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Medical News from Journal Watch

Medical News from Journal Watch

Brief reviews of current news that affects your practice — from medical journals, government agencies, scientific conferences, and major media reports.

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November 6, 2009

CDC Stroke Registry Suggests Ways to Improve Care

In treating stroke, both physicians and the public can improve their roles, according to a 3-year analysis of results published in MMWR.

Data on some 60,000 patients with stroke from Georgia, Illinois, Massachusetts, and North Carolina were entered into the federally sponsored Paul Coverdell National Acute Stroke Registry between 2005 and 2007. Stroke types were as follows: hemorrhagic, 14%; ischemic, 56%; transient ischemic attack, 22%; and "ill-defined," 7%.

Researchers examined 10 treatment performance measures and their use among eligible patients. Among the results:

Over a third of patients used private transportation rather than emergency medical services to get to the hospital.
Only about 20% arrived at the hospital within 2 hours of symptom onset.
Almost all got antithrombotic therapy at discharge (98%) and within 48 hours of admission (95%).
About two thirds of those eligible received lipid-level testing.
About a third of those eligible received tissue plasminogen activator.

LINK(S):

MMWR Surveillance Summaries article (Free)

Published in Physician's First Watch November 6, 2009

November 5, 2009

'On-Demand' vs. Daily Chest Radiographs for Patients on Mechanical Ventilation

For mechanically ventilated ICU patients, performing chest radiographs as needed rather than daily can lead to more efficient care without compromising patients' safety, according to a Lancet study.

The study included 21 ICUs and nearly 850 patients in France. The ICUs were randomized to perform daily chest radiographs, or to follow an "on-demand" strategy whereby radiographs were performed only if necessary based on patients' morning exams (all ICUs performed additional radiographs as needed throughout the day). The ICUs followed their randomized strategy until all patients were discharged or had been on ventilation for 30 days. Then, they crossed over to the other strategy.

The mean number of radiographs per patient-day was 32% lower with on-demand than with daily radiographs (0.75 vs. 1.09). This reduction was achieved without adverse effects on mortality, number of days on ventilation, or length of ICU stay.

The authors say their findings "strongly support" on-demand radiography over a routine strategy.