Internal and emergency medicine
-
Randomized Controlled Trial
Short and long-term effects of continuous versus intermittent loop diuretics treatment in acute heart failure with renal dysfunction.
Intravenous loop diuretics are still the cornerstone of therapy in acute decompensated heart failure, however, the optimal dosage and administration strategies remain poorly defined particularly in patients with an associated renal dysfunction. This is a single-center, pilot, randomized trial involving patients with acute HF and renal dysfunction. Patients were assigned to receive continuous furosemide infusion (cIV) or bolus injections of furosemide (iIV). ⋯ A significant increase of in-hospital additional treatment as well as length of hospitalization was observed in cIV. Finally, cIV revealed a higher rate of adverse events during the follow-up period (p < 0.03). cIV appears to provide a more efficient diuresis and BNP level reduction during hospitalization, however, it was associated with increased rate of worsening renal function during hospitalization. cIV also appears related to a longer hospitalization and an increased number of adverse events during follow-up. For all of these reasons, a larger multi-center study is required to determine whether high-dose diuretics are responsible for worsening renal function and to define the best modality of administration.
-
Non-invasive hemoglobin measuring technology has potential for rapid, portable, and accurate way of providing identification of blood loss or anemia. Our objective is to determine if this technology is reliable in critically ill patients presenting to the Emergency Department. Prospective cross-sectional observational study was done at an urban level-one trauma center, 135 subjects were conveniently sampled, suspected of having active bleeding, sepsis, or other critically ill condition. ⋯ Univariate analysis shows none of the observed factors is associated with the difference values between the device Hb and laboratory Hb. Our results show that Radical-7 and Rad-57 devices do not report readings in 29% of patients and accuracy is significantly lower than reported by the manufacturer with over 50% of readings falling outside of ± 1 g/dL. We determined that none of the several potential factors examined are associated with the degree of device accuracy.
-
In Italy, emergency department (ED) triage is a complex and delicate interface in which different emergency healthcare providers interact: physicians, nurses, and pre-hospital rescuers. There are significant differences in the communication, training, and abilities of these providers. Communication failures during the pre-hospital/hospital interface have been identified as a major preventable cause of patient harm. ⋯ Currently, ED personnel receive poor verbal information from pre-hospital providers. The general habit of pre-hospital providers is to give different written reports to the triage nurses without a true shared transfer of responsibility. This lack of standardization in communication presumably has an adverse impact upon patient care.
-
Contrasting evidence shows a possible association between serum uric acid (SUA) and cognitive function in elderly subjects. We aimed at evaluating the impact of circulating SUA levels on cognitive function in a cohort of pharmacologically untreated young elderly subjects. For this study, we selected 288 healthy young elderly participants from the historical cohort of the Brisighella Heart Study (M: 108, F: 180; mean age: 69 ± 6 years old). ⋯ In the multiple regression analysis, the only factors associated with the MMSE score were: age (B = -0.058, 95% CI -0.108, -0.009, p = 0.022), LDL-C (B = -0.639, 95% CI -0.912, -0.411, p = 0.034) and SUA (B = -0.527, 95% CI -0.709, -0.344, p = 0.022). Repeating the analysis by low or high SUA level (based on the gender specific SUA distribution 50th percentile), it appears that in subjects with a low SUA, cognitive decline is only associated with age, while in those with high SUA it is associated with LDL-C (OR 1.18, 95% CI 1.07-1.33, p = 0.019) and SBP (OR 1.02, 95% CI 1.001-1.048, p = 0.039). Our data demonstrate a positive association between circulating levels of uric acid and cognitive dysfunction in a sample of pharmacologically untreated young elderly subjects.
-
The importance of focused cardiac ultrasound (FCU) in Internal Medicine care has been recognized by the American Society of Echocardiography. The aim of this study was to test what realistic skill targets could be achieved in FCU, with a relatively short training (theoretical and practical) of 9 h offered to Internal Medicine certification board attending students, and if the addition of further 9 h of training could significantly improve the level of competence. ⋯ As concerns the interpretative skills, only pericardial effusion and visual estimation of global systolic function could be correctly identified, while ventricular enlargement and IVC prove to be more difficult to evaluate. This study supports incorporating FCU into Internal Medicine fellowship training programs, and should facilitate the design of other similar training courses.