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When in doubt, examine the patient ▸
Retrospective chart review of patients admitted to a general medical service in Chicago found that 26% had new physical findings, leading to a change in diagnosis and treatment, when examined by the attending physician on take. The author acknowledged the small sample size (100 patients over 28 days) and lack of control group. Even taking this into account, in a clinical era of reliance upon sophisticated and technologically advanced investigations, it is refreshing to be reminded of the role of traditional examination skills.
Drug related admissions ▸
Prescribed drug related problems are well recognised. This observational study adds to an already large body of evidence. Some 6.5% of medical admissions to an acute teaching hospital screened by a pharmacist were judged to have resulted from drug related problems. Most of these were deemed to have been potentially preventable. The “problems” included prescribing problems, monitoring problems, and adherence/compliance problems. Of particular relevance to A&E, there was a comparatively large number of patients who presented with gastrointestinal problems having been prescribed non-steroidal anti-inflammatory agents in the presence of two or more “risk factors”.
Antibiotic therapy for secondary prevention of myocardial infarction ▸
It has been suggested that Chlamydia pnemoniae infection plays a part in the pathogenesis of coronary artery disease. This randomised placebo controlled trial looked at the possible role of a three month course of azithromycin in over 7747 patients with a recent myocardial infarction and positive IgG titres for C pneumoniae. No difference in the rates of death, re-infarction or need for re-vascularisation was found at 14 months.
A trial of automotive external defibrillators in out of hospital cardiac arrest ▸
This was the first of two companion papers on the potential role of automative external defibrillators (AEDs) in the prehospital setting. …