Emergency medicine: Where to from here? The College

This paper describes two group presentations of intoxicated patients to the Emergency Department of Gold Coast Hospital in October 1996 and July 1997 respectively. A total of 14 patients received treatment. The clinical features, investigation findings and clinical course of each patient are outlined. A discussion is undertaken of the literature surrounding the emergence of gamma hydroxybutyrate (GHB) as a drug of abuse, and of the major issues involved in the emergency department management of such patients.     

Palivizumab: where to from here?

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections. In severely immunosuppressed patients RSV can cause significant morbidity and mortality. The only FDA-approved drug for RSV is aerosolized ribavirin. Given the high morbidity and mortality in high-risk populations and inconsistent results with aerosolized ribavirin, new strategies for prevention and treatment of RSV are being sought. Palivizumab is an RSV-specific monoclonal antibody. A randomized, double-blind, placebo-controlled multicenter study showed significant reduction in hospitalization rates among children at high risk of RSV infection who had been given prophylactic palivizumab; these findings led to palivizumab's approval by the FDA in June 1998. Palivizumab also has a role in prevention of severe respiratory tract infections in high-risk infants. In immunocompromised patients, palivizumab has an excellent safety profile and may be beneficial in the prevention and treatment of RSV infections; however, clinical trials are needed to determine its effectiveness. In this article, we review the role of palivizumab in prevention and treatment of RSV infections in immunocompetent and immunocompromised patients.     

Where do we go from here? A small scale observation of transfer results from chronic to skilled ventilator facilities

PurposeSkilled nursing facility ventilator units (SNF) are a recent attempt to reduce the costs of an increasing number of patients who are in acute intensive care units and are not able to be liberated from ventilators. Transfers of such patients from long-term care chronic vent units (LTCVs) to SNFs in Maryland began in 2006. The safety of these transfers needs to be assessed.MethodsWe retrospectively followed up all patients designated as eligible by their insurance for transfer from our LTCV units to SNF from July 1, 2008 through June 30, 2010 looking only at survival. Those patients who refused transfer and appealed and remained in our LTCV were compared to those who were transferred to SNF ventilator units. The analysis was by Kaplan-Meier statistics.ResultsThere was an increased mortality (P = .025) of those transferred to SNF ventilator facilities as compared to those remaining in the LTCV.ConclusionWe recognize that bias may occur in patients choosing to remain in our LTCV compared to those accepting transfers, the magnitude of the difference in mortality indicates the need for more comprehensive well designed analysis investigating the outcome of all transfers occurring to and from LTCVs.