Assuntos
Viscosidade Sanguínea , Doenças Hematológicas/diagnóstico , Mieloma Múltiplo/diagnóstico , Dor nas Costas/etiologia , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Feminino , Doenças Hematológicas/sangue , Doenças Hematológicas/etiologia , Doenças Hematológicas/terapia , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Plasmaferese , SíndromeAssuntos
Amiloidose de Cadeia Leve de Imunoglobulina , Bortezomib/administração & dosagem , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Hemorragia/sangue , Hemorragia/diagnóstico , Hemorragia/tratamento farmacológico , Hemorragia/patologia , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Amiloidose de Cadeia Leve de Imunoglobulina/tratamento farmacológico , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Leiomioma/sangue , Leiomioma/diagnóstico , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Melfalan/administração & dosagem , Pessoa de Meia-IdadeRESUMO
To prevent death, necrotizing soft-tissue infections should be diagnosed quickly and treated with broad-spectrum antibiotics and surgical debridement.
Assuntos
Idioma , Exame Físico , Relações Médico-Paciente , Hospitais de Ensino , Humanismo , Humanos , Internato e Residência , Prontuários MédicosRESUMO
BACKGROUND: Bacteremia and its complications are important causes of morbidity and mortality in hospitalized patients. However, the yield of blood cultures is relatively low, with many false-positive results from bacterial contamination. METHODS: We investigated the relationship between patient food consumption and the presence of bacteremia. This was an observational analysis of a cohort of 1179 patients who underwent blood culture analysis between January 2005 and December 2009. Patients with anorexia-inducing conditions, such as gastrointestinal illness and malignant disease treated with chemotherapy, were excluded. Food consumption was rated by nurses as the percentage of food consumed during the meal preceding the blood culture. Groupings were as follows: low consumption (<50%), moderate (>50% to <80%), and high (>80%). RESULTS: Low consumption was observed in 39.8% of patients, moderate in 17.8%, and high in 41.6%. The average body temperature was 38.1 ± 1.1°C. Bacteremia was present in 18.5%, 3.9%, and 1.4% of patients in the low, moderate, and high food consumption groups, respectively. The negative predictive value was 98.3%, suggesting that bacteremia is very unlikely in the setting of good food intake. CONCLUSION: Bacteremia is an unlikely occurrence in hospitalized patients who maintain adequate food consumption at the time of blood culture.
Assuntos
Bacteriemia/diagnóstico , Sangue/microbiologia , Alimentos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Técnicas Bacteriológicas , Temperatura Corporal , Estudos de Coortes , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesAssuntos
Toxinas Botulínicas Tipo A/isolamento & purificação , Botulismo/diagnóstico , Clostridium botulinum tipo A , Oftalmoplegia/etiologia , Idoso , Botulismo/complicações , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Dispneia/etiologia , Humanos , Masculino , Nistagmo Patológico/etiologia , Distúrbios da Fala/etiologia , Verduras/enzimologia , Verduras/microbiologiaAssuntos
Medula Óssea/patologia , Hepatite C Crônica/complicações , Linfo-Histiocitose Hemofagocítica/patologia , Anemia/etiologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Confusão/etiologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Ferritinas/sangue , Febre/etiologia , Humanos , Infecções/diagnóstico , Falência Hepática/etiologia , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Pessoa de Meia-Idade , Radiografia Abdominal , Trombocitopenia/etiologia , Tomografia Computadorizada por Raios XRESUMO
The concept of thresholds plays a vital role in decisions involving the initiation, continuation, and completion of diagnostic testing. Much research has focused on the development of explicit thresholds, in the form of practice guidelines and decision analyses. However, these tools are used infrequently; most medical decisions are made at the bedside, using implicit thresholds. Study of these thresholds can lead to a deeper understanding of clinical decision making. The authors examine some factors constituting individual clinicians' implicit thresholds. They propose a model for static thresholds using the concept of situational gravity to explain why some thresholds are high, and some low. Next, they consider the hypothetical effects of incorrect placement of thresholds (miscalibration) and changes to thresholds during diagnosis (manipulation). They demonstrate these concepts using common clinical scenarios. Through analysis of miscalibration of thresholds, the authors demonstrate some common maladaptive clinical behaviors, which are nevertheless internally consistent. They then explain how manipulation of thresholds gives rise to common cognitive heuristics including premature closure and anchoring. They also discuss the case where no threshold has been exceeded despite exhaustive collection of data, which commonly leads to application of the availability or representativeness heuristics. Awareness of implicit thresholds allows for a more effective understanding of the processes of medical decision making and, possibly, to the avoidance of detrimental heuristics and their associated medical errors. Research toward accurately defining these thresholds for individual physicians and toward determining their dynamic properties during the diagnostic process may yield valuable insights.
Assuntos
Tomada de Decisões , Diagnóstico , Padrões de Prática Médica/normasAssuntos
Hipertensão/etiologia , Insuficiência Renal/etiologia , Escleroderma Sistêmico/diagnóstico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Análise Química do Sangue , Diagnóstico Diferencial , Edema/etiologia , Feminino , Humanos , Rim/patologia , Pessoa de Meia-Idade , Doença de Raynaud/complicações , Insuficiência Renal/patologia , Escleroderma Sistêmico/complicações , Automedicação , Urticária/etiologiaRESUMO
A case of a 78-year-old man with transitional cell carcinoma and a paraneoplastic leukemoid reaction. The leukocytosis was present at the diagnosis of carcinoma. It dissipated with complete tumor resection, was absent when a surveillance computed tomography scan showed no evidence of recurrence at 6 months, and had returned with tumor recurrence at 8 months. This case demonstrates that a paraneoplastic leukemoid reaction can be used as a tumor marker in cases of transitional cell carcinoma when a leukemoid reaction is found at presentation.