Rudolf Kumapley

Cook County Hospital, Chicago, Illinois, United States

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Publications (4)8.79 Total impact

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    ABSTRACT: Measurement of the inferior vena cava (IVC) diameters may improve decision-making for patients hospitalized with acute decompensated heart failure. Nevertheless, little is known about how the IVC is affected by loop diuretics. We sought to determine if bolus infusions of intravenous furosemide affect IVC diameters measured by hand-carried ultrasonography.
    Journal of Clinical Ultrasound 06/2014; · 0.70 Impact Factor
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    ABSTRACT: Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse. We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography. The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, -12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P=.0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography. Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied.
    The American journal of medicine 06/2011; 124(8):766-74. · 5.30 Impact Factor
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    ABSTRACT: The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain. To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program. Prospective cohort study. Large public teaching hospital. A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007. Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE. Diagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC). A total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5-fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2-fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments. The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.
    Journal of Hospital Medicine 09/2009; 4(6):340-9. · 1.40 Impact Factor
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    ABSTRACT: Procedure services may improve the training of bedside procedures. However, little is known about how procedure services may affect the demand for and success of procedures performed on general medicine inpatients. Determine whether a procedure service affects the number and success of 4 bedside procedures (paracentesis, thoracentesis, lumbar puncture, and central venous catheterization) attempted on general medicine inpatients. Prospective cohort study. Large public teaching hospital. Nineteen hundred and forty-one consecutive admissions to the general medicine service. A bedside procedure service was offered to physicians from 1 of 3 firms for 4 weeks. This service then crossed over to physicians from the other 2 firms for another 4 weeks. Data on all procedure attempts were collected daily from physicians. We examined whether the number of attempts and the proportion of successful attempts differed based on whether firms were offered the beside procedure service. The number of procedure attempts was 48% higher in firms offered the service (90 versus 61 per 1000 admissions; RR 1.48, 95% CI 1.06-2.10; P = .030). More than 85% of the observed increase was a result of procedures with therapeutic indications. There were no differences between firms in the proportions of successful attempts or major complications. The availability of a procedure service may increase the overall demand for bedside procedures. Further studies should refine the indications for and anticipated benefits from these commonly performed invasive procedures.
    Journal of Hospital Medicine 06/2007; 2(3):143-9. · 1.40 Impact Factor