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Patient-Centered Care in Acute Cardiovascular Disease
Abstract The need for increased focus on patient-centered care delivery approaches has been highlighted by numerous national organizations and health policy established over the past few years. Shared decision-making (SDM) is an approach to engaging patients in decision-making that involves the exchange of information between two or more parties, one of which must be the patient, and results in reaching a final decision by consensus. Limited studies have shown feasibility and efficacy of implementing SDM strategies within the emergency department to facilitate translation of scientific evidence to practic...
Source: Current Emergency and Hospital Medicine Reports - December 12, 2014 Category: Emergency Medicine Source Type: research

Current Diagnostic and Therapeutic Strategies in Microvascular Angina
Abstract Microvascular angina is common among patients with signs and symptoms of acute coronary syndrome and is associated with an increased risk of cardiovascular and cerebrovascular events. Unfortunately, microvascular is often under-recognized in clinical settings. The diagnosis of microvascular angina relies on assessment of the functional status of the coronary microvasculature. Invasive strategies include acetylcholine provocation, intracoronary Doppler ultrasound, and intracoronary thermodilution; noninvasive strategies include cardiac positron emission tomography, cardiac magnetic resonance, and ...
Source: Current Emergency and Hospital Medicine Reports - December 11, 2014 Category: Emergency Medicine Source Type: research

Contact Precautions for Methicillin-Resistant Staphylococcus aureus : Are They Still Valuable?
Abstract Guidelines from the US Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee recommend the use of contact precautions to prevent the transmission of methicillin-resistant Staphylococcus aureus in acute-care facilities. The merits of these recommendations are debated because it is not clear that contact precautions are essential for the control of this drug-resistant bacterium. Also, contact precautions are resource-intensive and may be detrimental to patient well-being. Recent studies have demonstrated that horizontal measures, such as impr...
Source: Current Emergency and Hospital Medicine Reports - November 4, 2014 Category: Emergency Medicine Source Type: research

Prothrombin Complex Concentrate (4PCC): A Review of its Use in Reversal of Vitamin K Antagonists
Abstract Bleeding continues to be a major adverse drug event associated with warfarin anticoagulation. The cornerstone of warfarin-related bleeding management involves repletion of affected plasma coagulation factor levels. Prothrombin complex concentrate (human) is a 4-factor prothrombin complex concentrate that contains vitamin K-dependent coagulation factors II, VII, IX, and X and anticoagulant proteins C and S. It recently received Food and Drug Administration approval for warfarin reversal for patients with major bleeding or requiring urgent surgery or other invasive procedures. Its role in reversing...
Source: Current Emergency and Hospital Medicine Reports - October 18, 2014 Category: Emergency Medicine Source Type: research

Legionella Pneumonia: When to Suspect, Diagnostic Considerations, and Treatment Strategies for Hospital-Based Clinicians
This article reviews the epidemiology and clinical manifestations of Legionnaires’ disease and updates the latest information on diagnostic approaches and treatment strategies for hospital-based clinicians and emergency department physicians alike. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - October 9, 2014 Category: Emergency Medicine Source Type: research

Dalbavancin: Roles for Once-Weekly Antibiotics in Difficult to Treat Gram-Positive Infections
Abstract Skin and soft-tissue infections (SSTI) are on the rise, accounting for nearly 3.5 million ED visits in 2010. In a world with a rising prevalence of multi-drug resistance organisms it has become imperative to create novel antibiotics for the 21st century. A new once-weekly antibiotic, Dalbavancin (Durata Therapeutics, INC), has shown great promise and was recently approved by the FDA for patients with SSTI cause by gram-positive microorganisms, including MRSA. Dalbavancin has been shown to have equal efficacy for SSTI caused by gram-positive infections when compared to vancomycin and linezo...
Source: Current Emergency and Hospital Medicine Reports - October 1, 2014 Category: Emergency Medicine Source Type: research

Contact Precautions for Methicillin-Resistant Staphylococcus aureus: Are They Still Valuable?
Abstract Guidelines from the US Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee recommend the use of contact precautions to prevent the transmission of methicillin-resistant Staphylococcus aureus in acute-care facilities. The merits of these recommendations are debated because it is not clear that contact precautions are essential for the control of this drug-resistant bacterium. Also, contact precautions are resource-intensive and may be detrimental to patient well-being. Recent studies have demonstrated that horizontal measures, such as improv...
Source: Current Emergency and Hospital Medicine Reports - September 29, 2014 Category: Emergency Medicine Source Type: research

A Critical Evaluation of Healthcare-Associated Pneumonia and the Need for Anti-pseudomonal Therapy, Including Double Coverage
Abstract In 2005, healthcare-associated pneumonia (HCAP) was described as a distinct entity, reflecting the concern that patients with HCAP have mortality rates and microbiologic culprits more akin to patients with hospital-acquired pneumonia (HAP) and, thus, warrant treatment similar to HAP, including empiric broad spectrum antibiotics. Increasing evidence suggests that the HCAP definition and criteria are insufficient predictors of which patients are at highest risk of being infected with a multi-drug resistant organism (MDRO); this lack of accuracy leads to overuse of broad spectrum antibiotics. New ri...
Source: Current Emergency and Hospital Medicine Reports - September 25, 2014 Category: Emergency Medicine Source Type: research

Clostridium difficile Infection Update for the Hospital-Based Physician
Abstract Clostridium difficile infection (CDI) hospitalization and mortality rates increased rapidly over the first decade of the 21st century associated with the emergence of an “epidemic” C. difficile strain. Improved knowledge of this strain and its unique characteristics as well as C. difficile in general have heightened awareness to its virulence, recurrence risks, and transmissibility. The overuse of certain antimicrobials, which in turn disrupt the protective intestinal micro environment, may be driving CDI emergence. Newer treatments and those on the horizon have shown pro...
Source: Current Emergency and Hospital Medicine Reports - September 6, 2014 Category: Emergency Medicine Source Type: research

Reducing the Readmission Burden of COPD: A Focused Review of Recent Interventions
Abstract The burden of chronic obstructive pulmonary disease (COPD) in the United States is high, especially with regard to readmission rates and annual cost of health care. However, to date, there is little consensus about which clinical interventions have the greatest impact on reducing COPD readmissions. We reviewed literature in PubMed/MEDLINE to identify interventions that have the greatest impact on COPD readmissions, stratified by four clinical domains: patient risk factors, longitudinal care, acute care, and post-discharge care. Patients with more severe disease and fewer social supports are mos...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

New Technologies in COPD Management
This article reviews the use of novel technologies in COPD patients, focusing on the medical literature from 2013. These advances affect the diagnosis, the management of acute exacerbations, and the long-term, outpatient care of this condition. Diagnostic advances are examined such as novel applications of computed tomography, plethysmography, and analysis of the breath. Acute interventions include oxygen therapy, extracorporeal gas exchange, and molecular or nanotechnology. Finally, a preponderance of recent literature focuses on telemedicine to facilitate monitoring and treatment. Emerging technologies have a significant...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

Current Concepts Surrounding Project Management for Complex Performance Improvement Initiatives
Abstract Hospitals are complex organizations that utilize highly trained, autonomously performing clinical professionals. Hospitals are now borrowing management practices from other industries. Most facilities have turned toward internal process improvement and team-based training. In this article, we will review the current concepts surrounding project management that are deployed to engage clinical specialists and improve care. Project management requires leadership commitment and an improvement aim. The essential drivers for success include creating an implementation plan, building consensus, develop...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

Update on Genetic Testing and Warfarin
Abstract Warfarin therapy is complex and often requires careful consideration of multiple patient specific factors during initiation and chronic management. Identification of genetic variants that influence warfarin response via pharmacogenetic testing provides an opportunity to enhance the quality of therapy. Many studies have attempted to identify how genetic testing can improve warfarin management. Due to the variability in the study results and the lack of clinical outcome data, the true benefits of pharmacogenetic testing for warfarin remain unclear. If genetic testing has been obtained or is readi...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

Recombinant Factor VII Activated and Prothrombin Complex Concentrate Use at a Tertiary Academic Medical Center
Abstract To describe the use of recombinant Factor VII activated (rFVIIa) and three factor prothrombin complex concentrate (PCC3) in the absence of published guidelines, we conducted a single center, retrospective, observational study to evaluate the appropriate of use of rFVIIa and PCC3 therapy based on institution-specific guidelines, which were based on limited published data. Six patients received rFVIIa and 32 received PCC3 during the analysis period. rFVIIa and PCC3 were utilized appropriately in 100 and 91 % of cases, respectively. rFVIIa indications included surgical bleeding (50 %), factor de...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research

Improving Glucose Management with Point-of-Care Testing in the Emergency Department
Abstract Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic states (HHS) have a significant impact on morbidity and mortality. Patients with type 1 and type 2 diabetes are at risk for developing these severe metabolic complications and often present to the emergency department requiring fluid management, electrolyte replacement, and insulin therapy for rapid and safe reversal. Early identification of hyperglycemic patients with the use of point-of-care (POC) testing may facilitate implementation of an institutional treatment algorithm in those patients presentin...
Source: Current Emergency and Hospital Medicine Reports - September 1, 2014 Category: Emergency Medicine Source Type: research