah, Husam Al Faleh, Abdelfatah Elasfar, Prasanth Panduranga, Rajvir Singh, Charbel Abi Khalil, Jassim Al Suwaidi
OBJECTIVES: The purpose of this study was to report prevalence, clinical characteristics, precipitating factors, management and outcome of patients with coronary artery disease (CAD) among patients hospitalized with heart failure (HF) in seven Middle Eastern countries and compare them to non-CAD patients. METHODS: Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute HF during February-November 2012 in 7 Middle Eastern countries...
October 13, 2016: Hospital Practice (Minneapolis)
Rana Khazar Al-Zoubi, Mouhanna Abu Ghanimeh, Ashraf Gohar, Gary A Salzman, Osama Yousef
Hepatic Hydrothorax (HH) is defined as a pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. It is an uncommon complication of cirrhosis, most frequently seen in association with decompensated liver disease. The development of HH remains incompletely understood and involves a complex pathophysiological process with the most acceptable explanation being the passage of the ascetic fluid through small diaphragmatic defects. Given the limited capacity of the pleural space, even the modest pleural effusion can result in significant respiratory symptoms...
August 31, 2016: Hospital Practice (Minneapolis)
Stephanie Law, Praneel Kumar, Sharon Woods, Krishna B Sriram
OBJECTIVES: There is a paucity of information on the prevalence and clinical implications of malnutrition in patients hospitalised for management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to fill this gap in knowledge. METHODS: We performed a retrospective observational cohort study of 100 hospitalised AECOPD patients. The Malnutrition Screening Tool (MST) was used to identify patients at risk of malnutrition (MST ≥2)...
August 25, 2016: Hospital Practice (Minneapolis)
Sebastiano Mercadante, Giovanna Prestia, Alessandra Casuccio
OBJECTIVES: To assess the nurses' performance in assessing, treating, and documenting breakthrough pain (BTP) in a palliative care unit where traditionally there is continuous training. METHODS: The study was performed in an acute palliative care unit. Once a week, a research nurse examined the documentation regarding all the episodes of BTP registered in a specific pain chart, designed by the institutional nurse board, as part of the routine nurse activity. RESULTS: The charts of 50 consecutive eligible patients (32 M/18 F), were analysed...
August 2, 2016: Hospital Practice (Minneapolis)
Yaasir Mamoojee, Rasha Mukhtar
Currently available guidelines in the acute management of severely symptomatic hypotonic hyponatremia vary in their approach to the use of hypertonic saline. In the acute setting, deciding on when to implement available treatment algorithm using hypertonic saline may be difficult, given that the duration of hyponatremia and potential alternative diagnoses presenting with similar symptoms may be hard to establish promptly. We present the case of a young female with symptomatic profound hyponatremia who subsequently developed osmotic demyelination syndrome due to rapid overcorrection of serum sodium concentration...
October 2016: Hospital Practice (Minneapolis)
John A Bosso, Anthony M Casapao, Jonathan Edwards, Kenneth Klinker, Christopher McCoy, David P Nicolau, Katherine K Perez, Andrew Marcarelli, Deeksha Dua
This article was written with the aim to establish a consensus clinical pathway for long-acting lipoglycopeptide antibiotics such as oritavancin (Orbactiv®) and dalbavancin (Dalvance®) for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Seven infectious diseases pharmacy specialists from a variety of facilities across the United States (US) participated in a roundtable discussion to consider the use of newer single-dose long-acting lipoglycopeptides, and integrate them into clinical pathways for ABSSSI...
October 2016: Hospital Practice (Minneapolis)
Victor F Tapson
Pulmonary embolism (PE) is a leading cause of mortality worldwide. Recognizing PE and administering anticoagulants can significantly improve patient outcomes by reducing mortality rates and preventing recurrent events. For more than 50 years, standard therapy has involved parenteral anticoagulation followed by long-term therapy with the vitamin K antagonist warfarin. However, management of warfarin therapy is challenging due to its narrow therapeutic range and interactions with genetic and environmental factors...
August 2016: Hospital Practice (Minneapolis)
Sheeva K Parbhu, Douglas G Adler
Pancreatic neuroendocrine tumors (PNETs) are neoplasms that arise from the hormone producing cells of the islets of Langerhans, also known as pancreatic islet cells. PNETs are considered a subgroup of neuroendocrine tumors, and have unique biology, natural history and clinical management. These tumors are classified as 'functional' or 'non-functional' depending on whether they release peptide hormones that produce specific hormone- related symptoms, usually in established patterns based on tumor subtype. This manuscript will review pancreatic neuroendocrine tumor subtypes, syndromes, diagnosis, and clinical management...
August 2016: Hospital Practice (Minneapolis)
Karna K Sundsted, Arya B Mohabbat, Dennis W Regan, Bradley R Salonen, Paul R Daniels, Karen F Mauck
Evidence in perioperative medicine is published in a wide variety of journals, given the multidisciplinary nature of its practice which spans medicine and its subspecialties, as well as surgery and anesthesiology. It can be difficult to identify new and important evidence, as perioperative practice continues to evolve in multiple areas such as medication management, anticoagulation and cardiac risk stratification, among others. New, high-quality evidence is published each year, and must be placed into the context of not only existing literature, but also practical real-world patient care...
August 2016: Hospital Practice (Minneapolis)
Babar Bashir, Doron Schneider, Mary C Naglak, Thomas M Churilla, Marguerite Adelsberger
OBJECTIVES: Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate...
August 2016: Hospital Practice (Minneapolis)
Jeffrey Chen, Roger D Smalligan, Suhasini Nadesan
INTRODUCTION: Colorectal cancer is the third most common cancer in the United States. The use of bevacizumab (Avastin), a vascular endothelial growth factor (VEGF) inhibitor, has been increasing due to observed improvement in metastatic colon cancer survival, but so has the incidence of bowel perforation. We present one unusual complication of bowel perforation, a colovesical fistula in a colorectal cancer patient treated with bevacizumab. CASE PRESENTATION: A 54-year-old white male diagnosed with Stage IV colorectal cancer was treated with folinic acid, leucovorin, fluorouracil, oxaliplatin (FOLFOX) and bevacizumab...
August 2016: Hospital Practice (Minneapolis)
Wing W Chan, Katherine Waltman Johnson, Howard S Friedman, Prakash Navaratnam
OBJECTIVES: Myocardial injury, worsening renal function, and hepatic impairment are independent risk factors for poor patient acute heart failure (AHF) outcomes. Biomarkers of organ damage may be useful in identifying patients at risk for poor outcomes. The objective of this analysis was to assess the relationship between abnormal AHF biomarkers and outcomes in AHF patients. METHODS: AHF admissions (N = 104,794) data from the Cerner Health Facts® inpatient database were analyzed retrospectively...
August 2016: Hospital Practice (Minneapolis)
Craig I Coleman, W Frank Peacock, Erin R Weeda, Veronica Ashton, Gregory J Fermann
OBJECTIVES: To characterize hospital variation in use of observation stays to manage pulmonary embolism (PE) and its association with subsequent outcomes. METHODS: We performed a cross-sectional study of hospitals reporting ≥75 PE encounters (emergency department, observation stay or inpatient admission) using Premier data from 11/2012-3/2015. We included hospital encounters for adults with a primary diagnosis of PE (415.1x), ≥1 diagnostic test claim for PE on day 0-2 and evidence of PE treatment...
August 2016: Hospital Practice (Minneapolis)
Satar Rezaei, Ali Akbari Sari, Mohammad Arab, Reza Majdzadeh, Faramarz Shaahmadi, Asghar Mohammadpoorasl
OBJECTIVES: Smoking is recognized as one of the main preventable causes of mortality and morbidity that imposes a high financial burden on healthcare systems and society. This study aimed to examine the association between smoking status and hospital length of stay (LOS) among patients with lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischemic heart diseases (IHD) in Iran in 2014. METHODS: A total of 1271 patients (415 LC patients, 427 COPD patients and 429 IHD patients) were included in the study...
August 2016: Hospital Practice (Minneapolis)
Bernardo J Selim, Kannan Ramar, Salim Surani
The steady growing prevalence of critically ill obese patients is posing diagnostic and management challenges across medical and surgical intensive care units. The impact of obesity in the critically ill patients may vary by type of critical illness, obesity severity (obesity distribution) and obesity-associated co-morbidities. Based on pathophysiological changes associated with obesity, predominately in pulmonary reserve and cardiac function, critically ill obese patients may be at higher risk for acute cardiovascular, pulmonary and renal complications in comparison to non-obese patients...
August 2016: Hospital Practice (Minneapolis)
Antony G Kaliyadan, Michael P Savage, Nicholas Ruggiero, David L Fischman
Over 780,000 patients in the United States are diagnosed with an acute coronary syndrome (ACS) each year. As physicians, it is our responsibility to provide prompt workup, diagnosis and management of these patients. After identification of the patient with ACS and confirming there is not ST-segment elevation MI requiring immediate revascularization, physicians should pursue a work-up for non-ST-elevation acute coronary syndrome (NSTE-ACS). It is important to understand the latest best practice guidelines in the treatment and management of patients with NSTE-ACS who carry high rates of in-hospital mortality...
August 2016: Hospital Practice (Minneapolis)
Andrew Brendan Harrison, Michael Sumner, Jeffrey Sobecki, Gregory Christiansen
Compartment syndrome presents with a slow onset of pain. Anything that causes an increased intra-compartmental pressure can lead to surgical emergency. A 45-year-old male presents to the emergency department with prolonged syncope. The patient is unable to recall the previous night except for using oxycodone. Patient medical history is significant for ischemic cardiomyopathy and myocardial infarction. Physical exam showed left arm pain and swelling, decreased sensation to light touch, and decreased range of motion...
July 22, 2016: Hospital Practice (Minneapolis)
Vicente Cés Souza-Dantas, Pedro Póvoa, Fernando Bozza, Marcio Soares, Jorge Salluh
Delirium is the most frequent and severe clinical presentation of brain dysfunction in critically ill septic patients with an incidence ranging from 9% to 71%. Delirium represents a significant burden for patients and relatives, as well as to the health care system, resulting in higher costs, long-term cognitive impairment and significant risk of death after 6 months. Current interventions for the prevention of delirium typically involve early recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predisposes the individual to delirium...
June 3, 2016: Hospital Practice (Minneapolis)
Lokesh Shahani, Rabih O Darouiche
OBJECTIVES: Clinical outcomes in patients with negative peripheral and positive central blood culture with coagulase negative staphylococci (CoNS) based on different treatment approach such as intravenous antibiotics, removal of CVC, combined approach or just observation are not known. METHODS: We conducted a retrospective review of patients with negative peripheral and paired positive central blood culture with CoNS admitted at our affiliated hospital between 2008 to 2013...
April 28, 2016: Hospital Practice (Minneapolis)
Peter J Barbour, Jill Arroyo, Star High, Lisa B Fichera, Marie M Staska-Pier, Mary Kay McMahon
OBJECTIVES: We set out to demonstrate the benefits of providing long-term care via telehealth for patients with Parkinson's disease living in continuous care facilities. METHODS: A cohort of 16 patients with Parkinson's disease residing at one of 2 locations of a multi-facility continuous care retirement organization were seen virtually in follow-up over a 3-year period by Telehealth Services at a large, academic, tertiary care hospital in southeastern Pennsylvania...
2016: Hospital Practice (Minneapolis)
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