Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed.

PURPOSE: The indications for requesting a diagnostic test are important for the selection and timing of imaging protocols. We sought to evaluate the diagnostic yield and impact on patient disposition when evaluating computed tomography (CT) of the abdomen and pelvis in adult patients presenting with gastrointestinal bleeding (GIB) to the Emergency Department (ED). METHODS: This study was an observational cohort study of consecutive adult ED patients with ICD10 codes related to GIB between 5/5/2018 and 6/1/2020. CT reports were reviewed for indications, exam type and findings. Reports were classified as positive (active bleeding, recent bleeding or suspected etiology for GIB), negative or other significant findings. Methodological guidelines for reporting observational studies were followed (STROBE). RESULTS: Among 943 patients with GIB during the study period, 33% (n = 312) had an abdominopelvic CT ordered. Most CTs included contrast, 64.1% (n = 200) used a single portal venous phase and 28.9% (n = 90) were multi-phase. CT identified active bleeding in 4.2% (n = 13/312) and intraluminal blood in 2.9% (n = 9/312) patients. Patients that had GIB indications on the CT order (n = 142) were more likely to receive a multiphase study compared to those without GIB indication (n = 94) (43.0% vs. 8.5%, difference 34.5%, 95% CI 23.7% to 43.7%, p < 0.0001). Patients that received multiphase studies were more likely to have a source of GIB identified compared to single-phase (18.9% vs 1.5%, OR 15.3, 95% CI 4.4 to 53.7, p < 0.0001). In 40.3% (n = 117/290) of patients without bleeding, an intra-abdominal cause for their symptoms was identified. Those with GIB or with an identified cause were more likely to be admitted. CONCLUSIONS: One-third of patients evaluated in the ED with GIB had a CT ordered. Active GIB was detected more often when multiphase exams were performed. Multiphase exams are done more often if GIB is listed in the CT indication. When a CT is positive, patients are more likely to be admitted or observed. Accurate indications are critical to optimize exam performance.

CNS metastases of carcinoma ex pleomorphic adenoma of the parotid gland.

Pleomorphic adenomas (PAs), also known as benign mixed tumors, are common tumors of the parotid gland. These tumors occasionally undergo malignant transformation, with potentially devastating consequences. This case report presents the clinical and radiographic features of a rare case of biopsy proved brain and spinal cord metastases arising from carcinoma ex PA of the parotid gland.

Improved vectors for expression library immunization--application to Mycoplasma hyopneumoniae infection in pigs.

Expression library immunization (ELI) has previously been used in a number of disease models in mice. Here, we describe the first example of the application of ELI to a large animal model with the immunization of pigs against enzootic pneumonia, a disease caused by Mycoplasma hyopneumoniae. The development of new plasmid vectors and library screening methods facilitated the application of ELI to this disease by allowing random libraries to be screened for clones expressing recombinant proteins. In this way the vast majority of clones in random libraries that are unproductive can be eliminated, meaning that libraries are more likely to give protection and are subsequently easier to further screen and analyze. By using this approach we have used one library screen and two animal trials to progress from an original library of 20,000 clones to a group of just 96 clones.

The head nurse role in redesign.

As administrators review how best to meet patient's needs and redesign patient care givers' job content, as well as introduce multiskilled workers to the patient care unit, the head nurse role must be reviewed and revamped at the same time. The author describes the experiences of two different institutions in overloading the head nurses with reporting relationships that they were ill-equipped to supervise. The solution in both institutions was the same, and emphasizes the need for interactive planning for these complex and interdependent models.

The managed care-hospital relationship. Part 2 of 2.

When asked what they look for in a participating hospital, the managed care companies all had the same initial response: quality. But they also indicated that providers combining quality care with cost-containment measures are looked upon most favorably.

Responding to patients: the unit hostess.

As acuity levels increase and nurses are busier with the increased intensity of their patients' procedures and treatments, what happens to the basic amenities so important to patients? The author discusses one institution's approach to satisfying basic patient needs while still continuing to provide complex nursing care.

Vice-president of medicine/vice-president of nursing. Collaboration or conflict?

In the current environment of Diagnosis Related Groups and competition for the health care market share, there is a significant increase of vice-president of medical affairs or medical director positions on the hospital management team. This partnership is seen as vital for the survival of private practice physicians and hospitals. What does the addition of this role mean to the nursing administrator? What is the likelihood of a confusion of responsibilities between the vice-president of nursing and the vice-president of medical affairs or medical director? What involvement should the vice-president of nursing have in the vice-president of medical affairs or medical director's job description? These are some of the questions discussed in this article.