By  | March 31, 2009 |  2
John Nelson writes… Daily encounters are a good metric for financial analyses, but I think they’re not so good when thinking about quality of care or hospitalist career longevity. Most groups track the average number of encounters per hospitalist each day (or rounding) shift.  And everyone wants to know what it the right or SHM […]
By  | March 30, 2009 |  0
In a follow-up study from the JUPITER trial (which randomized >17,000 older adults with LDL<130 and CRP >2 to rosuvastatin or placebo), after a median of 2 years, the rosuvastatin group had a lower risk of incident VTE (HR 0.57, CI 0.37-0.86). Although it would be premature to use statins for primary prevention of VTE, […]
By  | March 30, 2009 |  0
In this small single-center retrospective analysis of patients with a diagnosis of pneumonia, of those who had both CT and Cxray performed, 27% had a negative (or non-diagnostic) Cxray, and a CT consistent with pneumonia (infiltrate / consolidation). This indicates that in patients with clinical signs / symptoms of pneumonia and a normal / non-diagnostic […]
By  | March 30, 2009 |  0
This analysis is from a large prospective trial of over 20,000 patients with STEMI who were randomized to unfractionated (UFH) or low molecular weight heparin (LMWH). UFH was dosed bythe ACC/AHA weight based nomogram, with centrally monitored aPTTs (60 U/kg bolus and 12 U/kg/hour gtt). Despite 99% adherence to the nomogram, only 34% of initial aPTT’s were therapeutic. Markedly […]
By  | March 30, 2009 |  6
A disconcerting pattern has emerged: a blockbuster study finds that a certain practice leads to improved outcomes. Large national organizations codify the practice into a quality measure, forcing widespread adoption. Later studies prove the practice to be unhelpful, perhaps even dangerous. Oops. Think about it – we’ve now seen quality measures that prompted the use […]
By  | March 27, 2009 |  0
In this meta-analysis of 12 trials with over 1800 participants, HCo3 reduced the risk of contrast induced nephropathy (CIN) compared to controls (OR 0.46, CI 0.26-0.82) and compared to normal saline (OR 0.39, CI 0.2-0.8), but not compared to N-acetylcysteine / normal saline combination. It also did not reduce the need for renal replacement therapy, in hospital […]