Clinical

D-Dimer Not Reliable Marker to Stop Anticoagulation Therapy

Clinical question: In patients with a first unprovoked VTE, is it safe to use a normalized D-dimer test to stop anticoagulation therapy? Background: The risk of VTE recurrence after stopping anticoagulation is higher in patients who have elevated D-dimer levels after treatment. It is unknown whether we can use normalized D-dimer levels to guide the… [Read More]

Noninvasive Ventilation Improves Outcomes for COPD Inpatients

Clinical question: Do patients hospitalized with acute COPD exacerbations have improved outcomes with noninvasive ventilation (NIV) compared to those treated with invasive mechanical ventilation (IMV)? Background: Previous studies have shown that in select patients, NIV has a mortality benefit over IMV for acute COPD exacerbations requiring hospitalization. NIV may also decrease complication rates and reduce… [Read More]

Bova Risk Model Predicts 30-Day Pulmonary Embolism-Related Complications

Clinical question: Can the Bova risk model stratify patients with acute PE into stages of increasing risk for 30-day pulmonary embolism (PE)-related complications? Background: The Bova score is based on four variables assessed at the time of PE diagnosis: heart rate, systolic blood pressure, cardiac troponin, and a marker of right ventricular (RV) dysfunction. In… [Read More]

Intracranial Bleeding Risk for Head Injury Patients on Warfarin

High bleeding rates reported for patients taking warfarin after minor, minimal head injuries

Enriched Nutritional Formulas Help Heal Pressure Ulcers

Arginine, zinc, antioxidant-supplemented formulas improve healing in malnourished patients

High-Volume Hospitals Have Higher Readmission Rates

Clinical question: Is there an association between hospital volume and hospital readmission rates? Background: There is an established association between high patient volume and reduced complications or mortality after surgical procedures; however, readmission represents a different type of quality metric than mortality or complications. Studies on the association between hospital patient volume and readmission rates… [Read More]

Hospital Testing Overuse Done to Reassure Patients, Families

Clinical Question: What is the extent of, and factors associated with, testing overuse in U.S. hospitals for pre-operative evaluation and syncope. Background: Little is known about the extent and drivers of overuse by hospitalists. Study design: Two vignettes (pre-operative evaluation and syncope) were mailed to hospitalists. They were asked to identify what most hospitalists at… [Read More]

Functional Impairment Boosts Readmission for Medicare Seniors

Clinical question: Is functional impairment associated with an increased risk of 30-day readmission? Background: Many Medicare seniors suffer from some level of impairment in functional status, which, in turn, has been linked to high healthcare utilization. Studies that examine the role of functional impairment with readmission rates are limited. Study design: Prospective, cohort study. Setting:… [Read More]