BACKGROUND:
Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated.
METHODS:
We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay.
RESULTS:
At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant.
CONCLUSIONS:
In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.
Objectives: To investigate the association between baseline pain drawings and future psychological status, and estimate the prognostic value of pain drawing assessment for predicting somatization, distress, and depression at one-year follow-up, in patients with recurrent or chronic low back pain (RCLBP). Methods: This was a multi-center prospective cohort study of 138 patients with RCLBP. Participating patients completed at baseline and one-year follow-up: a blank pain drawing; the Modified Somatic Perceptions Questionnaire; modified Zung Depression Scale; and Distress and Risk Assessment Method. Pain drawings were analyzed quantitatively using the Pain Sites Score (PSS) and Simple Body Region (SBR) method. The association between baseline pain drawing assessment and one-year psychological status was estimated using correlation and Relative Risk (RR) statistics. Results: We obtained complete data from 81 patients (59%). Psychological status and pain drawings did not differ significantly between completers and non-completers. Pain drawing area at baseline was associated with depression and somatization at one-year follow-up (Spearman's Rho 0.25, P50.022; 0.31 P50.006, respectively). Stronger associations resulted from analyses using the PSS, compared with the SBR. Patients with abnormal PSS pain drawings at baseline had significantly greater RR of depression (RR 6.1, 95% CI 1.1, 33.5), somatization (RR 4.1, 95% CI 1.7, 9.9) and distress (RR 6.8, 95% CI 1.9, 25.3) at one-year follow-up. Discussion: These results provide the first evidence that abnormal baseline pain drawings predict greater risk of abnormal psychological states or poor psychological outcome at one-year follow-up, in patients with RCLBP.
Venous thromboembolism is a condition that includes both deep venous thrombosis and pulmonary embolism. Venous thromboembolism disease can result because of a combination of risk factors, including patient-related, treatment-related, and, more specifically, cancer-related factors. It is not disease-specific or a population-specific disorder, but it is more prevalent in certain specialty populations. This article will cover those specialty populations including cancer, pregnancy, and athletes.
Background: Telemedicine allows for interprofessional care of geriatric patients and allows older adults to access healthcare from their homes. The coronavirus pandemic has prompted a rapid shift to telemedicine. In 2016-2017, only 58% of medical schools in the US offered telemedicine curricula. Thus, a large gap in medical education has emerged. There are specific skills needed to ensure students’ “webside” manner is comparable to their bedside manner.This curriculum was created to train medical students in geriatric-sensitive telemedicine using standardized patients (SP). Methods: A didactic detailing geriatric interviewing preceded the SP encounter. Students were assigned roles for the SP encounter as follows: A) Set agenda, elicit questions, triage problems, perform a history, ensure appropriate lighting and audio B) Perform a geriatric review of systems and reconcile medications C) Present an assessment and plan to the preceptor D) Relay the plan to the SP E) Provide feedback. Students were given pre- and post-surveys to assess their comfort using telemedicine and caring for SP’s >65 years old. Results: Seventeen participants were surveyed (pre-survey=17, post-survey=10). Fifty-nine percent of participants reported no prior experience with telemedicine. Participants reported statistically significant increases in comfort using telemedicine (p=0.022), using telemedicine for patients >65 years old (p<0.001), interviewing patients >65 years old over telemedicine (p=0.007), managing patients over telemedicine (p=0.040), and managing patients >65 years old over telemedicine (p=0.001) after completing the curriculum. Discussion: This virtual curriculum improved medical student comfort with geriatric care and telemedicine and highlights the need for telemedicine curricula in medical schools.
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