Clinical

PICCs Increase Risk for Upper- and Lower-Extremity DVT

Clinical question: Do peripherally inserted central catheters increase the risk for upper- and lower-extremity deep venous thromboses? Bottom line: Although the association between peripherally inserted central catheters (PICCs) and upper-extremity deep venous thromboses (DVTs) was already known, this study shows that PICCs are also associated with a greater risk of lower-extremity DVTs, suggesting that PICC… [Read More]

NSAIDs Safe, Effective Option for Pleurodesis Pain

Clinical question: For pleurodesis, do nonsteroidal anti-inflammatory drugs and smaller chest tubes, as compared with opioids and larger tubes, provide better pain relief while maintaining efficacy of the procedure? Bottom line: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are not necessarily more effective than opiates for pain relief after pleurodesis, they should be considered a safe and… [Read More]

Illustration shows vascularized cancer cells in the background upper left, with arteries going into it and a venous plexus coming off which joins up with a bigger vein with valves. larger pink molecular balls represent the procoagulation factor that tumor cells produce that directly jump starts the coagulation pathway. the procoagulation factor molecules are binding to regular leukocytes, endothelium and platelets that will then start producing tissue factor that also encourages coagulation. Also shown are  tumor cells binding to endothelium which cause production of tissue factor, causing clots to form. two of the clots are shown embolizing. fibrinogen and platelets are throughout.

Prophylaxis and Treatment of Venous Thromboembolism in Cancer Patients

The Case A 62-year-old woman with a past medical history significant for metastatic adenocarcinoma of the lung presents to the ED with complaints of fever and shortness of breath. She has recently completed her first cycle of carboplatin, pemetrexed, and bevacizumab. Upon admission, she is found to have an absolute neutrophil count of 800 and… [Read More]

Early Invasive Strategy for Acute Coronary Syndrome May, or May Not, Improve Outcomes

Clinical question: Does an early invasive strategy for acute coronary syndrome improve short-term outcomes? Bottom line: According to this real-world observational study, an early invasive strategy—coronary angiogram within 72 hours of presentation—is associated with lower risks of short-term cardiac death and rehospitalization for myocardial infarction (MI). However, this inference may not be valid because of… [Read More]

What Should Hospitalists Know about Surgical Tubes and Drains?

Case A 45-year-old woman was admitted with choledocholithiasis. Two days prior, following endoscopic retrograde cholangiopancreatography (ERCP), she had gone to the OR for cholecystectomy. The procedure was completed laparoscopically, though the surgeon reported a difficult dissection. The surgeon left a Blake drain in the gallbladder fossa, which initially contained punch-colored fluid. Today, there is bilious… [Read More]

Value of Ultra-Brief Cognitive Assessments in Predicting Negative Hospital Outcomes

Clinical question: What is the value of ultra-brief cognitive assessments in predicting hospital outcomes? Background: Cognitive assessment tools can be used to predict patient outcomes in the hospital setting. Physician time constraints limit use of longer traditional cognitive testing, and little is known about the effectiveness of ultra-brief (less than one minute) assessments and their… [Read More]

Criteria for Appropriate Use of Peripherally Inserted Central Catheters

Clinical question: What are criteria for appropriate and inappropriate use of PICCs? Background: PICCs are commonly used in medical care in a variety of clinical contexts; however, criteria defining the appropriate use of PICCs and practices related to PICC placement have not been previously established. Study design: A multispecialty panel classified indications for PICC use… [Read More]