Arch Intern Med
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Multicenter Study
Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea.
Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP concentrations has been described. ⋯ In patients with and without acute heart failure, the NT-proBNP concentrations are relatively lower in overweight and obese patients with acute dyspnea. Despite this, the NT-proBNP concentration retains its diagnostic and prognostic capacity across all BMI categories.
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Rapid influenza testing decreases antibiotic and ancillary test use in febrile children, yet its effect on the care of hospitalized adults is unexplored. We compared the clinical management of patients with influenza whose rapid antigen test result was positive (Ag+) with the management of those whose rapid antigen test result was negative or the test was not performed (Ag0). ⋯ Rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.
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Diagnostic errors are the leading basis for malpractice claims in primary care, yet these errors are underidentified and understudied. Computerized methods used to screen for other types of errors (eg, medication related) have not been applied to diagnostic errors. Our objectives were to assess the feasibility of computerized screening to identify diagnostic errors in primary care and to categorize diagnostic breakdowns using a recently published taxonomy. ⋯ Electronic screening has potential to identify records that may contain diagnostic errors in primary care, and its performance is comparable to screening tools for other types of errors. Future studies that validate these findings in other settings could provide improvement initiatives in this area.
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The relationship between marijuana smoking and pulmonary function or respiratory complications is poorly understood; therefore, we conducted a systematic review of the impact of marijuana smoking on pulmonary function and respiratory complications. ⋯ Short-term exposure to marijuana is associated with bronchodilation. Physiologic data were inconclusive regarding an association between long-term marijuana smoking and airflow obstruction measures. Long-term marijuana smoking is associated with increased respiratory symptoms suggestive of obstructive lung disease.