By  | April 29, 2012 |  10
The press gave the Choosing Wisely initiative, unveiled several weeks ago, a great deal of attention.  Briefly, the ABIM foundation collaborated with Consumer Reports to produce Top 5 lists from nine specialty societies to identify “five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.”  It is a first […]
By  | April 25, 2012 |  0
There are >250,000 cases of appendicitis in the US annually, most of which are diagnosed by CT scan. This study compared the diagnostic accuracy of low dose versus high dose CT for diagnosing appendicitis, and found no difference between the 2 study types in rates of negative appendectomies (surrogate for false positives) or appendix perforation […]
By  | April 25, 2012 |  0
This large retrospective cohort found ~6% of endocarditis cases are associated with cardiac devices (the majority pacemakers), 2/3 of which are caused by staph. In hospital and 1 year mortality rates were 15% and 23%, and mortality was lower among those whose device was removed (hazard ratio 0.42, CI 0.22 to 0.82). (abstract)
By  | April 25, 2012 |  0
In this large retrospective analysis, the rate of VTE following knee arthroscopy was 0.4%; given the overall low risk, most patients will not require VTE prophylaxis, but it should be considered in those at high risk (e.g. prior VTE) (abstract)
By  | April 25, 2012 |  0
As new antithrombotics become available, contemporary efficacy of warfarin to reduce afib-related stroke is needed to determine which agents are best for which patients. In this meta-analysis of 8 large RCTs, time spent in therapeutic range was 55% to 68%, and annual risk of stroke was 1.7% per year (higher with higher CHADS2 scores) and […]
By  | April 25, 2012 |  0
In this randomized trial of patients with renal insufficiency undergoing procedures with IV contrast, they were randomized to normal saline (1cc/kg/hr for 12 hours before and after procedure), or Hco3 (2 different regimens; 3cc/kg an hour before and 1cc/kg/hr for 6 hours after, or 3cc/kg 20 minutes before and oral Hco3 after at 500mg/10kg). The […]