Use of a once-daily NSAID in treatment of cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is a rare disorder characterized by episodes of intense vomiting and nausea separated by symptom-free periods. We report the case of a 71-year-old man who presented with a long history of poorly controlled CVS whose symptoms resolved with the addition of a once-daily dose of meloxicam, a semi-selective non-steroidal anti-inflammatory drug (NSAID). This is the first report of symptom alleviation in a CVS patient using a once-daily NSAID, as well as one with selectivity to COX-2 inhibition. This is important due to both the increased compliance seen with once-daily medications, as well as the decreased gastrointestinal effects seen with selective COX-2 inhibitors compared to nonselective NSAIDS.

A protocol based, electronic medical record enabled care coordination system improves the timeliness and efficiency of care for patients with hematuria.

PURPOSE: We determined whether including a care coordination system to manage the referral process for hematuria would lead to improved quality of care. MATERIALS AND METHODS: Inflection Navigator, a protocol based, electronic medical record enabled care coordination system, was developed to support primary care physicians evaluating newly discovered hematuria. We studied the system for patients referred for microscopic and gross hematuria from May 2009 to May 2010. We compared outcomes in these 106 patients and in 105 referred to our urology department for hematuria during the same period who did not use the system. RESULTS: Patients in the care coordination group completed the evaluation in a significantly shorter time with more than a 1-month difference in time between referral and the completion of the imaging and cystoscopy components of the assessment (mean 40.9 vs 74.1 days, p <0.05). This system potentially lowered health care costs by decreasing the mean ± SD number of urology visits needed to complete an evaluation from 2.1 ± 1.5 in the standard referral group to 1.6 ± 1.4 in the care coordination group (p <0.05). CONCLUSIONS: A protocol based care coordination system for hematuria decreased the time needed to complete an evaluation and decreased the number of overall visits required to make a final diagnosis. Thus, the Inflection Navigator system is an example of an electronic medical record enabled process innovation that can improve the efficiency of care while potentially lowering health care costs.