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08/17/2011 - prosthetic valve endocarditis and toe temperature

posted Sep 28, 2011, 5:13 PM by Chief Resident   [ updated Sep 28, 2011, 5:15 PM by Purnema Madahar ]
Now that we're hitting the mid-month mark for the residents, let's look ahead for a minute:

1. I hope to send out the Moses ward teams for September this weekend; I'm still waiting for confirmation of the attendings on service; the call schedule has been up on amion for several weeks.
2. The Weiler call schedule for October is up on amion. It's going to take a little while before we get the list of attendings, so I won't be sending the team grid any time soon.
3. In October, the inservice exam will be offered on October 11, 12 and 19. You will be scheduled for one of those dates and will be asked to cover for someone on another date if you are on elective, research or OPD.

Earlier today I sent an email about the ACP NY Chapter Forum on October 29. It offers the Dr's Dilemma Competition, where up to eight teams compete for a fully paid trip to the ACP meeting in New Orleans. Should be fun! Let me know if you're interested and we'll see if we can put together a team of three.

Some miscellaneous tidbits that came up over the past few days:

Q: Are prosthetic heart valves at increased risk for endocarditis and is there a difference between biological and mechanical valves?
A: Estimates of incidence of PVE (prosthetic valve endocarditis) range from 20 to 30% of all IE (infective endocarditis) episodes, where the incidence of IE is 3–10 episodes/100 000 persons/year. Risk differs by time after surgery: incidence in the first 6 months after surgery is 1.4–3.1% (> during the first 5–6 weeks), thereafter 0.2–0.35% yearly. Higher risk for mechanical valves than biological in the first 3 months, then equal. Localization of PVE: aortic 58.6%, mitral 21.4%, both 15% of patients. Numbers are from the attached review paper.

At yesterday's noon conference, Lewis Eisen mentioned that toe temperature of a patient in shock is well suited to classify the type of shock as distributive (septic) versus other. There are several papers that confirm this. One of the first is the attached paper from 1969, that showed a correlation between cardiac output as measured by indicator-dilution and temperature of the toe, with a correlation coefficient r=0.71.