Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

OBJECTIVES:

Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.

METHODS:

We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.

RESULTS:

Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).

CONCLUSIONS:

Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.     

Brief communication: Respiratory function is closely associated with basal metabolic rate in elderly persons

To investigate the association between respiratory function and basal metabolic rate (BMR), pulmonary function indices and BMR were measured in 251 elderly persons using a spirometer and a body composition analyzer. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were more strongly correlated with BMR (r = 0.48 and r = 0.43, p < 0.01) than with lean body mass (r = 0.36 and r = 0.35, p < 0.01) and waist-to-hip ratio (r = -0.29 and r = -0.32, p < 0.01) in elderly men. FVC and FEV1 in elderly men with BMR > or = 1390 kcal/day averaged 4.05 +/- 0.56 L and 3.19 +/- 0.45 L, which were significantly above the values (3.54 +/- 0.51 L and 2.80 +/- 0.42 L, p < 0.01) in men with BMR < 1390 kcal/ day. Prevalences of the subjects with elevated FVC or FEV1 were significantly higher in the group of men with BMR > or = 1390 kcal/day than in those with BMR < 1390 kcal/day (66.0% and 68.0% vs 28.3% and 33.9%, p < 0.01). No significant differences were observed between the postmenopausal women with BMR > or = 1135 kcal/day and those with BMR < 1135 kcal/day. In summary, respiratory function is more closely associated with BMR in elderly persons, compared to lean body mass, waist-to-hip ratio, or body fat mass, and these associations are stronger in men than in women.     

Association between respiratory function and osteoporosis in pre- and postmenopausal women

OBJECTIVE: To investigate the relationships between respiratory function and osteoporosis, 132 premenopausal and 98 postmenopausal women were evaluated. METHODS: Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. Pulmonary function and anthropometric parameters were measured using a spirometer and a body composition analyzer. RESULTS: Lumbar spine and proximal femur BMDs in postmenopausal women with forced expiratory volume in 1s (FEV1) > or = 92.0% averaged 0.83 +/- 0.12 g/cm2 and 0.67 +/- 0.11 g/cm2, which were significantly above the values (0.76 +/- 0.14 g/cm2 and 0.61 +/- 0.12 g/cm2, P < 0.05) in those with FEV1 <92.0%. The prevalences of osteoporosis at lumbar spine and proximal femur were 59.2 and 46.9% in the postmenopausal women with peak expiratory flow rate (PEFR) <5.12 l/s, significantly higher than those of osteoporosis at the corresponding sites in the women with > or = 5.12 l/s (36.7 and 20.4%, P < 0.05). Lumbar spine and proximal femur BMDs were positively correlated with FEV1 (r = 0.28, P < 0.05; r = 0.31, P < 0.05) and PEFR (r = 0.35, P < 0.05; r = 0.23, P < 0.05) in postmenopausal women; however, no significant correlations were observed in premenopausal women. CONCLUSION: Pulmonary function seems to be more closely associated with BMD in postmenopausal women than in premenopausal women. Poor respiratory function may be an indicator of postmenopausal women at increased risk of osteoporosis.     

Associations of serum TRAIL concentrations, anthropometric variables, and serum lipid parameters in healthy adults

To investigate the relationships of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), anthropometric variables, and lipid parameters, we measured serum TRAIL concentrations, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 207 healthy adults. There were no significant differences in serum TRAIL concentrations between men and women, nor between elderly persons and middle-aged subjects. However, men with TBF 16.4 kg (75th per centile) exhibited significantly higher serum TRAIL concentrations than those with TBF 11.2 kg (25th per centile) (69.7 +/- 15.1 pg/ml vs 50.2 +/- 14.3 pg/ml, p < 0.05). Serum TRAIL concentration averaged 76.2 +/- 16.1 pg/ml in women with low-density lipoprotein cholesterol (LDL-C) 165 mg/dl (75th per centile), which was significantly above the values (53.1 +/- 12.9 pg/ml, p < 0.05) in those with LDL-C 117 mg/dl (25th per centile), although no differences were observed on the basis of TBF (75th percentile vs 25th percentile). Serum TRAIL concentrations correlated significantlywithTBF (r = 0.31, p < 0.05) and lean body mass (r = -0.26, p <0.05) in men and LDL-C (r = 0.32, p < 0.05) and total cholesterol (r = 0.21, p < 0.05) in women. In conclusion, serum TRAIL concentrations are associated with serum lipid levels and body adiposity in healthy adults, but are unrelated to a subject's age or gender.     

Apocrine (cutaneous) sweat gland carcinoma of axilla with signet ring cells: a diagnostic dilemma on fine-needle aspiration cytology

Carcinoma arising in the apocrine sweat glands is rare and there are few reports describing the cytological features of this neoplasm. We describe the cytological features of a histologically confirmed apocrine carcinoma occurring in a 55-year-old man who presented with an ulcerated mass in the right axilla. Fine-needle aspiration cytology revealed features of a signet ring adenocarcinoma. The significance of this infrequently encountered neoplasm lies in its potential for diagnostic confusion with more common lesions containing signet ring cells. In an axillary mass lesion, cytological features along with clinical correlation are essential to distinguish primary apocrine carcinoma from mammary neoplasms with signet ring cells and other metastatic adenocarcinomas.     

Prevalence of primary immunodeficiency in Korea

This study represents the first epidemiological study based on the national registry of primary immunodeficiencies (PID) in Korea. Patient data were collected from 23 major hospitals. A total of 152 patients with PID (under 19 yr of age), who were observed from 2001 to 2005, have been entered in this registry. The period prevalence of PID in Korea in 2005 is 11.25 per million children. The following frequencies were found: antibody deficiencies, 53.3% (n = 81), phagocytic disorders, 28.9% (n = 44); combined immunodeficiencies, 13.2% (n = 20); and T cell deficiencies, 4.6% (n = 7). Congenital agammaglobulinemia (n = 21) and selective IgA deficiency (n = 21) were the most frequently reported antibody deficiency. Other reported deficiencies were common variable immunodeficiencies (n = 16), X-linked agammaglobulinemia (n = 15), IgG subclass deficiency (n = 4). Phagocytic disorder was mostly chronic granulomatous disease. A small number of patients with Wiskott-Aldrich syndrome, hyper-IgE syndrome, and severe combined immunodeficiency were also registered. Overall, the most common first manifestation was pneumonia. This study provides data that permit a more accurate estimation PID patients in Korea.     

Fulminant and Fatal Multiple Organ Failure in a 12-Year-Old Boy With Mycoplasma pneumoniae Infection

Mycoplasma pneumoniae (Mp) is a unique pathogen that causes not only pulmonary but also extrapulmonary manifestations that must be rapidly diagnosed. A 12-year-old boy, with no relevant medical history, presented with fever, severe epigastric pain, and vomiting. Laboratory findings showed fulminant and cholestatic hepatitis, hemolytic anemia, thrombocytopenia, acute kidney injury, disseminated intravascular coagulopathy, acute myocardial infarction, and rhabdomyolysis. His clinical condition rapidly deteriorated during intubation and continuous renal replacement therapy. Despite intensive treatment, he did not recover. We report a case of fulminant and fatal multiple organ failure in a previously healthy boy with Mp infection, describing the possible pathomechanisms of multiple organ failure involved in the disease.     

Application of non-destructive impedance-based monitoring technique for cyclic fatigue evaluation of endodontic nickel-titanium rotary instruments

This study investigates the application of non-destructive testing based on the impedance theory in the cyclic fatigue evaluation of endodontic Ni-Ti rotary instruments. Fifty Ni-Ti ProTaper instruments were divided into five groups (n=10 in Groups A to E). Groups A to D were subjected to cyclic fatigue within an artificial canal (Group E was the control group). The mean value of the total life limit (TLL), defined as the instrument being rotated until fracture occurred was found to be 104 s in Group A. Each rotary instrument in Groups B, C and D were rotated until the tested instruments reached 80% (84 s), 60% (62 s) and 40% (42 s) of the TLL. After fatigue testing, each rotary instrument was mounted onto a custom-developed non-destructive testing device to give the tip of the instrument a progressive sideways bend in four mutually perpendicular directions to measure the corresponding impedance value (including the resistance and the reactance). The results indicated that the impedance value showed the same trend as the resistance, implying that the impedance was primarily affected by the resistance. The impedance value for the instruments in the 80% and 60% TLL groups increased by about 6 mΩ (about 7.5%) more than that of the instruments in the intact and 40% TLL groups. The SEM analysis result showed that crack striations were only found at the tip of the thread on the cracked surface of the instrument, consistent with the impedance measurements that found the impedance value of the cracked surface to be significantly different from those in other surfaces. These findings indicate that the impedance value may represent an effective parameter for evaluating the micro-structural status of Ni-Ti rotary instruments subjected to fatigue loading.