Thursday, November 02, 2006

Background Resources for October 2006 Case

Table 1 of our current case lists several medical concepts which are central to our clinical question. This post is intended to explain why each concept is important, how to assess the quality and relevance of background information sources, and to provide links to freely available resources may be useful for acquiring background knowledge on these topics. You may also wish to consult textbooks, databases, or other subscription items available at your own library.
The Question:
What is the evidence basis for the use of intravenous colistin for multi-drug resistant Acinetobacter infections in the adult, non-neutropenic, critical care population?

How to Evaluate Online Resources:
  • Medical Library Association: A User's Guide to Finding and Evaluating Health Information on the Web
  • MedlinePlus: Guide to Healthy Web Surfing
  • National Center for Complementary and Alternative Medicine: 10 Things To Know About Evaluating Medical Resources on the Web
  • National Cancer Institute: How To Evaluate Health Information on the Internet: Questions and Answers
  • U.S. Food and Drug Administration: How to Evaluate Health Information on the Internet

    The Concepts:
    Respiratory Failure
    The patient was admitted to the ICU with respiratory failure; this informs you that the patient is currently unable to breathe on his own, resulting in the use of mechanical ventilation and leading to the development of ventilator-associated pneumonia (VAP).
  • eMedicine: Respiratory Failure
  • The Merck Manuals Online Medical Library, Home Edition: Respiratory Failure
  • MeSH Database: Respiratory Insufficiency

    Ventilator-Associated Pneumonia
    The patient is showing signs of VAP, which is why the cultures (brochoscopy and bronchoalveolar lavage) were conducted, leading to the identification of the Acinetobacter species in this patient.
  • CDC: Ventilator-Associated Pneumonia
  • MeSH Database: Pneumonia, Bacterial; Respiration, Artificial; Ventilators, Mechanical

    This is the organism identified as causing the patient's pneumonia, and you've been asked to find evidence on drugs to treat this specific type of infection.
  • CDC: Drug Resistant Acinetobacter Infections in Healthcare Settings
  • eMedicine: Acinetobacter
  • MeSH Database: Acinetobacter

    Chronic Liver Failure with Hepatic Encephalopathy
    This is the other condition (in addition to respiratory failure) for which the patient was admitted to the ICU. It may or may not turn out to have an impact on the drug regimen the patient receives, but helps you understand the overall clinical picture for this patient. Hepatic encephalopathy is the underlying cause of the patient's respiratory failure, as it leads to decreased mental status which in turn causes respiratory dysfunction and the inability of the patient to protect his own airway. The resources listed below address hepatic encephalopathy, but we don't know the cause or type of the chronic liver failure.
  • MedlinePlus Medical Encyclopedia: Hepatic encephalopathy
  • eMedicine: Encephalopathy, Hepatic
  • MeSH Database: Hepatic Encephalopathy; Liver Failure

    The patient underwent bronchoscopy when signs of VAP developed. Bronchoscopy is a fairly common procedure, so it will help you in the future to understand this term.
  • MedlinePlus Medical Encyclopedia: Bronchoscopy
  • UpToDate Patient Information: Fiberoptic Bronchoscopy
  • MeSH Database: Bronchoscopy

    Bronchoalveolar Lavage
    The procedure is used with bronchoscopy to identify the infectious organism affecting a patient. "Lavage" essentially means "to wash," and has its origin in the Latin lavare - the lungs are washed with fluid, which is then suctioned back up for culturing and diagnostic purposes.
  • MeSH Database: Bronchoalveolar Lavage
  • Wikipedia: Bronchoalveolar Lavage - Normally, you might want to consult other, more authoritative background resources before checking Wikipedia, but there is very little basic information on this procedure online. In this case, reading the Wikipedia entry can give you a basic idea of what bronchoalveolar lavage consists of.

    Antibiotic Sensitivity/Susceptibility Testing
    This type of testing is used to determine which agents will be effective against an infectious organism. It is how doctors know what the "right" antibiotic is to use for an infection.
  • Lab Tests Online: Susceptibility Testing
  • MeSH Database: Microbial Sensitivity Tests

    Colistin is an antimicrobial (or antibacterial) drug, and the clinicians would like to know if it has been proven effective against Acinetobacter infection. A search of free resources does not turn up much of anything on this drug. However, through further investigation, we find that Colistimethate is a derivative of Colistin, and information is available on that.
  • MeSH Database: Colistin
  • MedlinePlus Drug Information: Colistimethate Injection

    Have other suggestions for background resources? Post them in the comments.

    Anonymous Anonymous said...

    Have you set up a comments feed for this blog? If not, I recommend it, especially if these posts start soliciting a lot of discussion.

    11/06/2006 12:26 PM  
    Blogger jmlaeditor said...

    Great suggestion -- we're working on a comments feed and we'll post as soon as we have it up and running!

    11/07/2006 6:26 PM  

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