Clinical

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]

ACP Guidelines for Evaluation of Suspected Pulmonary Embolism

Clinical question: What are best practices for evaluating patients with suspected acute pulmonary embolism (PE)? Background: Use of CT in the evaluation of PE has increased across all clinical settings without improving mortality. Contrast CT carries the risks of radiation exposure, contrast-induced nephropathy, and incidental findings that require further investigation. The authors highlight evidence-based strategies… [Read More]

Early Palliative Care Can Save Money

Clinical question: Does time to consult after admission change the effect palliative care consultation has on cost of care? Background: Studies have shown that early palliative care involvement improves quality of life and survival among cancer patients while reducing the cost of care. Little is known about the optimal timing of palliative care consultation and… [Read More]

Parental Perceptions of Nighttime Communication Are Strong Predictors of Patient Experience

Clinical question: How does parental perception of overnight pediatric inpatient care affect the overall patient experience? Background: Restrictions on resident duty hours have become progressively more stringent as attention to the effects of resident fatigue on patient safety has increased. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited total weekly duty hours… [Read More]

Effectiveness of Antipsychotics in Treatment of Delirium

Clinical questions: Are antipsychotics for the treatment of delirium safe and effective? Does efficacy differ between ICU and non-ICU settings? Does efficacy differ between first- and second-generation antipsychotics (SGA)? Background: Delirium is common in hospitalized patients. Data are mixed about the use of antipsychotics for treatment of delirium, and safety concerns are well founded. A… [Read More]

Predictors for Surgical Management of Small Bowel Obstruction

Clinical question: Are there clinical or computerized tomography (CT) findings that identify which patients will need early surgical management in adhesive small bowel obstruction (ASBO)? Background: Previous studies determined adverse outcomes resulting from delayed surgery in patients with ASBO: increased length of stay (LOS), complications, and mortality. Most patients respond to nonoperative management, however. Study… [Read More]

Adding Advanced Molecular Techniques to Standard Blood Cultures May Improve Patient Outcomes

Clinical question: Does the addition of rapid multiplex polymerase chain reaction molecular techniques to standard blood culture bottle (BCB) processing, with or without antimicrobial stewardship recommendations, affect antimicrobial utilization and patient outcomes? Background: Standard BCB processing typically requires two days to provide identification and susceptibility testing results. PCR-based molecular testing is available to test positive… [Read More]

Some Readmission Risk Factors Not Captured by Medicare

Clinical question: Are there patient characteristics not currently measured by the Medicare readmission program that account for differences in hospital readmission rates? Background: The Medicare Hospital Readmissions Reduction Program (HRRP) financially penalizes hospitals with higher than expected 30-day readmission rates. During 2014, more than 2,000 U.S. hospitals were fined $480 million for high readmission rates…. [Read More]

Methylphenidate Linked to Sleep and Appetite Loss

LONDON – Researchers voiced concern on Nov. 25 about poor quality studies on the popular ADHD treatment methylphenidate, saying evidence of some benefits, but also of sleep problems and appetite loss, suggests the drug should be prescribed with caution. Methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) has been used to treat attention deficit hyperactivity disorder (ADHD) for more than 50… [Read More]

Stent Thrombosis Risk Linked to Bioresorbable Scaffold

NEW YORK – Restenosis rates are similar one year after implantation of an everolimus-eluting bioresorbable vascular scaffold or an everolimus-eluting metallic stent, but the scaffold has a higher risk of device thrombosis within 30 days, a new meta-analysis shows. The meta-analysis suggests that the two interventions have a “similar requirement of repeat revascularization out to 1-year follow-up, despite inferior angiographic performance,”… [Read More]