Management of Do Not Resuscitate Orders Before Invasive Procedures.

Background: In 2017, the US Department of Veterans Affairs (VA) implemented the Life-Sustaining Treatment Decisions Initiative (LSTDI), which created a portable and durable code status for use across its health care system. Patients who now have a durable do not resuscitate (DNR) status may undergo invasive procedures. Few studies have examined whether proceduralists discuss DNR status and document changes before procedures.

Quality of Chronic Obstructive Pulmonary Disease-Related Health Care in Rural and Urban Veterans Affairs Clinics.

Only minor disparities were found between patients at rural and urban clinics in this examination of the differences in the quality of health care for patients with COPD.

Inaccuracy in patient handoffs: discrepancies between resident-generated reports and the medical record.

A handoff is the transfer of a patient's care from one provider to another. It usually involves both a verbal and written exchange of information. Although written handoff sheets are critical to good patient care, there is little data on the quality of information they contain.

A Randomised, Cross-Over, Placebo-Controlled Study of Aloe vera in Patients with Irritable Bowel Syndrome: Effects on Patient Quality of Life.

Background. Irritable bowel syndrome (IBS) is a chronic, difficult to treat condition. The efficacy of Aloe vera in treating IBS symptoms is not yet proven.

Peritoneal mesothelioma.

Peritoneal disease accounts for just under a third of all malignant mesothelioma. Its insidious onset means that diagnosis is often made at an advanced stage, however, new therapeutic techniques are starting to lead to improved outcomes.

Black cohosh: a cause of abnormal postmenopausal liver function tests.

The health scares restricting the use of hormone replacement therapy have made women tend to opt for 'natural' remedies that are generally perceived as safe. Unfortunately, there is lack of definite opinion on the safety of herbal remedies. Black cohosh is commonly used for postmenopausal symptoms.

Influencing referral practice using feedback of adherence to NICE guidelines: a quality improvement report for dyspepsia.

Problem: Rising demand and increasing waiting times for upper gastrointestinal endoscopy (gastroscopy).

Design: Quality improvement study with pre- and post-intervention data collection.

Setting: Three endoscopy units in two hospital trusts (Singleton, Morriston and Baglan Hospitals endoscopy units), UK.

An innovative approach to teaching resuscitation skills.

We report the impact of a monthly educational exercise for residents that emphasized practical skills and equipment usage rather than knowledge of advanced cardiac life support (ACLS) protocols. Residents were divided into groups of approximately four that rotated through three stations. Each station included several objectives, most of which related to specific types of equipment.

Clinical guidelines online: do they improve compliance?

Background: The introduction of intranet services in a district general hospital provided an opportunity to put evidence based national guidelines online to facilitate access and promote application of best practice in acute medical care. This study evaluated the effectiveness of this approach.

Method: Local guidelines were made available online at ward terminals after they had been distributed in paper form.

Diffuse esophageal leiomyomatosis: another cause of pseudoachalasia.

The patient was a 22-year-old woman who had presented in early childhood with gastroesophageal reflux and who subsequently underwent surgery. It was commented upon by the surgeons at that time that the esophagus was abnormally thickened. The patient subsequently presented during her first pregnancy with a vulval tumor, which proved histologically to be a leiomyoma.

Ileitis due to Yersinia pseudotuberculosis in Crohn's disease.

We present the case of a young woman with fulminating terminal ileitis due to Yersinia pseudotuberculosis, in whom Crohn's disease was subsequently diagnosed. Serological testing was prompted by radiological, macroscopic and histological changes which were atypical of Crohn's disease. We speculate that Y.

Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty.

Background: and objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding endoscopic procedure that varies from a simple diagnostic to a highly complex therapeutic procedure. Simple outcome measures such as success and complication rates do not reflect the competence of the operator or endoscopy unit, as case mix is not taken into account. A grading scale to assess the technical difficulty of ERCP can improve the objectivity of outcome data.

Impact of noninvasive studies to distinguish volume overload from ARDS in acutely ill patients with pulmonary edema: analysis of the medical literature from 1966 to 1998.

Study Objective: To assess the impact of substituting noninvasive diagnostic studies for Swan-Ganz catheter (SGC) placement in the evaluation of acutely ill patients.

Design: Modified decision analysis.

Methods: Using published studies that define effectiveness of clinical examination, echocardiography, and SGC placement to diagnose pulmonary edema, an analysis of the impact of substituting three diagnostic approaches using (1) clinical assessment (CA), (2) M-mode two-dimensional transthoracic echocardiography (EC), or (3) CA then EC if necessary for SGC placement was considered.

Hepatocellular carcinoma arising in non-cirrhotic liver in genetic haemochromatosis.

The occurrence of primary hepatocellular carcinoma (HCC) in patients with genetic haemochromatosis (GH) with cirrhosis is well known. In the past it has been suggested that patients with GH without cirrhosis have the same risk of HCC and life expectancy as the general population. However, recently there have been cases of HCC arising in non-cirrhotic livers, and we report another such case.

Withdrawal of chronic systemic corticosteroids in patients with COPD: a randomized trial.

The benefits of chronic systemic corticosteroids for patients with chronic obstructive pulmonary disease (COPD) are not well established. To determine whether chronic corticosteroid treatment can be safely withdrawn in "steroid-dependent""COPD patients, we performed a double-blind, placebo-controlled study of 38 patients with steroid-dependent COPD. Patients were randomly assigned to receive their usual maintenance prednisone dose for 6 mo (continuous group) or to be withdrawn from prednisone at a rate of 5 mg per week (demand group).

Management of a giant fluid-filled bulla by closed-chest thoracostomy tube drainage.

A 53-year-old man was admitted to the hospital for management of pneumonia and a giant fluid-filled bulla. He appeared acutely ill and had persistent fever despite prolonged therapy with parenteral antibiotics and aggressive bronchial drainage. Percutaneous placement of an 8.

In vitro duodenal iron uptake and serum and mucosal iron protein levels, with special reference to rheumatoid arthritis.

Duodenal biopsies from control subjects, patients with iron-deficiency anaemia and rheumatoid arthritic patients with anaemia of chronic disorders (ACD) were investigated for their ability to take up 59Fe from iron ascorbate. Additionally, duodenal tissues were analysed for iron and immunoreactive ferritin and transferrin. Biopsies from iron-deficient subjects showed a 2- to 3-fold increase in the apparent Vmax for 59Fe uptake, compared to control values.

Identification of hydrogen peroxide as a Streptococcus pneumoniae toxin for rat alveolar epithelial cells.

Streptococcus pneumoniae infections of the lung are associated with significant damage to the alveolar epithelium. Host phagocytes and pneumolysin, a cytolytic toxin of S. pneumoniae, are believed to contribute to this cellular damage, yet experiments in which these elements are absent demonstrate the presence of an additional soluble S.

The relationship between muscle fibre atrophy factor, plasma carnosinase activities and muscle RNA and protein composition in chronic alcoholic myopathy.

The relationship between chronic ethanol consumption and muscle biopsy morphometry (i.e. atrophy factor), plasma analytes, including carnosinase activities and tissue composition was investigated.

Toxicity of pneumolysin to pulmonary alveolar epithelial cells.

Mortality during the first several days of pneumococcal pneumonia has not decreased appreciably over the past 30 years, despite the widespread use of antibiotics. Disruption of the alveolar epithelial barrier is likely an initial step in the pathogenesis of pneumococcal pneumonia. We report that soluble factors from Streptococcus pneumoniae can directly injure isolated rat alveolar epithelial cells.