OBJECTIVE -Our objective was to compare the performance of oral glucose tolerance tests (OGTTs) and multivariate models incorporating commonly available clinical variables in their ability to predict future cardiovascular disease (CVD).RESEARCH DESIGN AND METHODS -We randomly selected 2,662 MexicanAmericans and 1,595 non-Hispanic whites, 25-64 years of age, who were free of both CVD and known diabetes at baseline from several San Antonio census tracts. Medical history, cigarette smoking history, BMI, blood pressure, fasting and 2-h plasma glucose and serum insulin levels, triglyceride level, and fasting serum total, LDL, and HDL cholesterol levels were obtained at baseline. CVD developed in 88 Mexican-Americans and 71 non-Hispanic whites after 7-8 years of follow-up. Stepwise multiple logistic regression models were developed to predict incident CVD. The areas under receiver operator characteristic (ROC) curves were used to assess the predictive power of these models.RESULTS -The area under the 2-h glucose ROC curve was modestly but not significantly greater than under the fasting glucose curve, but both were relatively weak predictors of CVD. The areas under the ROC curves for the multivariate models incorporating readily available clinical variables other than 2-h glucose were substantially and significantly greater than under the glucose ROC curves. Addition of 2-h glucose to these models did not improve their predicting power.CONCLUSIONS -Better identification of individuals at high risk for CVD can be achieved with simple predicting models than with OGTTs, and the addition of the latter adds little if anything to the predictive power of the model. Diabetes Care 25:1851-1856, 2002A principal reason that is typically given for screening large segments of the population with 2-h oral glucose tolerance tests (OGTTs) is to identify individuals with impaired glucose tolerance (IGT), because such individuals are at increased risk for diabetes. We have previously shown that individuals at high risk for diabetes can be more efficiently identified using multivariate models that do not require OGTT (1). A second reason that is typically given for screening the population for IGT is that individuals with this condition are also at increased risk for cardiovascular disease (CVD) (2,3). In this study, we examine the possibility that as good or superior identification of individuals at high risk for CVD can be achieved using readily available clinical measurements that, again, do not require OGTT.As in our previous report (1), we evaluated the performance of various tests using receiver operator characteristic (ROC) curves in which the sensitivity of a test is plotted against the corresponding falsepositive rate. In the present context, sensitivity refers to the percentage of individuals whose initial values were above a given cutpoint among those who later developed CVD and false-positive rate refers to the percentage of these individuals among those who nevertheless remained free of CVD. The area under the ROC curve mea...

In this survey, physicians reported they were aware of, agreed with, and practiced according to published pneumonia guidelines; however, the overwhelming majority did not choose guideline-concordant therapy when tested.

Greater intracompetition weight loss is not associated with impaired performance but rather may be an aspect of superior performance. Narrow pulse pressure was associated with a high likelihood of failure to finish.

Context Massive naproxen overdose is not commonly reported. Severe metabolic acidosis and seizure have been described, but the use of renal replacement therapy has not been studied in the context of overdose. Case Details A 28-year-old man ingested 70 g of naproxen along with an unknown amount of alcohol in a suicidal attempt. On examination in the emergency department 90 min later, he was drowsy but had normal vital signs apart from sinus tachycardia. Serum naproxen level 90 min after ingestion was 1,580 mg/L (therapeutic range 25-75 mg/L). He developed metabolic acidosis requiring renal replacement therapy using sustained low efficiency dialysis (SLED) and continuous venovenous hemofiltration (CVVH) and had recurrent seizure activity requiring intubation within 4 h from ingestion. He recovered after 48 h. Discussion Massive naproxen overdose can present with serious toxicity including seizures, altered mental status, and metabolic acidosis. Conclusion Hemodialysis and renal replacement therapy may correct the acid base disturbance and provide support in cases of renal impairment in context of naproxen overdose, but further studies are needed to determine the extraction of naproxen.

Rationale & Objective Hospitalized patients receiving hemodialysis frequently have routine, daily laboratory studies drawn by peripheral venipuncture-a painful process that damages peripheral veins that may be needed for future dialysis access. Some of these peripheral venipunctures are likely preventable by drawing blood samples off the hemodialysis machine circuit. We describe an initiative to allow and encourage blood to be drawn “with dialysis.” Study Design Quality improvement study. Setting & Participants Non–critically ill adult patients treated with hemodialysis at Stanford Health Care between September 2018 and September 2019. Quality Improvement Activities We modified the electronic health record to allow providers to order laboratory studies with the frequency “with dialysis.” Use of the “with dialysis” frequency was promoted through educational efforts aimed at primary medical teams, nephrology consult staff, and nephrology advanced practice providers. Outcomes We tracked the number of “with dialysis” blood draws and the number of eligible patients per week during the first year of implementation. Analytical Approach The number of “with dialysis” blood draws and eligible patients per week were measured over time. Cost savings were estimated by multiplying the difference in cost between peripheral venipuncture and “with dialysis” blood draw by the number of “with dialysis” blood draws performed. Results Uptake during the first year of implementation was an average of 6.3 “with dialysis” draws per 100 eligible patients per week. Estimated savings exceeded $7,000 in the first year of the program. Limitations Our single-center study may not be generalizable to other institutions, especially those without dialysis ordering and laboratory ordering housed within the same electronic system. We were unable to track additional outcomes, including the number of peripheral venipunctures and delays in laboratory results. Conclusions The prevention of unnecessary peripheral venipuncture in hospitalized patients receiving hemodialysis is a promising and valuable quality improvement target, which may be aided by the electronic health record. Future work is needed to increase recognition and use of “with dialysis”blood work options.