Clinical

Stroke Centers More Common Where Laws Encourage Them

State laws have played a big part in boosting the number of hospitals where specialized stroke care is available, a new study shows. During the study, the increase in the number of hospitals certified as primary stroke centers was more than twice as high in states with stroke legislation as in states without similar laws…. [Read More]

Anticoagulation Therapy Probably Not Needed While A-fib Patients Undergo Surgery

NEW YORK (Reuters Health) – When patients with atrialfibrillation need surgery or other invasive therapy, doctors can safely interrupt their warfarin therapy without offering a bridging anticoagulation regimen, according to a new U.S.-Canadian study. The test of 1,884 patients treated at 108 centers found virtually identical rates of arterial thromboembolism in people who were switched… [Read More]

Increased VTE Prophylaxis Shows Little Benefit following Colorectal Surgery

NEW YORK—Although venous thromboembolism (VTE) rates are low in hospitalized patients following colorectal surgery, the increasing use of prophylaxis seems to have little impact, according to Washington state-based researchers. Dr. Scott R. Steele, of Madigan Army Medical Center, Tacoma, and colleagues in JAMA Surgery note that although VTE is an important complication of such surgery… [Read More]

New Tool Improves Harm Detection for Pediatric Inpatients

The newly developed Pediatric All-Cause Harm Measurement Tool (PACHMT) improved detection of harms in pediatric inpatients in a recent pilot study. Using the tool, researchers found a rate of 40 harms per 100 patients admitted, and at least one harm in nearly a quarter of the children in the study. Close to half of the… [Read More]

Risk Stratification Insufficient for Predicting DVT in Hospitalized Patients: JAMA Internal Medicine Study

The Wells score is only slightly better than a coin toss for predicting deep vein thrombosis (DVT) in hospitalized patients, researchers have found. “The Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting,” Dr. Patricia C. Silveira from Brigham and Women’s Hospital in Boston says…. [Read More]

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Continued Statin Therapy Has No Survival Benefit in Advanced Life-Limiting Illness

Clinical question: What is the impact of statin discontinuation in palliative care setting? Background: There is compelling evidence for prescribing statins for primary or secondary prevention of cardiovascular disease for patients with long life expectancy, but there is no evidence to guide decisions to discontinue therapy in those with limited prognosis. Study design: Multicenter, unblinded,… [Read More]

SIRS Criteria Could Identify More Patients with Severe Sepsis

Clinical question: Does inclusion of two or more SIRS criteria in the definition of severe sepsis accurately identify patients with higher mortality risk, as compared with patients with infection and organ failure but with fewer than two SIRS criteria? Background: SIRS describes dysregulation of the inflammatory response to illness. The current definition of severe sepsis… [Read More]

Trimethoprim-Sulfamethoxazole Use in Older Patients Taking Spironolactone

Clinical question: Does trimethoprim-sulfamethoxazole (TMP-SMX) increase the risk of sudden death in older patients taking spironolactone? Background: TMP-SMX increases the risk of hyperkalemia when used with spironolactone; however, previous studies have not examined whether the drug interaction is associated with an increased risk of sudden cardiac death, a predictable consequence of hyperkalemia. Study design: Population-based,… [Read More]

Medicare Nonpayment for Hospital-Acquired Conditions May Have Reduced Infection Rates

Clinical question: What was the effect of the Centers for Medicare and Medicaid Services’ (CMS) nonpayment for hospital-acquired conditions? Background: In 2008, CMS implemented the Hospital-Acquired Conditions (HAC) initiative, denying incremental payment to hospitals for complications of hospital care, including central-line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers, and injurious… [Read More]