Hospital practice (1995)
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Hospital practice (1995) · Aug 2016
ReviewAn update on management of the patient presenting with non-ST-elevation acute coronary syndromes.
Over 780,000 patients in the United States are diagnosed with an acute coronary syndrome (ACS) each year. As physicians, it is our responsibility to provide prompt workup, diagnosis and management of these patients. After identification of the patient with ACS and confirming there is not ST-segment elevation MI requiring immediate revascularization, physicians should pursue a work-up for non-ST-elevation acute coronary syndrome (NSTE-ACS). ⋯ Physicians must integrate the clinical history and examination, electrocardiogram and laboratory findings in order to properly diagnose an NSTE-ACS. Early treatment with guideline directed medical therapy is imperative even in the setting of an early invasive strategy with cardiac catheterization and percutaneous coronary intervention. The focus of this review is to discuss the appropriate strategies for evaluation and management of patients with NSTE-ACS based on the most recent ACC/AHA practice guidelines.
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Hospital practice (1995) · Aug 2016
Evaluation of prediction strategy and care coordination for COPD readmissions.
Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate. ⋯ Factors influencing COPD readmissions are complex and poorly understood. LACE index did not predict 30-days all-cause COPD readmissions. Posthospital care coordination for transition of care from hospital to the community showed a 4.3% reduction in the 30-days all-cause readmission rate which did not reach statistical significance (p = 0.62).
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Hospital practice (1995) · Aug 2016
Association between cardiac, renal, and hepatic biomarkers and outcomes in patients with acute heart failure.
Myocardial injury, worsening renal function, and hepatic impairment are independent risk factors for poor patient acute heart failure (AHF) outcomes. Biomarkers of organ damage may be useful in identifying patients at risk for poor outcomes. The objective of this analysis was to assess the relationship between abnormal AHF biomarkers and outcomes in AHF patients. ⋯ Renal function measures were associated with outcomes in patients hospitalized for AHF. Increased vigilance of renal biomarkers may be warranted to assess risk and promote proactive clinical management to improve outcomes.
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Hospital practice (1995) · Aug 2016
Case ReportsWhen a good call leads to a bad connection: colovesical fistula in colorectal cancer treated with bevacizumab.
Colorectal cancer is the third most common cancer in the United States. The use of bevacizumab (Avastin), a vascular endothelial growth factor (VEGF) inhibitor, has been increasing due to observed improvement in metastatic colon cancer survival, but so has the incidence of bowel perforation. We present one unusual complication of bowel perforation, a colovesical fistula in a colorectal cancer patient treated with bevacizumab. ⋯ Hospitalists encounter patients with colorectal cancer on a regular basis, so clinicians must be aware of the uncommon but potentially serious side effect of bowel perforation when bevacizumab is used. This case has illustrated an even more rare complication, the formation of a colovesical fistula that was treated with laparoscopic surgical intervention with a diverting colostomy.
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Hospital practice (1995) · Jan 2016
ReviewRole of extracorporeal membrane oxygenation in adult respiratory failure: an overview.
Extracorporeal membrane oxygenation (ECMO) provides complete or partial support of the heart and lungs. Ever since its inception in the 1960s, it has been used across all age groups in the management of refractory respiratory failure and cardiogenic shock. While it has gained widespread acceptance in the neonatal and pediatric physician community, ECMO remains a controversial therapy for Acute Respiratory Distress Syndrome (ARDS) in adults. ⋯ However, the lack of rigorous clinical data has prevented ECMO from becoming the standard of care in the management of ARDS. Therefore, the results of two large ongoing randomized trials, which will hopefully throw more light on the role of ECMO in the management of this disease entity, are keenly awaited. In this article we will provide a basic overview of the development of ECMO, the types of ECMO, the pathogenesis of ARDS, different ventilation strategies for ARDS, the role of ECMO in ARDS and the role of ECMO as a bridge to lung transplantation.