Iodixanol compared to iohexol for contrast procedures: a case-matched retrospective cohort study.

BACKGROUND: Previous studies that have attempted to evaluate the effectiveness of an iso-osmolar contrast medium (IOCM) iodixanol compared to a low-osmolar contrast medium (LOCM) for contrast procedures show variable results. PURPOSE: To evaluate the nephrotoxicity of the IOCM iodixanol compared to the LOCM iohexol. MATERIAL AND METHODS: We performed a retrospective cohort study from April 2004 to March 2006. All contrast procedures with a pre- and post-exposure creatinine value were evaluated for inclusion. Contrast nephropathy (CN) was defined as post-exposure creatinine elevation of > or = 25% or > 0.5 mg/dl within 7 days of contrast exposure. Cases of iodixanol exposure were matched to control cases of iohexol exposure (1:1) based on age, sex, presence of diabetes, pre-exposure creatinine value, and type of imaging study performed. We matched 397 cases of iodixanol (IOCM) exposure to 397 cases of iohexol (LOCM) exposure. Cases of iodixanol which could not be matched to controls were not included in the analysis. RESULTS: After adjustment for prior creatinine, medications, contrast iodine load, prior exposure to contrast material, heart failure, and hypertension, use of iodixanol did not significantly alter rates of CN compared to iohexol (OR 0.92, 95% CI 0.57-1.46; P = 0.71) or mortality (RR 0.79, 95% CI 0.59-1.06; P = 0.12). CONCLUSION: The use of the IOCM iodixanol was not associated with statistically significant protection against contrast nephropathy or all-cause mortality compared to a matched cohort of patients receiving the LOCM iohexol.

Use of a palliative care order set to improve resident comfort with symptom management in palliative care.

Although one-fourth of all medicare dollars are spent during the last year of life, symptom management for terminal hospitalized patients has continued to be inadequate. Quality end-of-life care is often overlooked, seldom taught and rarely measured within Internal Medicine Residency Programmes. We studied the effects of a palliative care order set and educational e-mail on resident comfort. Survey of residents showed that only 54% were comfortable across nine aspects of palliative care. Three months after release, 88% of residents were using the order set and 63% believed it increased their comfort with palliative care. Resident comfort managing palliative symptoms increased an average 10% (P = 0.02). First-year residents exposed to this order set increased in comfort from 40% to 65% (P < 0.0001), which significantly surpassed the 48% of second-year residents who reported being comfortable (P = 0.002). Introducing a palliative care order set improves resident comfort with symptom management in dying patients.

A large-scale evaluation of terminology integration characteristics.

OBJECTIVE: To describe terminology integration characteristics of local specialty specific and general vocabularies in order to facilitate the appropriate inclusion and mapping of these terms into a large-scale terminology. METHODS: We compared the sensitivity, specificity, positive predictive value, and positive likelihood ratios for Automated Term Composition to correctly map 9050 local specialty specific (dermatology) terms and 4994 local general terms to UMLS using Metaphrase. Results were systematically combined among exact matches, semantic type filtered matches, and non-filtered matches. For the general set, an analysis of semantic type filtering was performed. RESULTS: Dermatology exact matches defined a sensitivity of 51% (57% for general terms) and a specificity of 86% (92% general terms). Including semantic type filtered matches increased sensitivity (75% dermatology; 88% general); as did inclusion of non-filtered matches (98% and 99%). These inclusions correspondingly decreased specificity (filtered: 82% and 74%; non-filtered: 52% and 32%). Positive predictive values for exact matches (93.0% dermatology, 97.6% general) were improved by small but significant (p < 0.001) margins by including filtered matches (95.1% dermatology, 98.4% general) but decreased with non-filtered matches (89.2% dermatology, 87.8% general). Adding additional semantic types to the filtering algorithm failed to improve the positive predictive value or the positive likelihood ratio of term mapping, in spite of a 2.3% improvement in sensitivity. CONCLUSIONS: Automated methods for mapping local "colloquial" terminologies to large-scale controlled health vocabulary systems are practical (ppv 95% dermatology, 98% general). Semantic type filtering improves specificity without sacrificing sensitivity and yields high positive predictive values in every set analyzed.