Archive for April 2009

Bilateral temporal artery biopsy better than unilateral

In this small cohort of patients with confirmed temporal arteritis who underwent bilateral temporal artery biopsies (n=51), 13 of them had pathologic confirmation on only 1 of the 2 biopsies. This indicates that 13% of unilateral biopsies will miss the pathologic diagnosis, and that bilateral biopsies may be worth performing for the increased diagnostic yield (abstract)

Over-treatment of catheter-associated bacteriuria

In patients with foley or condom catheters, many have asymptomatic bacteriuria. In this retrospective cohort of 280 hospitalized patients with a urinary catheter and positive urine culture (>10,000 cfu), 164 (59%) had no symptoms (fever, urgency, frequency, dysuria, suprapubic tenderness, mental status change, or low BP). Of these, 32% were inappropriately treated with antibiotics. Many inpatients with catheter-associated bacteriuria are asymptomatic, and are being over-treated with antibiotics (abstract).

The juice to squeeze ratio for E&M services: follow up visits pay best.

John Nelson writes... Which Evaluation & Management visit (E&M code, or CPT code) commonly billed by a hospitalist provides the most attractive reimbursement for the work performed?  I think follow up codes (99231, 99232, and 99232) reimburse better than most others, but from what I can tell most hospitalists see it differently.  Here is my reasoning… (more…)

Predicting Cdiff recurrence

In this validation cohort of 89 patients with Cdiff, 3 clinical factorswere used to predict recurrence, including age >65, need for antibiotics after Cdiff treatment, or severe/fulminant illness (based on the 4 point Horn Index, which is a clinical judgement of severity of illness; mild, moderate, severe or fulminant). Those with 0-1 risk factors had recurrence risk of 13%, and those with 2-4 risk factors had recurrence risk of 37% (with an AUC of 0.80, CI 0.67-0.92). This simple clinical prediction rule can help facilitate prompt recognition, diagnosis, and treatment of patients at risk for recurrent (abstract).

New drug for acute CHF

In this phase 2 trial, patients with acute CHF, HTN (SBP >125) and mild-to-moderate renal insufficiency (GFR 30-75) were randomized to placebo or several doses of relaxin (human peptide that increases vasodilation and renal function). The relaxin group had improved dyspnea scores, shorter length of stay, and reduced CV death/CHF readmissions. Serious adverse events were similar between the groups. If confirmed in phase 3 studies, this will likely be a valuable addition to inpatient management of acute CHF (abstract).