Journal of academic hospital medicine, volume 7, issue 4 (2015 October-December)

Permanent URI for this collection

https://hdl.handle.net/10355/65710

Table of Contents
Research Article
- The Effect of Medication Prophylaxis on the Incidence of Delirium in Elderly Patients Undergoing Orthopedic Surgery: A Meta-Analysis / Nila Manandhar, MD, Syed Naqvi, MD
Review Article
- Dialysis in the Acute Setting / Kunal Malhotra, MD
Ask a Specialist
- Ask a Pathologist / Jessica Kneib, DO, Emily Coberly, MD
Case Report
- Meckel’s Diverticulum found on Virtual Capsule Endoscopy / Amar Mandali, MD, Benjamin Hinrichs, MD, Tanvi Dhere, MD

[Collection created September 4, 2018]

Browse

Now showing 1 - 5 of 5

Dialysis in the acute setting
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-10) Malhotra, Kunal
Acute kidney injury (AKI) is frequently encountered in the hospital setting. It may be present on admission or may develop during the hospital stay. Early and consistent recognition of AKI has been a challenge. This has led to the development of RIFLE and AKIN criteria for the definition of AKI. Acute Kidney Injury Network (AKIN) defines AKI as an abrupt (within 48 hours), absolute increase in the serum creatinine concentration of [greater than or equal to]0.3 mg/dL from baseline; a percentage increase in the serum creatinine concentration of [greater than or equal to]50 percent; or oliguria of [less than]0.5 mL/kg per hour for more than six hours. Additionally, the definition should be applied after volume resuscitation and exclusion of urinary tract obstruction if oliguria was used as the sole criterion[1].
Clincial Research : The effect of medication prophylaxis on the incidence of delirium in elderly patients undergoing orthopedic surgery : A meta-analysis
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-10) Manandhar, Nila; Naqvi, Syed
Delirium is common in the post-operative period in patients who have undergone orthopedic surgery, and the elderly are especially vulnerable. It leads to increased costs, longer hospital stays and higher rates of discharge to inpatient institutions. Various medications are being utilized to prevent the development of delirium, but there are only a few small studies investigating these agents in randomized controlled trials. This meta-analysis examined whether delirium could be prevented with pharmaceutical agents. : A search was performed for randomized controlled trials from the last ten years, which used medications for delirium prophylaxis in the study population of elderly patients undergoing orthopedic surgery. A random-effects model was used to calculate odds ratios for the incidence of delirium as well as length of hospital stay, a secondary outcome. : 943 patients from four trials were included in the meta-analysis, and results did not show significance in incidence of delirium in patients who received medication compared to those who were given placebo (OR 0.52, 95[percent] CI 0.21, 1.31). Data for secondary outcome of length of hospital stay also did not show a significant difference (mean difference -1.4, 90[percent] CI -3.30, 0.51). : Prophylactic medication in elderly patients undergoing orthopedic surgery does not decrease the incidence of delirium or length of hospital stay. These results may be in part due to a high level of heterogeneity and small sample sizes. More randomized controlled trials are needed to examine delirium prophylaxis, as an effective pharmaceutical agent could lead to better outcomes for patients.
Table of Contents
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-10)
Ask a pathologist
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-10) Kneib, Jessica; Coberly, Emily
Question: While completing the transfusion of one unit of packed red blood cells, my patient's temperature rose from 37.2 degrees C to 38.4 degrees C, without any other associated symptoms. What are the next steps I should take and what could be causing this reaction?
Case Reports : Meckel's diverticulum found on virtual capsule endoscopy
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-10) Mandalia, Amar; Hinrichs, Benjamin; Dhere, Tanvi
A healthy 39-year-old Caucasian male presented to an emergency department with three episodes of hematochezia over two days, along with a syncopal episode and diaphoresis. An upper endoscopy revealed mild esophagitis and a non-bleeding erosion in the duodenal bulb, and colonoscopy was unrevealing. Capsule endoscopy revealed an ulcerated diverticulum in the ileum (Figure A). A subsequent Meckel's scan (Figure B) with single photon emission computed tomography and pre-administration of cimetidine demonstrated activity in the right lower quadrant, likely in the ileum (, which indicated a Meckel's diverticulum (MD). He underwent a laparoscopic small bowel resection of the affected portion of the ileum, which on pathology was consistent with MD (Figures C and D).

Browse

Recent Submissions