Practice Management

In the Literature

LITERATURE AT A GLANCE

Use this guide to find the abstracts below that correspond to these recent clinical findings

Would 24-hour Hospital Clinic Reduce LOS, Stroke Risk?

Background: Transient ischemic attacks (TIA) precede up to 25% of completed strokes and can provide opportunity for critical intervention if identified early. A specialty clinic with immediate access to imaging facilities could provide early identification and intervention.

Study design: Cohort study statistical analysis of data.

Setting: SOS-TIA hospital clinic in Paris.

Synopsis: A leaflet about TIA with a toll-free telephone number for SOS-TIA was sent to 15,000 family doctors, cardiologists, neurologists, and ophthalmologists in Paris. Between January 2003 and December 2005, 1,085 patients with suspected TIA were admitted to the clinic. The median duration of symptoms was 15 minutes. All patients were started on a stroke-prevention program, 5% had urgent carotid revascularization, and 5% were treated for atrial fibrillation with anticoagulants. Further, 74% of all patients seen were sent home the same day. The 90-day stroke rate was 1.24%; the rate predicted was 5.96%. Limitations of the study included selective patient recruitment from family doctors and office-based specialists. Also, the study lacked a randomized control group.

Bottom line: Prompt evaluation and treatment of patients in a dedicated TIA clinic is associated with a lower stroke risk. The TIA clinic also may lower costs via decreased length of hospital stay.

Citation: Lavallee P, Meseguer E, Abboud H, et al. A transient ischemic attack clinic with round the clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6(11):953-960.

CLINICAL SHORTS

West of Scotland Coronary Prevention Study Shows Benefit 10 Years Out

This was a post-trial data comparison of clinical outcomes comparing Pravastatin with placebo in men showing the combined outcome of death from coronary heart disease or myocardial infarction was reduced from 7.9% to 5.5% 10 years after trial completion.

Citation: Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe SM. Long-term follow-up of the west of Scotland Coronary Prevention Study. N Engl J Med. 2007;357:1477-1486.

Quality of Care Lower for Medicaid Population

Synopsis: A study of 383 managed-care health plans compared the quality of care provided to Medicaid enrollees using eleven quality indicators (HEDIS). The study concluded that Medicaid managed care enrollees received lower quality care than they received by commercial managed care enrollees.

Citation: Landon BE, Schneider EC, Normand S-LT, Scholle SH, Pawlson LG, Epstein AM. Quality of care in Medicaid managed care and commercial health plans. JAMA. 2007;298:1674-1681.

Discharge Communication with Elderly Patients Insufficient

This cross-sectional telephone survey of 269 patients age 70 years or older demonstrated significant gaps in communication between patients and hospital staff at the discharge interface. Patients receiving both verbal and written instructions were more likely to understand the discharges instructions.

Citation: Flacker J, Park W, Sims A. Hospital discharge information and older patients: do they get what they need? J. Hosp Med. 2007;2:291-296.

Social Issues Implicated in Hospital Readmission

This semistructured, open-ended interview conducted with 21 patients demonstrated that difficult life and social circumstances outside the hospital can be as significant to clinical recovery and hospital readmission as the discharge system and coordination of care.

Citation: Strunin L, Stone M, Jack B. Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization? J Hosp Med. 2007;2:297-304.

Recognize Barriers to Patient Mobility in the Hospital

The study design consisted of qualitative interviews with 29 participants (including patients, nurses, and resident physicians). The findings indicated that there were multiple barriers affecting patient mobility including patient, treatment, institutional, and attitudinal factors. There was a divergence between patient and healthcare providers regarding the cause of attitudinal barriers.

Citation: Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. J Hosp Med. 2007;2:305-313.

Prior Pneumococcal Vaccination Improves Outcomes in Patients with CAP

This was a prospective study that involved 3,415 adults admitted with community-acquired pneumonia to six hospitals between 2000 and 2002. It demonstrated that previous inoculation with pneumococcal vaccine leads to better outcomes in those patients who go on to develop pneumonia and require hospitalization. These patients had a 40% relative reduction in hospital mortality or need for ICU admission.

Citation: Johnstone J, Marrie TJ, Eurich DT, Majumdar SR. Effect of pneumococcal vaccination in hospitalized adults with community-acquired pneumonia. Arch Intern Med. 2007;167:1938-1943.

Serum Calcium Level Predicts Stroke Volume

This was an analysis of data involving 173 patients with acute ischemic stroke whose total serum calcium levels were measured on admission. Higher serum calcium levels were associated with smaller cerebral infarct volumes.

Citation: Buck B, Liebeskind DS, Saver JL, et al. Association of higher serum calcium levels with smaller infarct volumes in acute ischemic stroke. Arch of Neurology 2007;64:1287-1291.

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