[THE SCHIZOPHRENIC PATIENT IN THE DEPARTMENT OF MEDICINE IN THE 21ST CENTURY: IS THERE ANYTHING NEW UNDER THE SUN?]

INTRODUCTION: A retrospective analysis of information from the computerized data of the Emek Medical Center (EMC) and Clalit Community Healthcare Services (CCHS) was conducted. Two hundred and seventy-five SPs and four hundred and twenty eight NPPs were enrolled in the study. AIMS: Patients returning to the emergency room, and re-hospitalizations in the internal medicine wards. BACKGROUND: Schizophrenic patients (SPs) are at risk for organic co-morbidities and tend to be excessively hospitalized in medical departments. It is important to understand the pattern of SP re-admissions to emergency rooms and medical departments in order to avoid re-hospitalizations. OBJECTIVES: To compare re-admissions to medical emergency rooms and medical departments between SP and non-psychiatric patients (NPPs) and to assess the changes that took place during the years 2001-2011. RESULTS: The likelihood that SPs would be referred to the ER during the first 6 months after discharge was 1.51 (95% CI 1.10-2.07), higher than in NPPs. The likelihood of being re-hospitalized in medical departments during the first 6 months after discharge was higher in SPs but did not reach statistical significance (26.18% among SPs vs.20.09% among NPPs (P = 0.059). The time from the index hospitalization to re-hospitalization during the first year was shorter in the SPs when compared with NPPs (P=0.0032). CONCLUSIONS: Medical patients with schizophrenia tend to be referred to the medical emergency room and to be re-hospitalized after their index hospitalization. The integration of medical and psychiatric systems may improve their medical care and reduce their re-admission rates.

Pattern of Blood Pressure Response in Patients With Severe Asymptomatic Hypertension Treated in the Emergency Department.

Severe asymptomatic hypertension (SAH) is a common cause of emergency department (ED) visits. Despite recommendations against using short-acting blood pressure (BP)-lowering drugs in the ED, it is still a common practice. The authors characterized BP response in the ED utilizing 24-hour ambulatory BP monitoring (ABPM). Patients with SAH who were not admitted to the hospital were recruited. All patients underwent 24-hour ABPM. A total of 21 patients (14 females) with a mean age of 58±16 years were studied. BP decreased from 199±16/101±17 mm Hg to 154±34/83±23 mm Hg after 5 hours but then rose to 174±25/94±17 mm Hg after 19 hours. In 17 patients, systolic BP was ≥180 mm Hg after 6.7±5.3 hours. Two patients experienced severe hypotension (systolic BP <90 mm Hg). Thus, data from a single site in Israel support the current recommendations for management of SAH in the ED.

Prosthetic vascular graft infections between blood and concordance of graft culture pathogen.

INTRODUCTION: Prosthetic vascular graft infection (PVGI) is an infrequent and potentially fatal complication of abdominal aortic aneurysm surgery and occlusive vascular disease. The predictive value of blood cultures in accurately identifying the causative pathogen (or pathogens) has not been determined. METHODS: We studied the compatibility between results of blood and graft cultures obtained from patients suffering from late-onset (>4 months after surgery) infections of abdominal prosthetic vascular grafts. RESULTS: Among 17 patients who suffered from late-onset abdominal PVGI, only in 3 patients (17.6%), the same microorganisms isolated from blood cultures were also identified by direct cultures from excised grafts or perigraft tissues. Three patients (17.6%) had negative blood cultures and the rest (n = 11; 64.7%) had different growth of microorganisms from the blood and graft cultures. Three patients were diagnosed with chronic Q fever vascular graft infection, all of whom had positive blood cultures. On the basis of graft cultures, Staphylococcus epidermidis and Escherichia coli were responsible for nearly 50% of cases. CONCLUSION: The yield of blood cultures in late-onset abdominal PVGIs is low. Presence of microorganisms in blood cultures does not necessarily indicate a causal relationship with graft infection. An empirical broad-spectrum antimicrobial therapy is advised in all suspected cases until a definitive etiology has been made.