Hand-carried echocardiography by hospitalists: a randomized trial

Background

Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse.

Methods

We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography.

Results

The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, −12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P = .0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography.

Conclusion

Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied.     

Assessment of prevalence and pathological response to orthostatic provocation in patients with multiple sclerosis

ObjectiveThe aim of this study was to determine the prevalence of pathologic response to orthostatic challenge in patients with relapsing remitting multiple sclerosis (RRMS) and the difference of the response in patients in relapse and remission.Patients and methodsWe included 112 RRMS patients; group 1 included 53 patients in a relapse and group 2, 59 patients in remission. The head up tilt table test was used to provoke an orthostatic reaction.Results71 (63%) patients (60.4% and 66% of relapse and remission subjects respectively) had a pathological response to orthostatic provocation. Syncope was found in 9 (17%) patients in group 1 compared to 22 (37.3%) in group 2 (p = 0.014). Postural orthostatic tachycardia syndrome (POTS) was found in 17 (32%) patients in group 1 compared to 4 (6.8%) in group 2 (p = 0.001). There was a significantly negative correlation between the Expanded Disability Status Scale (EDSS) and POTS (? 0.201; p = 0.034) and a positive correlation between the EDSS and syncope (0.190; p = 0.044).ConclusionThe prevalence of distinct types of orthostatic autonomic dysfunction in different phases of RRMS seems to be in direct correlation with the EDSS. Furthermore, certain autonomic dysfunctions of orthostasis, more specifically syncope and POTS, tend to be increased in remission and relapse respectively.     

Note on morphology of two nematode species <Emphasis Type="Italic">Ascaridia hermaphrodita</Emphasis> and <Emphasis Type="Italic">Ascaridia platyceri</Emphasis> (Nematoda): scanning electron microscope study

Summary  Morphological features of adult specimens of Ascaridia hermaphrodita and A. platyceri (Nematoda: Ascaridida), parasitizing parrots (Psittaciformes), were studied for the first time using scanning electron microscopy. The morphology of A. hermaphrodita, the type species of Ascaridia, coincides fully with the generic diagnosis. The shape of the labial inner structure (two spoon-like projections), cervical alae and spicule with cuticular wings were typical for this species. A. hermaphrodita has been found in the Czech Republic for the first time in a new host, Amazona pretrei, from Brazil. The morphology of Ascaridia platyceri does not correspond with the generic diagnosis in all aspects, as some variation was found, mainly in the presence of interlabia, small teeth in the inner ribbon of the lips and long lateral alae. These morphological characteristics in other species of Ascaridia are discussed. The generic diagnosis is to include the statement “interlabia very rarely present”.     

Belatacept conversion in an HIV‐positive kidney transplant recipient following anti‐thymocyte globulin induction

Herein, we describe a case of early belatacept conversion in a human immunodeficiency virus (HIV)‐positive kidney transplant recipient in an effort to improve suboptimal graft function and avoid drug interactions following anti‐thymocyte globulin (ATG) administration. We observed improvement in renal function without HIV disease progression or opportunistic infections. Donor‐specific antibodies appeared shortly after conversion but cleared without intervention. This case highlights belatacept as a means to improve renal function and avoid significant drug interactions even following ATG induction.     

Role of peripheral catecholamine mechanisms in central activation of the hypophyseo-adrenocortical system induced by reserpine

Inhibition of the function of the peripheral divisions of the sympathico-adrenal system prevents the manifestations of stimulation of the hypophyseo-adrenocortical system by the action of reserpine.Presented by Academician of the Academy of Medical Sciences of the USSR V. V. Zakusov.Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 70, No. 12, pp. 51–54, December, 1970.