Archive for December 2008

Incidence, etiology, and recurrence of anaphylaxis

In this population-based retrospective analysis, researchers found that anaphylaxis was relatively uncommon (incidence 50 per 100,000 person-years), was not morbid (resulted in no deaths), and was most commonly caused by foods (33%), followed by insect stings (19%), and medications (14%). The trigger was unknown in 25%. A second recurrence occurred in 21%, and a third recurrence in 5%. This study can help us educate our patients presenting with anaphylaxis (abstract)

Vancomycin or linezolid for skin or bloodstream infections

In this industry-sponsored phase-3 trial of patients with skin/skin-structure infections or catheter-related bloodstream infections with gram positive organisms, linezolid was non-inferior to vancomycin. For skin infections, clinical success rates were 90% in each group. For catheter related bloodstream infections, microbiologic success rates were 86% for linezolid and 91% for vancomycin (abstract). Linezolid is currently FDA approved to treat VRE infections, as well as pneumonia (nosocomial and community-acquired) and skin/skin-structure infections caused by resistant gram-positive organisms (FDA sheet). Based on this study, it can reasonably be used for resistant gram-positive bacteremia, when vancomycin cannot be used.

The 360 Evaluation

Rob Bessler writes... The New Year is upon us. Hospital medicine’s busiest time of year. There is no better time than now to do some needed housekeeping for your practice site. It is our belief at Sound that there is nothing more important that the quality of the team that we develop and support.  The team and all the clichés that go with that power are real. No individual is as strong in isolation as when powered by the collective support of the team.  These teams can then become the lifeblood of the hospital and the community they serve. Where strong teams exist, turn over is extraordinarily low and when it does occur the team keeps ugrading the talent. This cycle feeds on itself. (more…)

Are We Finally Entering the Golden Age of Healthcare Transparency?

When will patients start reviewing quality data before choosing their doctors and hospitals? The answer has been “soon” for several years, but “soon” may finally be the right answer. If you doubt it, check out the Commonwealth Fund’s new site, “Why Not The Best?” The central premise of the healthcare transparency movement has been that putting data on the Web (quality, safety, satisfaction, even cost) will change consumer behavior, the way such data does for autos and restaurants. The movement, which began in earnest with the launch of the HospitalCompare website by Medicare in 2003, lives by the following catechism:Let’s post some, even rudimentary, quality data on the WebPatients will look at the data, and demand improvement of their existing providers or choose better onesThis consumerism will create “skin in the game” around performance data Hospitals and providers, now motivated to improve, will do what it takes to get better.Shockingly,…

Ban on long-acting beta agonists for asthma

An FDA advisory panel has voted to ban the use of serevent (salmeterol) and foradil (formoteral) for the treatment of asthma, based on a comprehensive review of literature indicating that beta-agonist monotherapy for asthma is associated with higher risk of severe asthma exacerbations and possibly a higher risk of death (FDA site). For now, these agents should not be used as monotherapy for the treatment of asthma in children or adults.