S THE SPECIALTY OF HOSPItal medicine expands, the transfer of responsibility for p a t i e n t c a r e b e t w e e n hospital-based physicians (hospitalists) and primary care physicians becomes increasingly common, creating an urgent need to improve communication and information transfer between inpatient and outp a t i e n t p h y s i c i a n s a t h o s p i t a l discharge. [1][2][3] Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up may improve the continuity of this handoff. 4,5 By contrast, delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, may have substantial implications for continuity of care, patient safety, patient and clinician satisfaction, and resource use. [6][7][8][9][10] The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management, and arrangements for postdischarge follow-up. The Joint Context Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. Objectives To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Data Sources MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Study Selection Observational studies investigating communication and information transfer at hospital discharge (n=55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n=18). Data ExtractionData from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Data Synthesis Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information im...

Cyclic vomiting syndrome (CVS) is a disorder noted for its unique intensity of vomiting, repeated emergency department visits and hospitalizations, and reduced quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. Because no accepted approach to management has been established, the task force was charged to develop a report on diagnosis and treatment of CVS based upon a review of the medical literature and expert opinion. The key issues addressed were the diagnostic criteria, the appropriate evaluation, the prophylactic therapy, and the therapy of acute attacks. The recommended diagnostic approach is to avoid "shotgun" testing and instead to use a strategy of targeted testing that varies with the presence of 4 red flags: abdominal signs (eg, bilious vomiting, tenderness), triggering events (eg, fasting, high protein meal), abnormal neurological examination (eg, altered mental status, papilledema), and progressive worsening or a changing pattern of vomiting episodes. Therapeutic recommendations include lifestyle changes, prophylactic therapy (eg, cyproheptadine in children 5 years or younger and amitriptyline for those older than 5), and acute therapy (eg, 5-hydroxytryptamine receptor agonists, termed triptans herein, as abortive therapy, and 10% dextrose and ondansetron for those requiring intravenous hydration). This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the diagnosis and treatment of CVS in children and adolescents.

Although controlled trials are lacking, the evidence is sufficient to determine that the ketogenic diet is efficacious in reducing seizure frequency in children with refractory epilepsy.

Spectroscopy for the investigation of the characteristics of the atmosphere of Venus (SPICAV) is a suite of three spectrometers in the UV and IR range with a total mass of 13.9 kg flying on the Venus Express (VEX) orbiter, dedicated to the study of the atmosphere of Venus from ground level to the outermost hydrogen corona at more than 40,000 km. It is derived from the SPICAM instrument already flying on board Mars Express (MEX) with great success, with the addition of a new IR high-resolution spectrometer, solar occultation IR (SOIR), working in the solar occultation mode. The instrument consists of three spectrometers and a simple data processing unit providing the interface of these channels with the spacecraft. A UV spectrometer (118–320 nm, resolution 1.5 nm) is identical to the MEX version. It is dedicated to nadir viewing, limb viewing and vertical profiling by stellar and solar occultation. In nadir orientation, SPICAV UV will analyse the albedo spectrum (solar light scattered back from the clouds) to retrieve SO2, and the distribution of the UV-blue absorber (of still unknown origin) on the dayside with implications for cloud structure and atmospheric dynamics. On the nightside, γ and δ bands of NO will be studied, as well as emissions produced by electron precipitations. In the stellar occultation mode the UV sensor will measure the vertical profiles of CO2, temperature, SO2, SO, clouds and aerosols. The density/temperature profiles obtained with SPICAV will constrain and aid in the development of dynamical atmospheric models, from cloud top (not, vert, similar60 km) to 160 km in the atmosphere. This is essential for future missions that would rely on aerocapture and aerobraking. UV observations of the upper atmosphere will allow studies of the ionosphere through the emissions of CO, CO+, and CO2+, and its direct interaction with the solar wind. It will study the H corona, with its two different scale heights, and it will allow a better understanding of escape mechanisms and estimates of their magnitude, crucial for insight into the long-term evolution of the atmosphere. The SPICAV VIS-IR sensor (0.7–1.7 μm, resolution 0.5–1.2 nm) employs a pioneering technology: an acousto-optical tunable filter (AOTF). On the nightside, it will study the thermal emission peeping through the clouds, complementing the observations of both VIRTIS and Planetary Fourier Spectrometer (PFS) on VEX. In solar occultation mode this channel will study the vertical structure of H2O, CO2, and aerosols. The SOIR spectrometer is a new solar occultation IR spectrometer in the range λ=2.2–4.3 μm, with a spectral resolution λ/Δλ>15,000, the highest on board VEX. This new concept includes a combination of an echelle grating and an AOTF crystal to sort out one order at a time. The main objective is to measure HDO and H2O in solar occultation, in order to characterize the escape of D atoms from the upper atmosphere and give more insight about the evolution of water on Venus. It will also study isotopes of CO2 and minor species, and provide...

This prospective, cohort study analyzed the prevalence of alcoholism and patterns of alcohol intake over time in a cohort of HIV-infected patients, predominantly homosexual/bisexual men. One hundred eleven HIV-positive subjects were recruited from a comprehensive HIV clinic associated with a large Midwestern university hospital. Each participant completed the Michigan Alcoholism Screening Test (MAST) survey and a standardized quantity-frequency questionnaire on alcohol intake at enrollment. The quantity-frequency scale was repeated every six months for a total of 30 months. Forty-five of the 111 subjects (41%) met the criteria for alcoholism, as defined by a MAST score 5 or higher. There was a significant decrease in alcohol consumption over time, from 6.4 drinks/week in the initial time period to 3.9 drinks/week by the final time period (p < 0.001).

Abstract. The representation of the Tropical Tropopause Layer (TTL) in 13 different Chemistry Climate Models (CCMs) designed to represent the stratosphere is analyzed. Simulations for 1960 and 1980 -2100 are analyzed. Simulations for 1960 are compared to reanalysis model output. CCMs are able to reproduce the basic structure of the TTL. There is a large (10 K) spread in annual mean tropical cold point tropopause temperatures. CCMs are able to reproduce historical trends in tropopause pressure obtained from reanalysis products. Simulated historical trends in cold point tropopause temperatures are not consistent across models or reanalyses. The pressure of both the tropical tropopause and the level of main convective outflow appear to have decreased (increased altitude) in historical runs as well as in reanalyses. Decreasing pressure trends in the tropical tropopause and level of main convective outflow are also seen in the future. Models consistently predict decreasing tropopause and convective outflow pressure, by several hPa/decade. Tropical cold point temperatures are projected to increase by 0.09 K/decade. Tropopause anomaCorrespondence to: A. Gettelman (andrew@ucar.edu) lies are highly correlated with tropical surface temperature anomalies and with tropopause level ozone anomalies, less so with stratospheric temperature anomalies. Simulated stratospheric water vapor at 90 hPa increases by up to 0.5-1 ppmv by 2100. The result is consistent with the simulated increase in temperature, highlighting the correlation of tropopause temperatures with stratospheric water vapor.

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Iatrogenic complications are likely to be an extremely common experience for elderly medicine service patients with long lengths of stay. A significant portion of these complications may be potentially preventable with closer attention to initial assessment and documentation of patients' functional status.