Although most current rapid assays for Cdiff toxin A and B tout very high sensitivity and specificity, the cautionary wisdom elucidated in this study (abstract) is to consider the positive predictive value (PPV) of the test, which depends on the prevalence of the disease in the population you are testing. The authors note that only about 10% of hospitalized patients with diarrhea will have Cdiff. If there are 500 stool samples submitted, even if the sensitivity and specificity of your Cdiff test is 95% and 97%, the PPV is only 78% (which means that 22% of +tests do not represent true Cdiff). The assays evaluated in this study had median sensitivites from 76-95% and specificities from 93-100%. You can determine the PPV of the cdiff test at your hospital by determining the sensitivity and specificity of the assay, and the # (and % of total) of positive tests . This will greatly help you interpret your cdiff tests!
This large systematic review found rectal NSAIDs significantly reduced the risk of post-ERCP pancreatitis compared to pancreatic duct stents (abstract).
This large population-based cohort found the most common causes of drug induced liver injury to be augmentin and diclofenac, followed by herbal and nutritional supplements (abstract).
This large trial of patients with a relative contraindication for enteral feeds were randomized to early TPN or usual care. There were no differences in the groups in 60 day mortality or LOS, but those on TPN did have a shorter time ventilated and less muscle/fat loss. It is unclear based on this trial if […]