Updated CHEST Guidelines for Antithrombotic Therapy of VTE

Clinical question: What are the current recommendations for antithrombotic therapy in various venous thromboembolism (VTE) scenarios? Background: VTE is commonly encountered with a multitude of therapeutic options. Selecting the optimal anticoagulant is as important as making the diagnosis and requires knowledge of individual patient characteristics to initiate the correct therapy. These factors include malignancy, location… [Read More]

Tamsulosin Can Be Used as Expulsive Therapy for Some Ureteric Stones

Clinical question: Is tamsulosin efficacious as an expulsive therapy for distal ureter stones ≤10 mm in diameter? Background: Ureteric calculi are a common reason for hospital admission, and use of medical expulsive therapy during observation periods for small caliber stones has gained much attention recently. Specifically, tamsulosin has been suggested as a medical therapy for… [Read More]

Prevalence, Characteristics of Physicians Prone to Malpractice Claims

Clinical question: Do claim-prone physicians account for a substantial share of all paid malpractice claims? Background: Many studies have compared physicians who have multiple malpractice claims against them with colleagues who have few or no claims against them and have identified systemic differences in their age, sex, and specialty. However, only a few published studies… [Read More]

Association of Frailty on One-Year Postoperative Mortality Following Major Elective Non-Cardiac Surgery

Clinical question: What is the association of preoperative frailty on one-year postoperative mortality? Background: Frailty is an aggregate expression of susceptibility to poor outcomes owing to age and disease-related deficits that accumulate with multiple domains. Frailty in this study was defined by the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. It is a… [Read More]

Patients Who Don’t Speak English are Likely to Return to the Emergency Room

(Reuters Health) – Patients in the emergency room who don’t speak English well are slightly more likely to return within days, suggesting their care the first time was not as good as it could have been, researchers say. In a study in one New York hospital, about 4 percent of English speakers made an unplanned… [Read More]

The Treatment of Obstructive Hypertrophic Cardiomyopathy is best in Higher-Volume Hospitals

NEW YORK (Reuters Health) – Higher-volume hospitals do better in treatment of obstructive hypertrophic cardiomyopathy (HCM), but more efforts are needed to direct patients to these centers, according to New York-based researchers. In an April 27 online paper in JAMA Cardiology, they note that recommendations are that the treatments, septal myectomy (SM) and alcohol septal… [Read More]

Study Shows Statins lower the Risk of Cardiovascular Disease

NEW YORK (Reuters Health) – Lipid-lowering therapy, consisting almost entirely of statins, substantially lowered the risk of cardiovascular disease (CVD) and cardiovascular death in individuals with type 1 diabetes without a history of CVD, according to a new study. Among more than 24,000 Swedish patients with type 1 diabetes, over a mean follow-up of six years, primary prevention with lipid-lowering therapy… [Read More]

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Should Patients Who Develop Postoperative Atrial Fibrillation Start Anticoagulation?

Case A 66-year-old man with diabetes mellitus type 2 and hypertension underwent left total knee replacement. Several hours after surgery, the patient developed atrial fibrillation (AF). He was asymptomatic, and reversible causes of AF were ruled out. Approximately 18 hours later, he spontaneously reverted back to sinus rhythm. Should this patient, who has no known… [Read More]

Not All EDs Adopt Interventions to Improve Flow, Decrease Crowding

Clinical question: What is the relationship between crowding in the ED and the number of interventions adopted by the ED to address this? Background: ED crowding results in long waits, prolonged lengths of stay, and delays in providing treatments, which can result in adverse events. Numerous interventions, including bedside registration, ED observation units, fast track,… [Read More]

Close INR Monitoring Might Prevent Adverse Events

Clinical question: What is the appropriate frequency of INR monitoring in the hospital and its relationship to the risk of over-anticoagulation and warfarin-related adverse events? Background: Warfarin use is a common cause of adverse drug events in hospitalized patients due to narrow therapeutic windows, drug interactions, and variability of metabolism. Current guidelines, including those by… [Read More]