Stroke: Journal of the American Heart Association
Source reference:
Rose K, et al “Predictors of time from hospital arrival to initial brain-imaging among suspected stroke patients: the North Carolina Collaborative Stroke Registry” Stroke 2008; DOI: 10.1161/STROKEAHA.108.524686.

MedPage Today (http://www.medpagetoday.com/Neurology/Strokes/tb/10471): “Three-quarters of the stroke patients who arrive at the hospital within two hours of symptom onset are not getting the appropriate care, researchers found. 

Of 3,549 stroke patients who arrived at a North Carolina hospital quickly, only 23.6% received a diagnostic CT scan within 25 minutes, as recommended, Kathryn Rose, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues reported online in Stroke: Journal of the American Heart Association…The authors acknowledged some limitations of the study, including the fact that they captured only when a CT scan was performed, not when it was read. ”

ABSTRACT

Background and Purpose—We examined patient demographic and hospital characteristics and clinical predictors of delay time from hospital arrival until CT among 20 374 patients enrolled in the North Carolina Collaborative Stroke Registry (January 2005 to April 2008).

Methods—Delay time was log-transformed in linear regression analyses and dichotomized (<25 minutes, >25 minutes) in logistic regression analyses to correspond to a 1999 National Institute of Neurological Disorders and Stroke guideline.

Results—In multiple linear regression analyses, prehospital delay time, mode of transport, race, gender, presumptive diagnosis, time of day of arrival, weekday versus weekend arrival, and hospital type (defined by Joint Commission Primary Stroke Center certification and teaching status) were significantly associated with CT delay. In analyses of 3549 patients arriving within 2 hours of symptom onset, time of day of arrival and weekday versus weekend arrival were no longer significant. Among patients arriving within 2 hours of symptom onset, the strongest independent predictors of meeting the National Institute of Neurological Disorders and Stroke (NINDS) guideline were arrival by emergency medical services versus other modes of transportation (odds ratio, 95% CI=2.3 [1.9, 2.8]) and a presumptive diagnosis of transient ischemic attack versus unspecified stroke type (odds ratio, 95% CI=0.4 [0.3, 0.5]).

Conclusions—Most patients do not arrive to the hospital in a timely manner and cannot be considered for time-dependent therapies. Among those that do, disparities exist in time to receipt of CT scan, suggesting room for improvement in hospital-level stroke systems of care.

Infection Control Monitor, 8/8/08:  “Ancient warriors knew that if they sharpened their bronze or copper sword and put the shavings into a wound, it would not get infected.     

Along with his colleagues, Michael Schmidt, Ph.D., a microbiologist at the Medical University of South Carolina (MUSC) in Charleston, is now testing the ancient idea of using copper to reduce the transmission of infections, according to TheDenverChannel.com.

Copper is microbiocidal and kills bacteria on contact. MUSC researchers are now seeing if placing copper in the proximity of patients will short circuit the transfer of microorganisms from the environment to the patient, as Schmidt told the television station. Researchers are installing copper in vital places in the hospital to reduce the transmission of disease, such as bed tray tables, visitor chairs, computer keyboards and mice, bed rails, and nurse call buttons—all areas that can be contaminated with germs.
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Schmidt hopes, “by putting metallic copper onto these surfaces, we are going to reduce the concentration of indigenous microbes in the room to a level that will drop the incidence of hospital-acquired infections.” The current study, which will test how installing copper surfaces translates to hospital infection rates, will include MUSC, the VA Medical Center in Charleston, and Memorial Sloan-Kettering Cancer Center in New York City, the station reported.”

Intro:  Research on the usefulness of antibiotics in COPD patients concluded that  ”Treatment with antibiotics in addition to oral corticosteroids was associated with a longer time to the next exacerbation, and a decreased risk of developing a new exacerbation.”  The study came out of The Netherlands.  Not only did it seem that the Dutch patients did better on antibiotics, but their wooden shoes didn’t require as manyre-solings. 

MedWire, 7/8/08 (http://www.medwire-news.md/48/76872/Respiratory_News/Antibiotics_combat_COPD_exacerbations.html):

“Patients with chronic obstructive pulmonary disease (COPD) can reduce their risk for suffering an exacerbation by taking antibiotics in addition to oral corticosteroids, researchers report.

Berendina Roede (University of Amsterdam, The Netherlands) and team studied data on 49,599 Dutch patients with COPD.

A total of 18,928 patients experienced at least one exacerbation between 2003 and 2006. Of these, 52% received treatment with antibiotics as well as oral corticosteroids or other respiratory medications, while the remainder received no antibiotic treatment.

The researchers found that the average time to a second exacerbation in patients who initially received antibiotics was 418 days, compared with 321 days in those who did not receive antibiotics.

Furthermore, the average time to a third exacerbation was 240 days in the antibiotic group compared with just 127 days in the other group.

The protective effect of antibiotics against further exacerbations was greatest during the first 3 months after treatment.

The researchers also found that treatment with antibiotics was associated with improved survival during the monitoring period…”

MedWire, 8/7/08 (http://www.medwire-news.md/48/76870/Respiratory_News/Viral_infections_increase_exacerbations_in_COPD_patients.html): 

“Respiratory viral infections significantly increase the risk for exacerbations in patients with chronic obstructive pulmonary disease (COPD), researchers report…

“…Bacterial infections are associated with about half of all COPD exacerbations, but less is known about the role of viral infections, the authors explain.

To investigate further, they collected data from 136 patients with COPD who were experiencing an exacerbation, 68 with stable COPD and 16 disease-free smokers.

All the participants underwent lung tests and provided sputum samples that were examined for the presence of 12 different respiratory viruses.

The team found that 37% of COPD patients who were experiencing an exacerbation were infected with a respiratory virus, compared with just 12% of patients with stable COPD and 12% of smokers without the condition.

In addition, six patients experiencing an exacerbation were infected with more than one respiratory virus, whereas none of the other participants had a dual infection.

Rhinoviruses, which cause the common cold, were the most common viruses identified among the participants.

McManus and team conclude: “This study supports the hypothesis that respiratory viral infection is associated with exacerbations of COPD.”