Boletín de la Asociación Médica de Puerto Rico
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Observational Study
Manatí Medical Center Sepsis Management Epidemiological Study.
Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving Sepsis Campaign" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. ⋯ Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.
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Randomized Controlled Trial Comparative Study
Does Injection Site Matter? A Randomized Controlled Trial to Evaluate Different Entry Site Efficacy of Knee Intra-articular Injections.
Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular injections of corticosteroids (IACS) have been considered as an option for disease progression modification, pain control, and improvement of function. However, some studies have suggested poor accuracy rates of IA injections depending on the entry site chosen. It is therefore the aim of this study to evaluate the efficacy of IA knee corticosteroid injection in reducing pain and improving function in patients with early osteoarthritis and whether the low accuracy rates reported with the Anterolateral joint line injection site translate to worse functional and pain outcome measures as compared to Suprapatellar lateral injections. ⋯ We have therefore continued the use of palpation-guided intra-articular knee injections in an effort to reduce costs as compared to other injection modalities with positive results in our osteoarthritis patients.
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Although many institutions in the United States have incorporated palliative care practices in their emergency departments, very little has occurred in Puerto Rico. Information regarding palliative care training of emergency medicine physicians in Puerto Rico is unclear and most physicians have poor or no access to palliative care services for their patients. This study explores the perceptions and barriers encountered by practicing emergency physicians in providing palliative care in Puerto Rican Emergency Departments. ⋯ Despite recognizing palliative care as an important competence, emergency physicians in Puerto Rico reported insufficiencies in training, decreased level of comfort, and lack of access to specialists in palliative care. Efforts to enhance physician training and provide palliative care resources must be pursued in order to improve the quality of care given to patients visiting Puerto Rican Emergency departments.
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There are 1.7 million sepsis-related hospitalizations each year making it the sixth most common cause for hospitalization in the United States. Not only are this hospitalizations common, they are expensive to our medical system with $15.3 billion spent yearly (3) and hospitalizations lasting 75% longer than for other conditions. In 2001, Rivers et al published in the NEJM the results of his study "Early Goal Directed Therapy (EGDT) in The Treatment of Severe Sepsis and Septic Shock". ⋯ In a study performed in PR by Fernandez et al. in 2006, only an alarming 31.4% of doctors from different specialties correctly identified SIRS criteria. Our goal is to educate physicians about the importance of early identification and treatment of the septic patient. A campaign to increase awareness and improve care is essential and we propose treatment protocols for our Puerto Rican hospitals to help reduce morbidity, mortality, length of stay and costs.