Archive for February 2013


I clipped sentences while reading the last few weeks with the intent of compiling them for this post.  I want you to examine below and glean a pattern. (more…)

HIT Job: How the New York Times Blew it on Healthcare IT

I’m well aware that a good fraction of the people in this country – let’s call them Rush fans – spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be high on my list of things to bring to a desert island. But every now and then, the paper screws up, and it did so in a big way in its recent piece on the federal program to promote healthcare information technology (HIT). Let’s stipulate that the Federal government’s $20 billion incentive program (called “HITECH”), designed to drive the adoption of electronic health records, is not perfect. Medicare’s “Meaningful Use” rules – the standards that hospitals’ and clinics’ EHRs must meet to qualify for bonus payments – have been criticized as both too soft and too restrictive. (You know the rules are probably about right when the…

Dabigatran vs warfarin for extended treatment of VTE

This large placebo controlled trial of patients with VTE, already treated with 3 months of anticoagulation, randomized them to dabigatran, warfarin, or placebo; dabigatran and warfarin had similar rates of recurrent VTE, but dabigatran had lower rates of major/minor bleeding (abstract).

Updated guidelines from surviving sepsis campaign

The Surviving Sepsis Campaign guidelines have been updated. Some of the highlights include (abstract): Initial fluids with crystalloids at 30cc/kg, with goal in first 6 hours of CVP 8-12mmHg, MAP>65 mmHg, and urine output >0.5cc/kg/hr; Antibiotics within 1 hour No steroids unless refractory shock and no RBC transfusions unless Hb<7 Vasopressor of choice is norepinephrine with epinephrine added if needed, phenylephrine only with arrhythmias, if cardiac output is high with low BP, or as salvage therapy, and dobutamine for myocardial dysfunction or continued hypoperfusion.

Any beta blocker for systolic CHF will do

This large meta-analysis found a significant mortality benefit for all beta blockers in patients with systolic CHF, with no significant differences between the different types, indicating any beta blocker will do (abstract).