Clinical

Aspirin vs. Anticoagulation for VTE Prevention in Lower Extremity Orthopedic Surgery

Clinical question: What are rates of venous thromboembolism (VTE) and bleeding among adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery? Background: VTE is common after hip fracture surgery and elective total knee/hip arthroplasty. National guidelines recommend pharmacologic thromboprophylaxis but leave clinicians to select the specific agents. The efficiency and safety of… [Read More]

Depletive Fluid Management Strategy During Weaning from Mechanical Ventilation Can Lower VAP Rates

Clinical question: What is the benefit associated with a depletive fluid management strategy on ventilator-associated complication (VAC) and ventilator-associated pneumonia (VAP) during weaning from mechanical ventilation? Background: VAP is common in the ICU. Pulmonary edema predisposes patients to pneumonia by altering the alveolar microenvironment through enhancement of bacterial colonization and infectivity and a decrease in… [Read More]

Limitations of Best Practice Alerts on Curbing Blood Transfusions

Clinical question: Why do providers continue to transfuse blood products outside of recommended guidelines, despite best practice alerts (BPAs)? Background: There is evidence that a restrictive approach to blood transfusion versus a liberal approach is beneficial in reducing cost, morbidity, and mortality. It is unclear why providers continue to order transfusions outside of recommended guidelines… [Read More]

Peri-Operative Atrial Fibrillation, Long-Term Risk of Ischemic Stroke

Clinical question: Is there an association between peri-operative AF and long-term risk of ischemic stroke in patients undergoing any type of surgery? Background: Peri-operative AF is usually viewed as a transient response to physiological stress, and the long-term risk of stroke after peri-operative AF is unclear. The incidence of peri-operative AF ranges widely, from 1%… [Read More]

Lower Health Literacy Contributes to Post-Discharge Medication Errors

Clinical question: What patient characteristics contribute to post-discharge medication errors? Background: Post-discharge medication errors are common, but the characteristics of patients associated with those errors are not well understood. Study design: Prospective study with patient data collected via baseline interview while hospitalized and then follow-up telephone calls at three, 30, and 90 days post discharge…. [Read More]

Weijen Chang, MD, SFHM, FAAP

Use, Interpretation of SpO2 Treatment for Pediatric Bronchiolitis Is Questioned

Clinical question: Does artificial elevation of pulse oximetry measurement in bronchiolitis patients during ED evaluations affect hospitalization rates? Background: Bronchiolitis is the leading cause of hospitalization for infants younger than one year, leading to direct medical costs in the U.S. of $543 million in 2002. Compromised oxyhemoglobin saturation in bronchiolitis often leads to hospitalization and is… [Read More]

Elderly Patient Care Guide Goes Beyond Textbooks, Treatment Guidelines

EDITOR’S NOTE: Third in an occasional series of reviews of the Hospital Medicine: Current Concepts series by members of Team Hospitalist. Summary Older patients comprise an increasingly large part of the population we serve as hospitalists. We are all very familiar with the standard medical problems—congestive heart failure, COPD, or stroke—that these individuals present to… [Read More]

ITLresearch

Depletive Fluid Management Strategy During Weaning from Mechanical Ventilation Can Lower VAP Rates

Clinical question: What is the benefit associated with a depletive fluid management strategy on ventilator-associated complication (VAC) and ventilator-associated pneumonia (VAP) during weaning from mechanical ventilation? Background: VAP is common in the ICU. Pulmonary edema predisposes patients to pneumonia by altering the alveolar microenvironment through enhancement of bacterial colonization and infectivity and a decrease in… [Read More]

TH_May_2014_pp12_01

Antibiotic Therapy Guidelines for Pediatric Pneumonia Helpful, Not Hurtful

Hospitalists need not fear negative consequences when prescribing guideline-recommended antibiotic therapy for children hospitalized with community-acquired pneumonia (CAP), according to a recent study conducted at Cincinnati Children’s Hospital Medical Center (CCHMC). “Guideline-recommended therapy for pediatric pneumonia did not result in different outcomes than nonrecommended [largely cephalosporin] therapy,” lead author and CCHMC-based hospitalist Joanna Thomson MD,… [Read More]

ITLresearch

No Survival Benefit With Early Goal-Directed Therapy for Septic Shock

Clinical question For patients presenting with early septic shock, does early goal-directed therapy reduce mortality? Bottom line As compared with usual resuscitation care, early goal-directed therapy (EGDT) using central venous monitoring does not improve mortality in patients presenting to the emergency department with septic shock. Reference ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, et… [Read More]