By  | September 30, 2009 |  31
In this week’s New England Journal, Peter Pronovost and I make the case for striking a new balance between “no blame” and accountability. Come on folks, it’s time. At most hospitals, hand hygiene rates hover between 30-70%, and it’s a near-miracle when they top 80%. When I ask people how they’re working to improve their […]
By  | September 29, 2009 |  0
Researchers analyzed all randomized controlled trials listed in pubmed in 2008 in 3 clinical area (GI, cardiology, and rheumatology) in 10 high impact clinical journals. They found that of the 323 trials, only 46% were adequately registered (registered before the end of the trial with the primary outcome cleared stated). Among those adequately registered, 31% had […]
By  | September 29, 2009 |  0
In this case-control study of dialysis and non-dialysis patients with UGI bleeding, all had endoscopic control of their bleeding, and received 3 days of IV PPI (40mg IV BID), then oral PPI (20mg qday) for 2 months. The rate of re-bleeding at 7 days was about the same in the 2 groups, but between 7-30 […]
By  | September 29, 2009 |  0
In this large retrospective cohort of 88,074 patients admitted with a COPD flare, researchers determined 3 variables (BUN>25, HR>109, and acute mental status change) predicted risk of mortality and intubation. In those with all 3 factors, mortality was 13%-15% (in the derivation and validation cohorts). In those with none of those factors and <age 65, […]
By  | September 28, 2009 |  2
A quick heads up on an article written by a very talented UCSF psychiatrist named John Young, which I had the opportunity to co-author. John observed that, despite all the recent literature about handoffs (such as here and here), no one has given much thought to the Mother of all Handoffs: the transition of outpatient […]
By  | September 25, 2009 |  0
In this trial of 92 patients with creatinine >1.7 mg/dl undergoing cardiac catheterization, they were randomized to saline hydration, or euvolemic forced diuresis (with saline, mannitol, and furosemide). The forced diuresis group had a significantly higher rate of CIN (50% vs 28%). The same study did a meta-analysis (including 2 other studies with a total […]