Archive for March 2013

Wisdom Via Ariely

I am a huge fan of Dan Ariely.  A behavioral economist from Duke, his sense of humor and intellectual curiosity make him immediately appealing (watch a video and see). (more…)

DM controls does not affect outcomes after knee arthroplasty

This large retrospective cohort of patients undergoing elective knee arthroplasty found HbA1c above or below 7% did not affect any major outcomes (VTE, revisions, infections, readmissions, or AMI). There is not a clear correlation between preop HbA1c levels and postop outcomes (abstract).

Predicting 30 day readmissions

This large derivation and validation cohort found the following factors independently increased the risk of 30 day readmissions (known as the HOSPITAL score): Hemoglobin at discharge, Oncology service discharge, Sodium at discharge, Procedure during index admission, Index Type of admission, Admits in last 12 months, and Length of stay. Although a single center study, the score had good discriminatory power (C statistic 0.71) and may be useful for predicting readmissions if further validated (abstract).

Effects of work hour restrictions

This single center cohort randomized general medical teams to a pre-2011 work hour schedule (30 hour limit with q4 call) or 1 of 2 post-2011 work hour schedules (both with 16 hour limits with either q5 call or a night float system). Compared to the old model, both newer models increased handoffs, decreased teaching conference time, and reduced resident and nurse perception of quality of care (abstract). Another study found the 2011 work hour restrictions did not affect the hours slept, depression ratings, or well being scores, but did increase interns concerns about making a serious medical error (abstract).