Archive for September 2010

Widespread dexamethasone use improves pneumococcal meningitis outcomes

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 suspected pneumococcal meningitis (abstract)

Unintended consequences of hard stops in CPOE

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 resulted in clinically significant delays in appropriate medication use in 4 patients. The risk and benefit of hard stops, and anticipating unintended consequences, should be thoroughly investigated before the implementation of CPOE hard stops (abstract).

Urinary pneumococcal antigen useful in CAP

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)

PPI and clopidogrel; resolving the controversy?

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 clopidogrel. This study implies that it is the PPI, not the co-administration of PPI and clopidogrel, that increased the CV risk post MI (abstract)

Short term neuromuscular blockers good in ARDS

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)