By  | September 30, 2010 |  0
In this nationwide before-after study of dissemination of a dexamethasone protocol for use in patients with suspected pneumococcal meningitis, dexa use increased from 3% to 84%, unfavorable outcomes decreased from 50% to 39%, and mortality decreased from 20% to 10%. This is further evidence of the widespread benefits of early dexa use in patients with […]
By  | September 28, 2010 |  0
In this single institution study, the implementation of a hard stop to medication ordering (of concomitant warfarin and trimethoprim-sulfamethoxazole) resulted in significant reductions in the co-ordering of the 2 medications, but also resultedĀ in clinically significant delays in appropriate medication use in 4 patients. The risk and benefit of hard stops, and anticipating unintended consequences, should […]
By  | September 28, 2010 |  0
In this diagnostic trial of patients with community acquired pneumonia (CAP), urinary pneumococcal antigen testing was found to have a positive liklihood ratio of about 20, indicating that a positive result is clinically valuable (and can lead to early tailoring of the antibiotics) (abstract)
By  | September 24, 2010 |  0
There is controversy about whether PPIs reduce the clinical efficacy of clopidogrel. In this large cohort in Denmark of patients discharged after an MI, those discharged on a PPI had an increased risk of MI/stroke/CV death, regardless of whether or not they were discharged on clopidogrel, and there was no statistical interaction between PPI and […]
By  | September 24, 2010 |  0
In this trial of 340 ICU patients with ARDS, they were randomized to 48 hours of cisatracurium or placebo. The adjusted in-hospital mortality was lower in the cisatracurium group (hazard ratio 0.68, CI 0.48-0.98). Cisatracurium short term use should be considered in patients with ARDS (abstract)
By  | September 24, 2010 |  0
In this large trial of 3114 patients hospitalized with acute stroke, they were randomized to thigh high or knee high stockings for DVT prophylaxis. Those with thigh high had significantly fewer DVTs than those with knee high (6% vs 9%). For acute stroke DVT prophylaxis, thigh high stockings are more effective than knee high for […]