Coronary Artery Perforation Following Percutaneous Coronary Intervention.

Coronary artery perforation (CAP) is a rare but serious complication of percutaneous coronary intervention. Risk factors for CAP include female gender, older age, and lesion complexity. The most common causes of CAP include wire perforation, atherectomy, and aggressive sizing of balloons and stents. Complications of CAP vary greatly from clinical insignificance to hemodynamic collapse and death, depending on the severity of the CAP. Early recognition is of utmost importance to surviving CAP. Generally accepted treatment options depend on lesion severity, and include balloon inflation to tamponade the vessel, reversal of anticoagulation, covered stents, and embolization. Emergent pericardiocentesis or surgical evacuation may be required for the most severe cases.

Impact of a kiosk educational module on HIV screening rates and patient knowledge.

We assessed the effect of a kiosk educational module on HIV screening rates and patient knowledge about HIV testing. The evaluation was performed in a walk-in clinic offering routine HIV screening. During alternating two-week periods, patients were referred either to view a kiosk-based, educational module prior to receiving usual care, or the kiosk module was turned off and no alterations to care processes were made. The primary outcome was HIV testing rate. The secondary outcome was knowledge about HIV rapid screening, as measured with a questionnaire. There were 71 patients in the kiosk periods and 79 patients in the usual-care periods. The overall HIV testing rate was 41%. The kiosk period was not associated with greater odds of HIV testing (OR 0.7; 95% CI: 0.4-1.4). In 44 patients who completed the knowledge survey, the kiosk group was strongly associated with increased knowledge (predicted increase in knowledge score: 1.3; 95% CI: 036-2.1). The brief kiosk educational module did not improve HIV screening rates, but it increased overall patient knowledge about HIV testing.

Prognostic factors and jaw and renal complications among multiple myeloma patients treated with zoledronic acid.

Few studies have evaluated prognostic factors among patients with multiple myeloma (MM) since new therapies have become available. Monthly zoledronic acid (ZOL) has been incorporated into many treatment regimens to reduce skeletal-related events (SREs), but outcomes among patients receiving this bisphosphonate have not been well-defined. The aim of this retrospective study was to determine baseline and on-treatment prognostic factors in these patients. Data were collected from the date of diagnosis on 300 consecutive MM patients treated with ZOL. Median duration of ZOL was 18 months (range 1-121 months). The skeletal morbidity rate was 0.116 events per patient year. Five-year overall survival (OS) was 69%. Risk factors for shortened OS included SREs, increased serum creatinine, and International Staging System (ISS) Stage II or III. Thirty-four (11%) patients showed worsening renal function. In 28 of these patients, ZOL was discontinued and restarted in half of these patients following a brief delay. Only 5 of the 34 patients showed worsening of their renal function. Fourteen patients (4.7%) developed osteonecrosis of the jaw (ONJ). All patients with ONJ are in remission or with stable disease except one patient who died of a myocardial infarction while in remission. Only two patients showed some worsening of ONJ despite of ongoing monthly ZOL. Overall, these results suggest that skeletal complications are an important prognostic factor for MM. Although ONJ and renal deterioration may infrequently occur with ZOL, most patients do not experience worsening of these conditions with ongoing treatment with this bisphosphonate.

Effect of an education kiosk on patient knowledge about rapid HIV screening.

Patient education is an important part of routine HIV screening. In a pilot study, we assessed the effect of a computer kiosk education module on patient knowledge about routine HIV screening. A systematic sample of walk-in clinic patients completed a questionnaire before and after using the education module. The primary outcome was a composite nine-point knowledge score. Secondary outcomes included willingness to undergo HIV screening and patient satisfaction. Of 185 patients who were eligible to participate, 100 completed the study. The median duration of kiosk interaction was 3.9 min. The median knowledge score increased from 7 to 8 (P < 0.0001) after viewing the module. There was no significant change in the proportion of patients who were interested in HIV screening. The majority of patients expressed excellent (38%) or very good (39%) satisfaction with the kiosk module. The results suggest that a computer kiosk can deliver brief and targeted education to improve knowledge about HIV screening.