Archive for October 2012

Civil War Medicine

There are troves of books archiving Civil War medicine.  It is a subject of interest for me, so this short piece in the NYT today caught my eye.  In particular, it focuses more on the medical than surgical realm, so as internists the lessons should hit home. As the war interfaced between periods--horse-and-buggy and industrial, accounts from soldiers of the day make for interesting reading and serve as a good comparison between then and now.  The battlefield and the treatment of our wounded currently is worlds apart, and the lessons learned not just from the Civil War, but all wars, is how our field advances.  Again, see WWII and Vietnam as illustrative examples.  This quote from the piece sums it up nicely: The Union Surgeon General, William A. Hammond, famously claimed the Civil War “was fought at the end of the medical Middle Ages.” The following are notable excerpts.  Of note,…

Serum procalcitonin can help with indeterminate pneumonia

In this prospective analysis of 528 adults with acute respiratory illness, procalcitonin was significantly higher in those with pneumonia compared to those with COPD, asthma, or acute bronchitis. In those with indeterminate chest X-rays, procalcitonin had an AUC of 0.72, indicating moderate accuracy in predicting pneumonia. (abstract)

1 in 7 elderly admitted with an injury are readmitted within 30 days

This large retrospective cohort of elderly patients admitted with an injury found 14 % of them were readmitted within 30 days after discharge. Risk factors for readmission included those who had a transfusion, an infection, or a patient safety indicator. Those discharged to nursing homes or with home health were more likely to be readmitted than those discharged home. Readmission reduction tactics should consider the site of discharge, and the prevention of complications during the index admission (abstract)

Cancer patients often overestimate chemo in metastatic cancer

In this study of patients with metastatic lung or colon cancer, about 3/4 reported not understanding that chemotherapy was not going to cure their cancer. This misunderstanding was more common in nonwhite and Hispanics, and among those who rated their physician communication as being good. Many patients with incurable cancer do not understand that chemo is not curative (abstract).

Anti-arrhythmics vs ablation for paroxysmal Afib

In this large randomized trial of patients with symptomatic paroxysmal Afib, they were randomized to treatment with radiofrequency ablation, or Class IC / III anti-arrhythmics. There was no difference in rates of freedom from Afib between the groups at up to 18 months follow up, but the rates at 24 months were lower in the ablation group (93% vs 84%). However, in the ablation group, there was 1 procedure-related death, and 3 cases of tamponade. Given the risks, anti-arryhthmics should be tried before ablation in patients with symptomatic paroxysmal Afib. (abstract)