Hospital practice (1995)
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Hospital practice (1995) · Dec 2009
ReviewCommon procedures in internal medicine: improving knowledge and minimizing complications.
Internal medicine physicians have long been trained with the skills, knowledge, and attitudes to become proficient at certain medical procedures. Specifically, the lumbar puncture, paracentesis, thoracentesis, and central venous catheter placement are common medical procedures encountered during residency. ⋯ In private practice many internists care for patients requiring these procedures. This review will summarize basic steps followed in these 4 medical procedures and highlight methods to minimize associated complications.
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Hospital practice (1995) · Dec 2009
Comparative StudyDo faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU?
Intensivists have been associated with decreased mortality in several studies, but in one major study, centers with intensivist-staffed units reported increased mortality compared with controls. We hypothesized that a closed unit, in which a unit-based intensivist directly provides and coordinates care on all cases, has improved mortality and utilization compared with an open unit, in which individual attendings and consultants provide care, while intensivists serve as supervising consultants. ⋯ We observed significant reductions in mortality and hospital LOS for patients initially admitted to a closed ICU versus an open unit. We did not observe a significant difference in ICU LOS or total cost after adjustment for severity.
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Hospital practice (1995) · Dec 2009
Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes.
Although hospital-acquired hyponatremia is well described, severe community-acquired hyponatremia has been studied less extensively. ⋯ Patients treated with thiazide or indapamide (particularly elderly women) may benefit from monitoring of serum sodium levels. Inappropriately rapid serum sodium correction is associated with osmotic demyelination, particularly in patients with risk factors for this condition. In contrast to what has been reported for hyponatremia in hospitalized patients, severity of hyponatremia on admission did not predict increased mortality in our patient population.
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Over 2.5 million accidental and intentional drug-related poisonings are reported annually in the United States. Early diagnosis and management of patients who present with acute intoxication can significantly reduce both morbidity and mortality. The initial evaluation of patients with suspected or proven intoxications should focus on hemodynamic stability, mental status, and respiratory function. ⋯ Important historical clues are often found in a social history that considers intravenous drug use, alcohol use, and any access or exposure to illicit substances. A patient's medication list should also be scrutinized for psychoactive or sedative medications, such as tricyclic antidepressants or opioids. In this article we present case-based discussions of the specific diagnosis and management of 5 commonly occurring acute intoxication syndromes.
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Hospital practice (1995) · Dec 2009
Application of a prediction rule to discriminate between aseptic and bacterial meningitis in adults.
Differentiating between aseptic and bacterial meningitis presents a difficult diagnostic challenge. Accurately ruling out bacterial meningitis may reduce unnecessary hospitalization, patient morbidity, and utilization of resources. This study applies a prediction rule previously developed in the pediatric population to an adult cohort. ⋯ The prediction rule, previously validated in a pediatric population, was accurate in ruling out bacterial meningitis in an adult cohort. Prospective validation in an adult population is warranted.