Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay.

Background: Hospital-based clinicians and educators face a difficult challenge trying to simultaneously improve measurable quality, educate residents in line with ACGME core competencies, while also attending to fiscal concerns such as hospital length of stay (LOS).

Objective: The purpose of this study was to determine the effect of multidisciplinary rounds (MDR) on quality core measure performance, resident education, and hospital length of stay.

Design: Pre and post observational study assessing the impact of MDR during its first year of implementation.

Treatment approaches and nursing applications for non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL), a malignancy that manifests in the lymphatic system, is one of the most commonly occurring hematologic disease types in the United States and other Westernized countries. NHL is divided into a range of subtypes with differing clinical features and outcomes. Depending on the type of NHL and the patient's overall clinical presentation, treatment varies from systemic combined chemotherapy regimens with or without immunotherapy, radioimmunotherapy, and transplants to investigational options.

Review article: appendicitis in groin hernias.

To review the clinical presentation, outcome and causes of acute appendicitis presenting within a groin hernia. A comprehensive review of the past 70 years of English language surgical literature was conducted pertaining to acute appendicitis presenting within an inguinal or femoral hernia. Thirty-four reports describing 45 patients were reviewed to determine age, position, gender, pathologic stage at presentation, causal suppositions, and clinical outcomes.

N-terminal pro-brain natriuretic peptide for detection of cardiovascular stress in patients with obstructive sleep apnea syndrome.

Patients with obstructive sleep apnea syndrome (OSAS) have an elevated incidence of cardiovascular events that may be related to an increased ventricular load and hypoxemia caused by apneas and hypopneas. N-terminal pro-brain natriuretic peptide (NTproBNP) appears to be an excellent marker of myocardial stretch and could serve as an indicator of subclinical cardiac stress, thereby identifying a patient population at risk for cardiac effects from OSAS. Adult patients presenting with suspected OSAS and scheduled for nocturnal polysomnography were recruited.

Buckwheat allergy.

Buckwheat, which has been abundantly consumed in Asian countries and has been increasingly popular in the United States, Canada, and Europe, can be a potent allergen when ingested or inhaled. A case is reported of a 36-year-old man who experienced nausea, vomiting, urticaria, a sensation of throat closing, inability to speak, dyspnea, and dizziness shortly after ingesting a large portion of buckwheat that required emergency room treatment. In the previous 2 years he had experienced asthma, contact urticaria, allergic conjunctivitis, and allergic rhinitis from sleeping with a buckwheat pillow.

Probiotics and their use in diverticulitis.

Probiotics are live microorganisms that when ingested affect the intestinal microbial flora and benefit the health of the host. Probiotics have been shown to have a positive effect on various gastrointestinal and other conditions; however, the beneficial effect of probiotics on treating diverticulitis and diverticular disease has not yet been clearly demonstrated. In this paper, the theoretical framework for using probiotics to prevent or treat diverticular disease is reviewed, and two preliminary studies on the use of probiotics for maintenance of remission of uncomplicated diverticular disease are briefly summarized.

Diagnosis and management of acute diverticulitis.

Although the diagnosis of acute diverticulitis is somewhat standardized, the scientific evidence and basis for treatment has been questioned. For years, medical and surgical management of acute diverticulitis has been based on the theory that more than 2 significant attacks of diverticulitis would lead to the recommendations of surgical resection. This should be questioned and further investigated with prospective randomized trials.

"How much should I weigh?"--Quetelet's equation, upper weight limits, and BMI prime.

Body mass index (BMI) is derived from Quetelet's equation. Federal guidelines define a healthy BMI range of 18.5 to 24.

Treatment approaches and nursing considerations for non-Hodgkin's lymphoma.

Objective: To discuss some common non-Hodgkin's lymphoma subtypes, and current systemic approaches including chemotherapy, monoclonal antibodies, radioimmunotherapy, and vaccines.

Data Sources: Research and review articles, textbooks, and guidelines

Conclusion: Non-Hodgkin's lymphoma is one of the most common types of malignancies for both men and women. It manifests itself in the lymph nodes, bone marrow, and extranodal sites, with or without B symptoms (fevers, sweats, weight loss) and it continues to be on the rise.

Comparison of FEV6 and FVC for detection of airway obstruction in a community hospital pulmonary function laboratory.

The National Lung Health Education Program recommends that primary care providers perform spirometry tests on cigarette smoking patients 45 years or older in order to detect airways obstruction and aid smoking cessation efforts [Ferguson GT, Enright Pl, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus statement from the national lung education program. Chest 2000; 117: 1146-61].

Prevalence of skin test reactivity in patients with convincing, vague, and unacceptable histories of penicillin allergy.

Penicillin (PCN) allergy has been vastly overdiagnosed, and too many people are incorrectly labeled as allergic to PCN, which affects their health by preventing the use of beta-lactam antibiotics. This investigation explores whether taking a careful history can eliminate the need for some to carry the PCN allergy label. A retrospective study of a focused history and PCN skin testing was done in a consecutive sample of a suburban allergy population of 319 patients who had a positive history of PCN allergy.

Amantadine for traumatic brain injury: does it improve cognition and reduce agitation?

Objective: To review the available literature pertaining to amantadine as therapy for improving cognition and reducing agitation following a non-penetrating traumatic brain injury (TBI).

Data Sources: Clinical literature was accessed through MEDLINE (from 1966 to February 2004) and bibliographic searches. Key search terms included 'amantadine', 'traumatic brain injury', 'cognition', and 'agitation'.

Use of diet and probiotic therapy in the irritable bowel syndrome: analysis of the literature.

Goal: The goal of this report is to review the use of dietary intake and probiotics in patients with irritable bowel syndrome (IBS) in published reports.

Background: Dietary factors can be important in inducing symptoms that occur in patients with the IBS. Dietary intolerances, dietary allergies, specific food metabolites, and regular diet contents all may act as triggers and aggravate the symptoms of IBS; but when any of these mechanisms can be proven to cause the symptoms, then their elimination results in the resolution of that patient's IBS.

Postcolectomy ileitis.

A case is presented of a patient who had classic ulcerative colitis, both clinically and on detailed pathologic study, that underwent an ileo-pouch anal anastomosis and then developed pouchitis followed by ileitis. The patient has done fairly well on routine medications, but this case represents ileitis developing post colectomy that did not exist previous to colectomy and raises the questions for the following presentations and discussions in this workshop symposium.

The natural history of diverticulitis: fact and theory.

Epidemiological and anatomic evidence indicates that approximately 60% of humans of westernized societies living into the sixth decade will develop diverticulosis of the colon. The cause remains unknown, but epidemiological studies indicate it is a combination of decreased dietary fiber intake and increased intracolonic pressure. The intraluminal pressure exerted on the wall causes a diverticular outpocketing at any one of the three areas in which vessels enter the wall.

Professional organizations in the emergency department.

It is not so important the specific professional organizations to which one belongs, but rather one's activity in the organization and his or her willingness to get involved and contribute to it. The relevance of a professional organization to a member of the ED staff is only as valid as the level of participation by that member in the professional organization. Membership in any organization, including a professional organization, is a contractual two-way street.

The positive impact of initiation of hospitalist clinician educators.

Objective: Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation.

Design: Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education.