Lung abscesses in children: diagnostic and therapeutic needle aspiration

Three children aged 17 months to 17 years developed right-sided peripheral lung abscesses. Clinical signs were fever and cough. Laboratory cultures were negative, and the patients did not respond to appropriate antibiotic coverage. Under fluoroscopic guidance, purulent material was removed from the abscesses by needle aspiration. The patients became afebrile within 24 hours; none suffered complications of bleeding or pneumothorax. Cultures of the aspirate were positive for microorganisms sensitive to the prescribed treatments. A simple aspiration technique is described and proposed as useful for selected patients when surgical drainage is recommended. There was no morbidity in our cases, and recovery from a typically prolonged course was shortened by the procedure.     

功能性消化不良者胃排空功能和体表胃电变化的研究

以ＳＰＥＣＴ胃排空检测技术和ＷＣＤＦ－４Ｂ胃电分析仪检测了１２例ＦＤ患者液、固体食物胃排空和体表胃电图的变化。结果显示：ＦＤ患者的液体胃排空与对照组无明显差异，仅在摄食后比对照组更多地分布于远端胃内：固体食物的排模式发生变化，表现为初始排空较快，继后的排空延缓，７例半排空时间延长。     

Evaluation of the red cell storage lesion after irradiation in filtered packed red cell units

Packed red cell units (n = 10) were filtered and divided equally. One-half unit from each donor was irradiated (x) (3500 cGy). On Days 0, 14, 28, and 42, ATP, K+, Na+, lactate dehydrogenase (LDH), plasma-free hemoglobin (PFH), and pH were determined. The reduction in ATP was greater in the irradiated than the nonirradiated (y) units by Day 42 (mean x-y: -70, p = 0.0005). The increase in K+ was greater in the irradiated than nonirradiated units on Days 14, 28, and 42 (mean x-y: 17-20, p = 0.0001). Decrease in pH and increases in LDH and PFH were significant (p less than 0.05) on Day 42 only. K+ increases added only 1.7 to 2.0 mmol per unit, a difference felt to be clinically insignificant. The changes noted in ATP, pH, LDH, and PFH are significant but minimal on Day 42 and imply that viability changes would also be minimal. These biochemical data support the storage of irradiated units for at least 28 days.     

A Poster Summarizing the American Academy of Orthopaedic Surgeons Knee Osteoarthritis Clinical Practice Guideline Is a Powerful Tool for Patient Education: A Randomized Controlled Trial

BackgroundIn 2013, the American Academy of Orthopaedic Surgeons (AAOS) published an evidence-based clinical practice guideline (CPG) on conservative treatment options for patients with knee osteoarthritis (OA). The purpose of this study is to evaluate the effectiveness of a poster outlining the AAOS knee OA CPG on patient comprehension and satisfaction in the clinic.MethodsThis is a prospective 2-armed randomized controlled trial. Patients were eligible if they were of age 40-85 years, had degenerative knee OA, and did not consent for surgery. Patients were randomized to nonposter (standard care) and poster rooms. Knee OA treatment options were described to the patient verbally and posters were used as a teaching tool when present. The main outcomes were comprehension and satisfaction scores on a survey.ResultsOf the 105 patients enrolled, 51 (48.6%) were randomized to usual care (control) and 54 (51.4%) to the intervention (poster). Poster patients outperformed control patients with an average of 55.3% ± 16.7% (mean ± SD) compared to 39.5% ± 13.3% correct answers (P < .001). And 66.7% of poster patients and 29.4% of control patients achieved an adequately informed status of >50% correct answers (P < .001; 50.5% overall). With a maximum possible score of 10, visit satisfaction scores were 9.4 ± 1.0 in poster patients and 9.2 ± 1.7 in control patients (P = .50).ConclusionPatients educated using an AAOS knee CPG poster showed significant improvements in knowledge and were more likely to achieve an adequately informed status. No difference existed in visit satisfaction. A poster offers a low-cost, effective educational tool.Level of EvidenceLevel 1.     

Interdisciplinary Discrepancies Between Parenteral Nutrition Macronutrient Prescribing and Recommendations: Is Body Mass Index a Factor?

Background: Formal nutrition training in medical schools and residencies is lacking and needed. Registered dietitians (RDs) are formally trained in nutrition support and considered experts in the nutrition field. Our purpose was to examine prescribing and recommending discrepancies of parenteral nutrition macronutrients between medical residents (MRs) and RDs and compare results with the ASPEN clinical care guidelines. We also looked at discrepancies among obese patients, due to their increased risk of mortality. Materials and Methods: The primary end point of this retrospective review was discrepancies in nonprotein calories (NPCs) and grams of protein (PRO) between MRs and RDs. The secondary end point was discrepancies in NPCs and PRO between MRs and RDs among patients stratified by body mass index category. Results: MRs prescribed 300 NPCs more versus RDs (P < .001). When compared with RDs, MRs prescribed fewer NPCs for underweight patients and more for obese patients (P < .001). The same analysis found that the PRO discrepancies significantly varied by body mass index classification as well (P = .022). When these results were compared with the ASPEN clinical care guidelines, RDs adhered closer to the guidelines than did MRs in terms of permissive underfeeding of obese patients. Conclusion: It is widely accepted that MRs are in need of increased formal training, and the results of our study confirm this need and suggest a short‐term solution of increasing order‐writing privileges for the RD. RDs with this privilege may adhere more closely to clinical care guidelines and therefore increase patient safety.