Medicine
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Observational Study
The importance of infectious disease specialists consulting on a weekly basis in a Japanese tertiary care hospital: A retrospective observational study.
Limited data are available regarding part-time infectious disease consultations (IDCs) and their importance in tertiary care teaching hospitals in Japan. This is a retrospective review of IDCs from June 2016 to March 2021 and describes IDC services provided by part-time infectious disease specialists once a week for 4 hours, and their impact on the quality of medical care, including antimicrobial stewardship. Data, such as the requesting department, requesting reasons, and final diagnoses, were analyzed. ⋯ DOT/1000 patient-days were reduced for meropenem and cefepime, while it increased for tazobactam/piperacillin. The DOT/1000 patient-days for the 3-antipseudomonal agents significantly decreased during this period. After implementing the QI tetanus vaccination project in the Emergency Room, the number of tetanus toxoid vaccinations per month increased.
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The apolipoprotein B (Apo B), Apo B/A1 ratio, lipoprotein (a), and low-density lipoprotein cholesterol (LDL-C)/Apo B ratio are associated with coronary artery disease (CAD). However, the association between these parameters and CAD in non-diabetic patients without high LDL-C levels is unclear. Our goal was to assess which parameter was most strongly associated with CAD in non-diabetic patients without high LDL-C levels. ⋯ The LDL-C/Apo B ratio was significant for the incidence of revascularization in multivariate analysis after adjustment for standard risk factors. The degree of coronary calcification and plaque burden according to the tertile of LDL-C/Apo B showed significant differences between the groups. Our data indicate that LDL-C/Apo B ratio is the most predictive parameter for coronary atherosclerosis in non-diabetic patients without high LDL-C levels.
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Aspiration pneumonia is a major, potentially fatal complication after ischemic stroke. Decreased coughing function is a significant risk factor for aspiration in ischemic stroke survivors. Peak cough flow (PCF) is a useful tool for assessing cough function. ⋯ Moreover, serum vitamin D levels were shown to be a significant predictor of PCF parameters. Serum vitamin D levels were related to PCF parameters in patients with ischemic stroke. In addition, serum vitamin D level may serve as a predictor of coughing function in patients with ischemic stroke.
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Observational Study
The cutoff value of presepsin for diagnosing sepsis increases with kidney dysfunction, a cross-sectional observational study.
As presepsin levels increase with kidney dysfunction (KD), our aim was to establish cutoff points for presepsin adapted to the level of KD in order to avoid bacterial infection overdiagnosis, antibiotic overprescription, and risk of bacterial resistance. This is a unicenter retrospective study, which included all patients admitted on an emergency basis to 2 departments of a teaching hospital during a 2-year interval to whom presepsin level was determined at the emergency department prior to admission. Serum creatinine (sCrt) was employed to estimate the severity of KD using 3 thresholds (1.5, 2, and 4 mg/dL) resulting in 4 degrees of severity: KD_1, KD_2, KD_3, KD_4. ⋯ The threshold for abnormal presepsin should be about 600, 1000, and 1300 pg/mL in patients with KD_1, KD_2, and KD_3, respectively. In patients with KD_4, presepsin has a poor discriminating power for sepsis diagnosis. If, notwithstanding, it is used for this purpose, the cutoff point should be at least at 2200.
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Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the institution type providing care. This review aimed to address this knowledge gap by reviewing the available evidence examining patient-reported outcomes of LF in non-metropolitan centers. ⋯ Current evidence suggests that patient-reported outcomes are favorable for patients undergoing LF in community settings, and are broadly comparable to those undergoing LF in tertiary-level centers.