Comparison of perioperative outcomes and cost of spinal fusion for cervical trauma: weekday versus weekend admissions.

Study Design: Retrospective database analysis.

Objective: To characterize the impact of the admission day (weekday vs. weekend) on the length of stay, costs, complications, and mortality in patients undergoing cervical spine surgery for spinal trauma.

The TRINITY Study: distribution of systolic blood pressure reductions.

Background: Elevated systolic blood pressure is more difficult to control than elevated diastolic blood pressure. The objective of this prespecified analysis of the Triple Therapy with Olmesartan Medoxomil, Amlodipine, and Hydrochlorothiazide in Hypertensive Patients Study (TRINITY) was to compare the efficacy of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment with the component dual-combination treatments in reducing elevated seated systolic blood pressure (SeSBP).

Methods: The 12-week TRINITY study randomized participants to either one of the three component dual-combination treatments (OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg) or the triple-combination treatment.

Pathophysiology of coronary vascular remodeling: relationship with traditional risk factors for coronary artery disease.

The relationship between cardiovascular risk factors and vascular remodeling is a relatively new area of investigation. We discuss the various mechanisms by which cardiovascular risk factors cause vascular remodeling. Endothelial dysfunction, lipoprotein alterations, inflammation, and platelet activation are the mechanisms by which remodeling occurs.

Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.

Context: Data are sparse on the effect of varying the durations of internal medicine attending physician ward rotations.

Objective: To compare the effects of 2- vs 4-week inpatient attending physician rotations on unplanned patient revisits, attending evaluations by trainees, and attending propensity for burnout.

Design, Setting, And Participants: Cluster randomized crossover noninferiority trial, with attending physicians as the unit of crossover randomization and 4-week rotations as the active control, conducted in a US university-affiliated teaching hospital in academic year 2009.

Double wire technique for stenting tortuous cerebral vessels.

The failure to catheterize distal vessels may preclude optimal endovascular intervention. We present a double wire technique to facilitate the selective placement of catheters into tortuous vasculature when a single wire and catheter technique does not suffice. A wide necked middle cerebral artery (MCA) aneurysm incorporated the origin of the inferior MCA trunk, and despite successful passage of a wire into the distal MCA, the catheter could not be advanced beyond 2 sharp turns at the inferior trunk origin.

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.

Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older.

Purpose: To evaluate outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older.

Methods: We identified 44 consecutive patients aged 70 years or older undergoing primary all-arthroscopic repair of symptomatic full-thickness tears of the rotator cuff. A minimum 2-year follow-up was performed by an independent examiner including range of motion and dynamometer strength testing, and shoulder functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and pain score on a visual analog scale were determined.

Vaginal mesh for prolapse: a randomized controlled trial.

Objective: To present 3-month outcomes of a double-blind, multicenter randomized controlled trial comparing traditional vaginal prolapse surgery without mesh with vaginal surgery with mesh.

Methods: Women with pelvic organ prolapse quantification prolapse stages 2-4 were randomized to vaginal colpopexy repair with mesh or traditional vaginal colpopexy without mesh. The primary outcome measure was objective treatment success (pelvic organ prolapse quantification stage 1 or lower) at 3 months.

Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration.

Purpose: The purpose of this study was to compare the clinical outcome of single-row (SR) and double-row (DR) suture anchor fixation in arthroscopic rotator cuff repair with a systematic review of the published literature.

Methods: We searched all published literature from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials for the following key words: shoulder, rotator cuff, rotator cuff tear, rotator cuff repair, arthroscopic, arthroscopic-assisted, single row, double row, and transosseous equivalent. The inclusion criteria were cohort studies (Levels I to III) that compared SR and DR suture anchor configuration for the arthroscopic treatment of full-thickness rotator cuff tears.

Efficacy and safety of dopamine versus norepinephrine in the management of septic shock.

The optimum septic shock vasopressor support strategy is currently debated. This study was performed to evaluate the efficacy and safety of norepinephrine (NE) and dopamine (DA) as the initial vasopressor in septic shock patients who were managed with a specific treatment protocol. A prospective, randomized, open-label, clinical trial was used in a medical intensive care unit comparing DA with NE as the initial vasopressor in fluid-resuscitated 252 adult patients with septic shock.

Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program.

Background: The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain.

Objective: To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program.

Design: Prospective cohort study.

Ethnic disparities in asthma morbidity in Chicago.

Rationale: The role of ethnicity and socioeconomic status in explaining variations in asthma morbidity is unclear.

Objectives: To describe the magnitude of ethnic disparities in asthma morbidity in Chicago and to determine whether differences in socioeconomic status explain these disparities.

Methods: We conducted a survey of 561 school-age children and 353 young adults with asthma and measured their self-reported ethnicity, socioeconomic status (using 11 variables), and asthma morbidity (symptom frequency, asthma-specific quality of life, and frequency of severe asthma exacerbations).

A hospitalist-run short-stay unit: features that predict length-of-stay and eventual admission to traditional inpatient services.

Background: Short-stay units (SSUs) provide an alternative to traditional inpatient services for patients with short anticipated hospital stays. Yet little is known about which patient types predict SSU success.

Objective: To describe patients admitted to our hospitalist-run SSU and explore predictors of length-of-stay (LOS) and eventual admission to traditional inpatient services.

Seizure control and side-effect profile after switching adult epileptic patients from standard to extended-release divalproex sodium.

Objectives: To assess changes in seizure frequency, medication side-effects (especially tremor) and formulation preference after switching patients overnight from immediate-release to extended-release divalproex sodium.

Methods: Prospective evaluation of consecutive adult outpatients at an urban public hospital who were followed for 6 months after switching drug formulations. Seizure frequency was estimated from patient self-reports.

Clinical trial of standing-orders strategies to increase the inpatient influenza vaccination rate.

We compared strategies to increase the rate of influenza vaccination. A written standing-orders policy that enabled nurses to vaccinate patients was compared with augmentation of the standing-orders policy with either electronic opt-out orders for physicians or electronic reminders to nurses. Use of opt-out orders yielded the highest vaccination rate (12% of patients), followed by use of nursing reminders (6%); use of the standing-orders policy alone was ineffective.

Corticotropin tests for hypothalamic-pituitary- adrenal insufficiency: a metaanalysis.

Context: The diagnostic value of tests for detecting hypothalamic-pituitary adrenal insufficiency (HPAI) is controversial.

Objective: Our objective was to compare standard-dose and low-dose corticotropin tests for diagnosing HPAI.

Data Sources: We searched the PubMed database from 1966-2006 for studies reporting diagnostic value of standard-dose or low-dose corticotropin tests, with patient-level data obtained from original investigators.

Impact of a bedside procedure service on general medicine inpatients: A firm-based trial.

Background: Procedure services may improve the training of bedside procedures. However, little is known about how procedure services may affect the demand for and success of procedures performed on general medicine inpatients.

Objective: Determine whether a procedure service affects the number and success of 4 bedside procedures (paracentesis, thoracentesis, lumbar puncture, and central venous catheterization) attempted on general medicine inpatients.