Archive for May 2010

The Times Hits the Right Notes on Hospitalists

You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness. The piece, written by the Times’ Jane Gross, profiled Dr. Subha Airan-Javia, a young hospitalist at the Hospital of the University of Pennsylvania. While Dr. Airan-Javia spends about half of her time in administrative, largely IT-related roles (like many of my faculty), the article (and an accompanying profile) gave us a day in her life on the wards: seeing patients, collaborating with consultants, talking to families, and orchestrating discharges. The fundamental advantages of the hospitalist model – tremendous availability, markedly improved efficiency, and a unique focus on systems improvement – came through unambiguously. For example, regarding availability, there was this:Because she was on the floor all day, [she] was able to schedule a long meeting…

Study confirms antibiotic benefit in COPD exacerbations

This large retrospective analysis of >84,000 patients hospitalized with COPD confirms the benefits of antibiotics; antibiotic treated patients had lower risks of mechanical ventilation, inpatient mortality, and COPD readmissions (although higher Cdiff readmission rates). This large analysis confirms guideline recommendations for antibiotic therapy in patients hospitalized with COPD exacerbations (abstract)

Carotid endarterectomy better than stenting

In this large trial, >2500 patients with carotid stenosis were randomized to either stenting or endarterectomy. There were no differences at 2.5 years in the rate of the primary outcome between the groups (composite of stroke, MI, or death), but at 4 years follow-up, the stent group had significantly higher rates of stroke/death (6% vs 5%). Carotid endarterectomy remains the procedure of choice for most patients requiring carotid revascularization (abstract)

No reason to routinely replace peripheral IVs

Although the CDC and many medical centers endorse routinely replacing peripheral IV catheters every 3-4 days, there is little evidence behind that recommendation. This Cochrane meta-analysis compared an as-needed versus routine approach, and found no difference in the rates of phlebitis, with a significant reduction in cost in the as-needed group. As-needed replacement of peripheral IV catheters is clinically reasonable and cost-effective (abstract)

Beta blockers beneficial in COPD

In this large observational cohort of >2,000 patients with COPD, the adjusted risk of mortality and COPD exacerbations were both lower in those on beta blockers (both hazard ratios were 0.7, CI 0.6-0.8). These data suggest there is no reason to avoid beta blockers in patients with COPD, and beta blockers may actually be associated with a lower risk of death and COPD exacerbations (abstract)