ED Bookings Up Stress Test Compliance

Scheduling an exercise stress test before angina patients leave the emergency department more than doubles the likelihood that they will have the test, Australian researchers found.

The rate of stress test completion was 75% among patients given an appointment while still at the ER, but 31% when told to make an appointment on their own (adjusted P<0.001), Kevin Chung, MD, of the University of Notre Dame in Fremantle, Australia, and colleagues reported here at the American College of Cardiology (ACC) meeting.

The mean time to stress testing for these intermediate-risk angina patients was much closer to being within the recommended 72 hours too, at 77 hours versus 316 hours with usual care (P<0.001).

That could make a difference for the 2% to 3% of such intermediate risk patients who would go on to have a heart attack, emergency revascularization, or die within a month after an initial episode of angina, Chung explained at a press conference.

"It is logical," commented ACC press conference moderator William A. Zoghbi, MD, of Methodist DeBakey Heart and Vascular Center in Houston, "If individuals come to your office and you don't give them a follow-up appointment, I can bet you they're not coming back."

The issue is logistics, Chung acknowledged.

The study included 96 patients in a prospective cohort study presenting with intermediate-risk chest pain at a hospital without an inpatient cardiac service.

This intervention group received an appointment time before discharge from the emergency department for exercise stress testing, typically on the following day. The department coordinated with the cardiology department to keep a specified number of appointment times open for these patients.

Their compliance with the appointments was compared with a historical control group given a referral for a stress test but asked to make their appointment themselves.

"There were some growing pains," Chung told MedPage Today, especially in determining how many patients were likely to be seen on the overnight.

Some centers would find that strategy easier than others, Zoghbi noted. "It depends on how integrated you are and how rushed you are in the emergency department," he told MedPage Today.

Even with the scheduling program, one-quarter of patients didn't return for exercise stress testing, which Chung called a concern.

When his group contacted patients to see what might have played a role in their keeping or neglecting the appointment, those who understood why they were referred for exercise stress testing were seven times more likely to follow through. Other factors were age and presence of known coronary artery disease.

"If patients are informed of the risks and reasons we refer them for testing, they are more likely to comply," Chung concluded. "We can further facilitate this by giving patients a pre-booked appointment time."

Patient outcomes at 30 days tended to be better in the group given a stress test appointment time at discharge from the emergency department, but the researchers cautioned that their relatively small study was not powered to look for a difference.

Medical Supplies, and Medical Equipment News.

BP Often High in Kids on Dialysis

Many children receiving dialysis continue to have poor blood pressure control even when on antihypertensive treatment, a cross-sectional study found.

Six months after beginning dialysis, 67.9% of pediatric patients with end-stage renal disease (ESRD) had hypertension that was either uncontrolled or untreated, according to Susan M. Halbach, MD, of Seattle Children's Hospital, and colleagues.

That despite the fact that 57.8% had been given antihypertensives, they reported in the April issue of the Journal of Pediatrics.

Factors that predicted higher blood pressure included age 12 or younger, black race, glomerular disease, and beginning dialysis before 2000 (P<0.0001 for all).

The cardiovascular challenges faced by children and teens with ESRD were highlighted in an editorial accompanying the study.

"A pediatric patient on dialysis has roughly the same cardiovascular risk as an 80-year-old without ESRD," wrote Sriram S. Narsipur, MD, of the State University of New York Upstate in Syracuse.

However, patient characteristics that influence blood pressure are incompletely understood, so Halbach's group analyzed data from the North American Pediatric Renal Trials and Collaborative Studies, which is a registry that enrolls patients from 150 centers.

To adjust for the effects of age, height, and sex on blood pressure, the researchers calculated standardized z scores for their analysis, which included 3,447 patients ages 1 to 21.

A total of 65.7% were on peritoneal dialysis, with the remainder being on hemodialysis.

Between 1992 and 2008, the use of antihypertensive medications among children on dialysis rose from 52% to 67%.

Over that time period, there also were decreases in mean systolic blood pressure z scores, from 1.7 to 1.4, and in mean diastolic scores, from 1.3 to 1 (P<0.001 for both).

"It is encouraging to see a trend of improvement of [blood pressure] control in this population over the past two decades," the researchers observed.

On a multivariate analysis to assess factors that predicted uncontrolled blood pressure, which was defined as pressures higher than the 90th percentile whether or not antihypertensive medications were used, these characteristics were associated with increased risk:

Medical Supplies New - Cristia Medical Blog

Deja vu all over again at RSNA 2010

Even though the theme for RSNA 2010 was "personalized medicine," exhibitors and attendees alike were continuing to discuss and debate the hot topic of last year's show - dose reduction.

Meaningful use and its impact placed a distant second for the buzz heard around the show floor, but interest will undoubtedly increase in the months to come as roll outs and requirements emerge.

Still, discussions of dose reduction carried the day and it was addressed in a myriad of ways. From talk of additional education and certification for radiologists to software and equipment updates, all intended to better monitor and control dose, all avenues were being explored at the show.

With troubling stories of excessive exposure emerging at nearly a weekly rate and even the FAA feeding the fire with the introduction of, and subsequent debate about, full body scans at airport security checkpoints, it wouldn't come as a surprise to find RSNA 2011's big buzz to be about dose reduction. But that's a whole new ball game.

Discount Medical Supplies

Go to www.CristiaMedicalSupply.com for thousands of Discounted Medical Supplies

Care Tips For Your Diabetic Cat

It is easy to be apprehensive of the future for cat lovers whose cat has been recently diagnosed with diabetes. Lucky this diagnosis is not a death sentence for your cat and they often will have no problem remaining healthy for a long happy life.

You the cat owner will have to take on the responsibility of watching and caring for your cat more diligently. It is nothing earth shattering and usually will not upset your normal activities. We’ve listed here the top three things you will have to look after:

#1 - The top responsibility you will have is to make sure you get your cat on a regular veterinarian visit schedule. It is vitally important to have a regular three month appointment for your veterinarian to check your cat’s insulin levels. This is easily done by drawing some blood.

It is not as hard as it sounds, the veterinarian will use a small device just like what humans use to get a drop of blood on a small strip. This strip is then inserted into a glucose monitoring device that your veterinarian has in the office. The most difficult part of the procedure is keeping your cat from eating twelve hours before the test.

#2 - The second responsibility may sound horrible and impossible for you to complete; the administration of the diabetes injection. If you shuddered you are not alone. But, don’t worry as it is much easier than you think and it makes your cat feel better so they will remind you when they need the shot.

Many people are surprised at first that their cat would actually meow at them to remind them when it is time for their injection. Most cats will require two separate injections a day twelve hours apart. Establishing a routine will make it easier for you and your cat to manage the administration of the proper dose of insulin.

Many cat owners found that giving the insulin injection in the morning before going to work or having breakfast and then again when they get home in the evening or right before dinner is an easy way to remember. As for the actual method to give the injection, your veterinarian will give you instructions. The easiest place to give your cat the shot is right between the shoulder blades. Actually the best place is in the loose skin area where a mother cat will pick up and carry their kittens.

#3 - The third responsibility is the most overlooked yet the easiest. Since the diabetic supplies you will need such as syringes and the insulin vials for your cat are not covered by insurance many people don’t keep an adequate supply on hand. You will need to get the insulin from your veterinarian and they may not always have enough on hand to cover your emergency. Many veterinarians recommend that you reorder the insulin when you have used 1/2 of your supply. This allows the supplier to restock the veterinarian which can take a couple of days to a week.

It is important to follow your veterinarian’s instructions including the administration of any additional vitamin supplements or special diet orders for your cat. Additionally, ask your veterinarian for the name and number of another vet that you can call in the event he or she is not available for an emergency.

A diabetic cat has days where it may not be easy to care for her. With the right amount of care and keeping a schedule plus a little bit of patience and a lot of live your cat will live a long and happy life.

Reasons to Purchase Online Medical Supplies

The modern consumer wants things to be convenient, reasonably priced, and of a good quality. Nowhere do such criteria apply more strongly than in the acquisition of medical supplies. Even though most supplies are required for overall good health, consumers still want to enjoy the best deals possible. This does not mean that people are willing to sacrifice on quality, however, and this can often make it difficult to find supplies at good prices.

Fortunately, the advent of the Internet has created a unique opportunity. Consider that most “brick and mortar” establishments are usually limited to only local or regional customers, but an online shop offering medical supplies will have a global audience instead. This usually means that they can offer excellent pricing because they themselves purchase merchandise in tremendous numbers and receive bulk discounts.

For example, one of the most frequently purchased category of medical supplies are those known as “ostomy” supplies, and those who use them will have to deal with high quantity purchases. There are adhesives, wipes, bandages, and tapes that are put to use each day and which are also consumed in large numbers. Clearly, the buyers of such goods are going to want the best prices simply because they go through so many of the materials, and the best online suppliers will be able to make quantity purchases available at deep discounts too.

Not only that, but many of the better vendors provide their clients with options for automatic re-ordering too. This means that someone who requires a regular shipment of Ostomy supplies might be able to sign up for the specific quantity and type of items they need, and all on a regular schedule. With a few clicks of the mouse, they can take care of an entire year’s worth of ordering work and also know that they will get the best pricing available!

Overview of home medical equipment and ostomy supplies

If you are looking for ostomy supplies then you must not check a lot of places. The best place is at your fingertip and that is internet. Yes, you can get the best home medical equipments and ostomy supplies online only. Otherwise, you need to search a lot and then also you can never be sure about the cost and reliability of the products. If you are sure about the brand then finding the best ostomy supplies over the net is simple and very easy. There are some online guides that can help you to find various home medical equipment and ostomy supplies at ease. That is why the professional are taking help from the online guides these days than any physical places.

Sometimes we face small accidents and for those times durable medical equipments can be very helpful. Durable medical equipments are also known as DME in short. If you have any medi-claim or insurances then the cost of these durable medical equipments are usually covered by them. Hospital beds, mattresses, walkers, crutches, shower chairs and all these types of equipments are known as durable medical equipment. In case of ostomy supplies the process is not very pleasant and even the experts do not opt for it unless it is an absolute necessity. These things can be temporary or permanent both. It depends on the situation and the expert take the decision based on various things.

If you are looking for ostomy supplies then it can be immensely confusing for you to find any reliable data. You can check online as there are some reliable guides available for the people. From there you can gather required information about quality and price. If the information can satisfy then you need to search for the reputed brand. Many people think that shopping online can be risky. But in case of medical equipments this is the most reliable way. You need not think about it and just choose what you want to buy. You just need to check that the company should comply with the HIPAA act otherwise you must not buy from them. If the company meets the terms of HIPAA act then they are genuine and you have absolutely no risk buying from them.

One can also take lease of these equipments. There are plenty of places from where you can take lease of these equipments. Though, that is not something advisable but if the problem is not so serious and buying the equipment is problematic then you can take lease of those equipments easily. You also need to know if there is potential financial benefit of the equipment. In future that can help you in some ways.