No abstract

Background Ambulatory care visits for chronic sinusitis outnumber visits for acute sinusitis. The majority of these visits are with non-otolaryngologists. In order to better understand patients diagnosed with chronic sinusitis by non-otolaryngologists, we sought to determine if incident cases of chronic sinusitis diagnosed by primary care (PC) or emergency medicine (EM) providers meet diagnostic criteria. Methods Retrospective cohort. Patients were identified using administrative data, 2005–2006. The dataset was then clinically annotated based on chart review. We excluded prevalent cases. Results We identified 114 patients with newly diagnosed chronic sinusitis in EM (75) or PC settings (39). Rhinorrhea (EM 61%, PC 59%) and nasal obstruction (EM 67%, PC 64%) were common in both settings but facial fullness (EM 80%, PC 39%) and pain (EM 40%, PC 18%) were more common in the EM setting. Few patients reported symptoms of 90 days or longer (EM 6.0%, PC 24%) and no patient had evidence of inflammation on physical examination. A minority of patients received a sinus CT scan (22.8%) or nasal endoscopy (1.8%). In total only 1 patient diagnosed with chronic sinusitis met the diagnostic criteria. Conclusions Most patients diagnosed with chronic sinusitis by non-otolaryngologists do not have the condition. Caution should be used in studying chronic sinusitis using administrative data from non-otolaryngology providers as a large proportion of the patients may not actually have the disease.

Compared with patients who underwent ligation, patients receiving TIVS had fewer amputations (47% vs 0%) and fewer fasciotomy procedures (93% vs 43%; P Ͻ .05). Mortality was 72% in the ligation group vs 43% in the TIVS group. In the patients treated with a TIVS, no TIVS thrombosed, and the mean shunt time was 22.3 hours.Comment: Temporary intravascular shunts have long been used as a method of temporarily restoring arterial circulation in patients with peripheral arterial injuries distal to the axillary crease and inguinal ligament. Prolonged use for maintaining arterial circulation after injuries at other sites is less recognized. The article indicates that a major vascular injury within the abdomen does not necessarily need to be acutely repaired in damage control situations. A shunt can be placed, the patient resuscitated, and the coagulopathy corrected, or the patient brought back to the operating room for interval repair of vascular and associated injuries. This may result in fewer amputations and improved survival. JOURNAL OF VASCULAR SURGERY

The creation and implementation of a standardized DVT risk assessment program in the electronic medical record significantly increased use of pharmacological and mechanical DVT prophylaxis before surgery in a Veterans Affairs Medical Center setting.