Hospital Discharge Disposition of Stroke Patients in Tennessee

Objectives: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with...

Management of Metastatic Spinal Cord Compression

Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing...

Commentary on “Hospital Discharge Disposition of Stroke Patients in the State of Tennessee”

In this issue of the Southern Medical Journal, Cho and colleagues assessed the hospital discharge location for patients with stroke and attempted to develop a tool to help determine the discharge location early in the clinical course.1 The treatment for acute ischemic stroke has come a long way since the approval of intravenous tissue plasminogen activator in 1995 to the advent and use of stent retrievers and large-bore aspiration catheters in...

Idiopathic Thrombocytopenic Purpura in Individuals Older than 75 Years: A Rare Series

To the Editor: Idiopathic thrombocytopenic purpura (ITP), currently referred to as primary immune thrombocytopenic purpura, is an autoimmune disease linked to the presence of autoantibodies responsible for the peripheral destruction and central inhibition of platelet growth.1 Bleeding results from unusually low levels of platelets, the cells that help blood coagulate.2 Treatment of ITP is based on the recommendations of experts2; however, in...

Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection

Objectives: Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of approximately $3 billion. The epidemiology of CDI has changed with the identification of novel risk factors for incident and recurrent CDI. The aim of this study was to identify the predictors of 30-day mortality in hospitalized patients with...

Impact of Polypharmacy on Seniors’ Self-Perceived Health Status

Objectives: Polypharmacy is common among older patients and is linked to increased risk of adverse health outcomes. This study aimed to explore the association of polypharmacy and self-perceived health status (SPHS) among geriatric patients. Methods: This cross-sectional analysis of longitudinal observational research used national survey data from 2005–2008. Multivariate logistic regressions examined the likelihood of having a good/poor...

Association between Weight Change, Health Outcomes, and Mortality in Older Residents in Long-Term Care

Objectives: Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the association among weight changes, health outcomes, and mortality in older residents of a skilled nursing facility. Methods: A 6-year retrospective chart review of residents of a long-term care facility was conducted, collecting monthly weights in...

Stroke Hospital Characteristics in the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities Study

Objectives: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics...

Colon Cancer Screening in Concierge Practice

Objectives: This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. Methods: We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the...

Effect of Diet Liberalization on Bowel Preparation

Objectives: Precolonoscopy dietary regimens often are restricted to clear liquids; however, the superiority of a clear liquid diet (CLD) for bowel preparation quality is ambiguous. We performed a meta-analysis of randomized trials comparing bowel preparation outcomes between a low-residue diet (LRD) or regular diet (RD) compared with a CLD. Methods: MEDLINE, clinicaltrials.gov, Cochrane Central Register, Scopus, Embase, Cumulative Index to...

Pirfenidone and Nintedanib for Treatment of Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis is one of the most common entities of the family of disorders known as the interstitial lung diseases. It is a chronic, progressive, and often-fatal disease with a median survival time of 3 to 5 years. In 2014 the US Food and Drug Administration approved pirfenidone and nintedanib, two antifibrotic agents for the treatment of idiopathic pulmonary fibrosis. Because these are the only drugs approved that can alter the...

Why Is Reverse Takotsubo “Reverse”?

Objectives: Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome simulating myocardial infarction that is characterized by transient wall motion abnormalities in the absence of coronary artery obstruction. Reverse TTC (rTTC) is a recently described variant of TTC. This review defines and compares both forms of TTC, stating their resemblances and differences. Methods: We conducted a search of the MEDLINE database. Forty-one cases of...

On “Battlefield Acupuncture: Is It Ready for Widespread Dissemination?”

To the Editor: You can easily call me schizophrenic. Not according to the medical definition but in the sense used by laypeople. In my article with Craig G. Gunderson, ‘‘Battlefield Acupuncture: Is it Ready for Widespread Dissemination?’’1 we conclude, after conducting a thorough literature search, ‘‘Although BFA is enticing because of its simplicity and low risk, in our opinion additional well-done studies need to be performed...

Physician Satisfaction in Treating Medically Unexplained Symptoms

Objectives: To determine whether treating conditions having medically unexplained symptoms is associated with lower physician satisfaction and higher ascribed patient responsibility, and to determine whether higher ascribed patient responsibility is associated with lower physician satisfaction in treating a given condition. Methods: We surveyed a nationally representative sample of 1504 US primary care physicians. Respondents were asked how...

Utility of Hemoccult Testing Before Therapeutic Anticoagulation in Venous Thromboembolism

Objectives: Fecal occult blood testing (FOBT) is performed routinely before starting therapeutic anticoagulation in patients despite it never being validated to predict gastrointestinal bleeding (GIB) risk. Our objective was to determine the utility in checking the guaiac FOBT test (gFOBT) before initiating therapeutic anticoagulation in patients with a new diagnosis of venous thromboembolism (VTE). Methods: This was a retrospective chart...

Aleukemic Myeloid Leukemia Cutis with a Kikuchi Disease–Like Inflammatory Pattern in Myelodysplastic Syndrome

Myeloid leukemia cutis (MLC) is a rare disease characterized by the infiltration of neoplastic myeloid, myelomonocytic, or monocytic precursors into the skin, producing clinically nonspecific-appearing papules, nodules, plaques, or purpura that necessitate biopsy for definitive diagnosis. In general, it is considered an extramedullary manifestation of acute myeloid leukemia (AML) similar to myeloid sarcoma, also known as a chloroma. MLC...

Autoimmune Neutropenia Updates: Etiology, Pathology, and Treatment

Autoimmune neutropenia (AIN) is defined as a neutrophil count...

Sleep Duration and C-Reactive Protein in US Adults

Objective: To use gender-stratified logistic regression analysis to examine the associations between elevated C-reactive protein (CRP; >3–10 mg/L) and sleep duration. Methods: The study sample included male (n = 5033) and female (n = 4917) adult (20 years old and older) participants in the 2007–2010 National Health and Nutrition Examination Survey. Sleep duration was categorized as short (≤6 hours/day), adequate (7–8 hours/day), or...

Comparison of QTc and Troponin Levels in ST Elevation MIs Compared with Non-ST Elevation MIs

Objectives: ST elevation myocardial infarctions (STEMIs) and non-ST elevation myocardial infarctions (NSTEMIs) have differences that can be important to differentiate. Our primary hypothesis was that corrected QT (QTc) duration and troponin I levels were higher in STEMIs compared with NSTEMIs. The objective of our study was to compare STEMIs with NSTEMIs for QTc duration and troponin levels. Methods: This was a retrospective case–control...

Analysis of Intensive Care Unit Admission and Sequelae in Patients Intravenously Abusing Extended-Release Oral Oxymorphone

Objectives: Prescription drug abuse is a major public health problem in the United States, with the rate of opioid-related deaths nearly quadrupling between 2000 and 2014. Extended-release oral oxymorphone hydrochloride (Opana ER) is a long-acting opioid prescribed for chronic pain; however, it also has the potential to be abused via intravenous injection. This retrospective review sought to analyze specific complications and sequelae requiring...