WMJ : official publication of the State Medical Society of Wisconsin
-
Review of existing evidence supports that percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in patients with acute myocardial infarction. If, however, a dedicated intervention team is not available onsite, transfer to another facility should be considered if reperfusion could be achieved within 90 minutes. ⋯ The value of administering full or modified dose thrombolytic therapy and then transferring for immediate PCI has not been demonstrated yet. Development of dedicated protocols for management of ST-elevation myocardial infarction developed by a community-based emergency medical service, emergency department, and cardiovascular service is highly recommended.
-
The implementation of guidelines for treatment of Community-Acquired Pneumonia (CAP) has been proposed as a quality improvement and cost-saving strategy, though the effectiveness of several recommendations has yet to be confirmed through clinical trials. We sought to analyze the development and implementation of guidelines at our hospital, and to identify particular successes and impediments. ⋯ Our implementation of CAP guidelines was challenging but overall instructive and contributory to patient care. We review further areas for improvement.
-
Neonatal mortality has been perceived as one of the critical and sensitive measures that reflect not only the heath status of infants and their mothers, but also the general well-being of a society. However, our knowledge of racial disparities in neonatal mortality associated with low birth weight and short gestation is relatively limited. As part of continuing statewide efforts to achieve better birth outcomes, this study intends to develop a better understanding of potential mechanisms contributing to the discrepancy in neonatal mortality rates (NMR) to help public health practitioners formulate more effective interventions to prevent unnecessary infant deaths. ⋯ Wisconsin infant mortality rates are largely driven by neonatal deaths. This shows an urgent need to develop effective public health interventions to prevent early neonatal deaths. To reduce racial/ethnic disparities in NMRs, the design of the interventions should also take into account the variation of the effects of birth weight and gestation age on neonatal mortality among racial/ethnic groups. It is hoped the result of this study will provide a critical understanding: when it comes to racial/ethnic disparities, there is far more to low birth weight or short gestational age than simply not having enough weight or days.
-
Low back pain is estimated to affect 80% of the general population at least once in their lifetime. It is the fifth leading cause of medical clinic visits and the leading work-related disability. Lumbar discography has been used to diagnose the source of low back pain when non-invasive imaging, such as magnetic resonance (MR), does not reveal morphologic abnormality consistent with symptoms. ⋯ These causes of positive pain provocation are not amendable to invasive treatment. In these cases, an invasive diagnostic procedure to identify problems best treated with conservative management is not practical. The conclusion of this review found no clear evidence-based purpose for discography in the diagnosis and treatment of low back pain.