The observation unit: a new interface between inpatient and outpatient care.

Purpose: Observation units for patients who present to emergency departments with chest pain have become common. We describe our 3-year experience with a multipurpose observation unit in which chest pain accounts for only a minority of patients' presenting clinical syndromes.

Subjects And Methods: We analyzed the effects of a 12-bed observation unit on inpatient admissions for common clinical syndromes, as well as its overall effects on inpatient medical admissions during its first 3 years of operation (1996 to 1998) compared with the 3 years preceding its creation (1993 to 1995).

Emergency department admissions to inpatient cardiac telemetry beds: a prospective cohort study of risk stratification and outcomes.

Purpose: Little is known about physicians' use of inpatient cardiac telemetry units among emergency department patients at risk for cardiac complications. We therefore studied the outcomes of patients admitted to inpatient telemetry beds to identify a subset of patients from whom cardiac monitoring could be withheld safely.

Subjects And Methods: We conducted a prospective cohort study of 1, 033 consecutive adult patients admitted to an inpatient telemetry unit from the emergency department of a 700-bed urban public teaching hospital.

Massive pelvic hemangioma in a patient with blue rubber bleb nevus syndrome.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by gastrointestinal and cutaneous hemangiomas. Patients typically present with gastrointestinal bleeding and anemia. Management of gastrointestinal bleeding may be challenging, since these lesions may be diffusely distributed throughout the gastrointestinal tract.

Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability.

Objectives: To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.

Design: Firm-based, controlled trial.

Setting: Urban public hospital.

Presentation and screening history of indigent women with cervical cancer: implications for prevention.

Objective: To identify missed opportunities for screening and early diagnosis of indigent patients with cervical cancer.

Materials And Methods: The authors conducted a retrospective review of charts and databases for demographic information, presenting symptoms, staging data, prior health system contacts, and Papanicolaou smears. Women with cervical cancer were evaluated at an urban public hospital between July 1, 1994, and March 31, 1998.

Assessing disease extent in women with bulky or clinically evident metastatic cervical cancer: yield of pretreatment studies.

Objective: The objective of this study was to determine the impact of pretreatment tests on staging and management for women with bulky or clinically evident metastatic cervical cancer.

Methods: Demographics and findings of clinic pelvic examination (PE), examination under anesthesia (EUA), chest x ray (CXR), abdominopelvic computed tomography (CT), and intravenous urography (IVU) were reviewed for women with primary, untreated cervical cancers either > or =4 cm or with extracervical disease apparent on PE or CXR evaluated between July 1, 1994, and March 31, 1999. Stage was assigned according to standards of the International Federation of Gynecology and Obstetrics.

Cervicovaginal cytology in the posttreatment surveillance of women with cervical cancer.

Objective: Our aim in this study was to determine the value of cervicovaginal cytology in surveillance for recurrent cervical cancer.

Materials And Methods: Charts were reviewed for 136 women with cervical cancer presenting at least 3 months after treatment with curative intent for a previously scheduled surveillance visit to Cook County Hospital between September 1, 1994, and December 31, 1995. Results of cytology and symptoms elicited by history and physical examination were compared to recurrences occurring within 6 months.

Verrucous carcinoma of the vulva in a patient infected with the human immunodeficiency virus.

Verrucous carcinomas of the vulva are rare and have not been reported in women infected with the human immunodeficiency virus. We present such a case in a 32-year-old woman characterized by bladder involvement that failed therapy with 13-cis-retinoic acid and interferon-alpha and required anterior exenteration.

Prevalence and predictors of squamous cell abnormalities in Papanicolaou smears from women infected with HIV-1. Women's Interagency HIV Study Group.

Background: Cervical neoplasia occurs with increased frequency among women infected with HIV-1.

Objective: To characterize prevalence of and risk factors for abnormal cervical cytology among women with HIV and to compare them to uninfected women.

Methods: Baseline cervical cytology was obtained from 1713 women seropositive for HIV and 482 at-risk control women who were enrolled in the Women's Interagency HIV Study, a multicenter prospective cohort study conducted in six U.

Performance and potential impact of a chest pain prediction rule in a large public hospital.

Purpose: To evaluate the performance of a previously validated prediction rule for patients presenting to the emergency department with chest pain and the potential impact of the rule on triage decisions.

Subjects And Methods: In a prospective cohort study, physician investigators interviewed consecutive patients admitted for suspected acute ischemic heart disease (n = 207) by emergency department attending physicians who had not used the prediction rule. We measured the accuracy of the rule in predicting cardiac complications in these patients, and compared actual triage decisions with those that might have been recommended by use of the prediction rule.

Giant pseudopolyps presenting as colocolic intussusception in Crohn's colitis.

Bowel obstruction is a well-known complication of Crohn's disease and is usually a result of stricture formation. Intussusception due to giant pseudopolyps is a rare form of bowel obstruction even in Crohn's disease. These giant pseudopolyps rarely regress with medical management alone and often require surgical resection.

Current antiretroviral therapy and its impact on human immunodeficiency virus-related wasting.

Recent improvements in the management of people living with human immunodeficiency virus (HIV) disease in the United States have led to remarkable reductions in HIV-related morbidity and mortality. The Centers for Disease Control and Prevention recently reported substantial reductions in acquired immunodeficiency syndrome (AIDS)-related opportunistic infections and conditions, including HIV-related wasting. These achievements followed the introduction of the new class of antiretroviral therapies, the aspartyl protease inhibitors, and their use in combination with nucleoside inhibitors in so-called highly active antiretroviral therapies.

Preventing mismanagement of community-acquired pneumonia at an urban public hospital: implications for institution-specific practice guidelines.

Study Objectives: To assess institutional performance of key diagnostic and therapeutic interventions and to identify areas amenable to improvement in the management of community-acquired pneumonia (CAP).

Design: A chart-based retrospective study.

Setting: Cook County Hospital, a large, urban, public teaching hospital.

Evidence-based morning report: a popular new format in a large teaching hospital.

Recent innovations in postgraduate medical education place greater emphasis on evidence-based curricula and self-directed, learner-centered education. Little has been published to date about how to apply these educational innovations to morning report, traditionally an important daily teaching venue in all internal medicine training programs. We describe here the content and conduct of a new evidence-based morning report at a large teaching hospital where it has become the popular hub for residents' self-directed academic activities.

Nosocomial infections in human immunodeficiency virus-infected patients in a long-term-care setting.

To our knowledge, the epidemiology of hospital-acquired infections in human immunodeficiency virus (HIV)-infected patients during long-term care has not been reported. For 13 months, we observed HIV-infected patients (50 men and 15 women) in a dedicated 21-bed unit in a long-term-care facility to determine the rate of nosocomial infections. The mean age of the patients was 39 years (range, 22-78 years); 74% of the patients had CD4 cell counts of < 200/mm3.

The role of speculoscopy in the diagnosis of cervical dysplasia.

Background: Concern about false negative screening cytology has led to the development of adjunctive tests, among them speculoscopy. Speculoscopy involves cervical examination after acetic acid wash with 5X magnifying loupes under chemiluminescent illumination.

Conclusions: Limited data support a role for speculoscopy to improve screening yield and allow triage of patients with borderline cytology, but indications and strategies for use require further definition.