Internal and emergency medicine
-
Detection of pulmonary embolism (PE) is not uncommon in patients undergoing computed tomography (CT) for routine staging of malignancy. Several studies have been conducted in recent years to evaluate the impact of unsuspected pulmonary embolism (UPE) on the prognosis and management of cancer patients. We aimed at summarizing the available evidence, to improve the understanding of the frequency and clinical significance of UPE in terms of survival, recurrent venous thromboembolism (VTE) and major bleeding. ⋯ In conclusion, UPE represents a non-infrequent finding on CT scans ordered for reasons other than suspected PE and is a challenging clinical situation in the management of cancer patients. Even if UPE is generally milder in the short term, it may share a similar impact on survival and recurrent VTE, as compared to symptomatic PE. Large collaborative projects and, hopefully, interventional trials are needed to clarify the best management strategies.
-
Comparative Study
High-frequency transducers for point-of-care ultrasound applications: what is the optimal frequency range?
To compare images obtained using two linear transducers with a different range of frequencies, and to determine if there is a significant difference in the quality of images between the two transducers for medical decision-making. This was a single-blinded, cross-sectional study at an academic medical center. Twenty-five emergency medicine clinical scenarios with ultrasound images (using both 10-5 and 14-5 MHz transducers) covering a variety of point-of-care ultrasound applications were presented to four emergency physician sonographers. ⋯ The images obtained with a 14-5 MHz transducer were preferred over 10-5 MHz transducer in only 16 % (95 % CI 7.7-24.3 %) of the cases. The 14-5 MHz transducer has a slight advantage over 10-5 MHz transducer for ocular, upper airway, and musculoskeletal (tendon) ultrasound applications. A 10-5 MHz linear transducer is adequate to obtain images that can be used for medical decision-making for a variety of point-of-care ultrasound applications.
-
Comparative Study
Prognosis and health-related quality of life in elderly patients after a mild to moderate trauma.
The aims of this study were to compare outcome after a mild to moderate trauma in three subgroups of patients of increasing age (A1: <50, A2: 50-74, A3: >74 years) and to assess potential health-related quality of life (HRQOL) impairment. This is a follow-up study of a cohort of 418 trauma patients admitted to the High Dependency Unit of the Emergency Department of the University Hospital of Florence from July 2008 to February 2012. Six months after the event, a telephone interview using the Physical component summary (PCS) and Mental component summary (MCS) Health Composite Score (SF12) was conducted. ⋯ All subgroups showed a highly significant reduction in the scores' value due to the trauma. After the event, the proportion of patients with normal scores was significantly lower (all p < 0.0001, except for MCS score in A1 subgroup, who showed p = 0.013) within all subgroups. Elderly patients' prognosis was significantly worse compared with the younger counterpart; despite young patients' optimal outcome, HRQOL was uniformly reduced across all age groups.
-
Observational Study
Delirium in elderly patients hospitalized in internal medicine wards.
A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). ⋯ The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.
-
The aim of this study was to investigate influence of traditional cardiovascular risk factors (CVRF) and subclinical atherosclerosis (ATS) burden on early stages of abdominal aortic diameter (AAD) widening among adults. 2,052 consecutive patients (P) (39 % women), mean age 52 ± 13 years, were prospectively screened for CVRF, ATS, and AAD. B-mode ultrasound was used to evaluate the largest AAD and to detect carotid and femoral atherosclerotic plaques. Mean AAD was 15.2 ± 2.8 mm. ⋯ These factors did not account for more than 30 % of interaction (R² = 0.30, p = 0.001). Furthermore, despite a large proportion of patients with high number of CVRF, and subclinical ATS, rate of patients with AAD ≥25 mm was low (1 %) and scattered regardless their CHD risk score or ATS burden. In conclusion, these results suggest that although some traditional CVRF and presence of ATS are associated with early stages of EAAD, other determinants still need to be identified for a better understanding of abdominal aortic aneurysm pathogenesis.