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1.
Itay Zmora Yonit Wiener-Well Evan Avraham Alpert 《The American journal of emergency medicine》2019,37(5):1006.e5-1006.e7
Background
Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.Case report
An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae.Why should an emergency physician be aware of this?
Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage. 相似文献2.
Feasibility and Diagnostic Potential of Pulmonary Transit Time Measurement by Contrast Echocardiography: A Pilot Study 下载免费PDF全文
3.
Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618
Background
Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).Methods
All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims.Results
Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P = .01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P = .02) but was similarly not predictive of 90-day readmission/complications.Conclusion
Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system. 相似文献4.
5.
A flow-through finite-dose diffusion cell has been designed for use in transdermal drug delivery research. The diffusion cell consists of an upper donor chamber and a lower receiver compartment through which a continuous supply of fresh solvent flows. The flow is directed to an automatic fraction collector. To validate the flow-through cell, its performance was compared directly against that of a conventional single-reservoir Franz cell. Homologous alkyl p-aminobenzoates were diffused through dimethylpolysiloxane membranes, and permeability coefficients increased with increasing chain length, reaching a plateau at the butyrate ester for both types of cells. This behavior suggests a shift from membrane-controlled diffusion to boundary layer control. Permeation of the butyrate and valerate compounds was significantly faster when the flow-through cell was used, suggesting that better mixing is obtained through the flow-through cell design. Considering the advantages offered in terms of time and labor saved through its use, the flow-through cell with automatic fraction collector appears to be a viable alternative to the conventional Franz cell. 相似文献
6.
Nurse practitioner and physician assistant practices in three HMOs: implications for future US health manpower needs. 下载免费PDF全文
This study empirically examines the practices of non-physician providers (NPPs) within three large competitive health maintenance organizations (HMOs), as well as the physicians' and NPPs' views regarding the ideal role of NPPs. These roles are compared with NPP delegation patterns incorporated in the modeling methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). GMENAC recommended relatively high levels of delegation by physicians to NPPs. One of the HMO sites made use of NPPs at rates even higher than GMENAC's national ideals, while the rates at the other two were lower. The normative ideals for pediatric NPPs developed at each HMO were consistently higher than their actual roles. Concerns with acceptance and the role of NPPs are clearly no longer issues. Instead, the limits on NPP involvement appear to relate to considerations of costs, availability, and the increasing numbers of physicians competing for similar opportunities. 相似文献
7.
Rats were trained in a Y-maze on a two-choice simultaneous black-white discrimination with either black or white as S+. Animals were then transferred to one of three discrimination tasks. In task 1 (New S–), a new stimulus, either vertical or horizontal stripes, was substituted for the original S–. In task 2 (New S+), a new stimulus, either vertical or horizontal stripes as in task 1, was substituted for the original S+. In task 3 (New S+/S–) animals were trained on horizontal-vertical discrimination. The pre-trial administration of 1 mg/kg d-amphetamine facilitated the acquisition of the original black-white discrimination with both black as S+ and white as S+. Likewise, the drug improved performance in all three transfer conditions. However, the course of learning in the three transfer tasks was different in the placebo- and amphetamine-treated animals. Amphetamine-treated animals were disrupted more by a change in S+ than by a change in S–, whereas the opposite pattern was evident in the placebo controls. When both discriminative stimuli were changed, placebo animals exhibited pronounced decrement in performance, whereas amphetamine animals exhibited excellent learning. The implications of these findings for the effects of amphetamine on discrimination learning are discussed. 相似文献
8.
9.
L J Lesko J R Benotti J S Alpert P M Brady J E McCue B H Weiner I S Ockene 《Journal of pharmaceutical sciences》1986,75(10):952-954
The pharmacokinetics of intravenous bepridil (1-[2-(N-benzylanilino)-1-(isobutoxymethyl)ethyl]pyrrolidine ) were studied in 16 patients undergoing cardiac catheterization for evaluation of coronary disease, all with normal base-line hemodynamic and renal functions. Ten patients received 3 mg/kg and six patients received 4 mg/kg of bepridil infused over a period of 30 min. Plasma bepridil concentrations were measured by HPLC and analyzed by model-dependent and model-independent methods. The mean (+/- SD) maximum plasma bepridil concentrations at the end of the infusion were 2047 +/- 820 ng/mL (3 mg/kg) and 2478 +/- 1426 ng/mL (4 mg/kg). Postinfusion bepridil concentrations were best described by a two-compartment open model. The model-dependent harmonic mean distribution and elimination half-lives were 1.7 h (range: 1.1-2.2 h) and 19.7 h (range: 8.0-61.9 h), respectively. The harmonic mean elimination half-life from model-independent analysis was 14.9 h (range: 7.4-64.0 h). The arithmetic means of other model-independent kinetic parameters were systemic clearance, 0.524 +/- 0.215 L X kg-1 X h-1; Vd, 15.3 +/- 10.9 L/kg; and Vdss, 10.1 +/- 6.0 L/kg. Model-dependent and model-independent estimates of half-life and clearance agreed reasonably well. Bepridil was well tolerated, effecting little or no change in central hemodynamics or EKG intervals. The extensive distribution and relatively slow clearance of bepridil account for its long elimination half-life. Intravenous bepridil appears to be a safe calcium (II) antagonist that is suitable for once-a-day dosing. 相似文献
10.