Left Atrial Appendage Closure Noninferior to Warfain for Cardioembolic Event Prophylaxis in Nonvalvular Afibrillation

Clinical question: Is mechanical, left atrial appendage (LAA) closure as effective as warfarin therapy in preventing cardioembolic events in patients with nonvalvular atrial fibrillation (Afib)? Background: Anticoagulation with warfarin has long been the standard therapy for prevention of thromboembolic complications of nonvalvular Afib; however, its use is limited by the need for monitoring and lifelong… [Read More]

Tramadol Associated with Increased Rate of Hypoglycemia

Clinical question: Does tramadol increase rates of hospitalization from hypoglycemia compared to other opioids? Background: As tramadol use has increased in the general population, there have been multiple reports of hypoglycemia after initiation of the painkiller, including in patients with no other known risk factors, such as diabetes mellitus. Study design: Case control study. Setting:… [Read More]

Longer Surgeries Associated with Increased VTE Risk

Clinical question: Does duration of surgical procedure influence venous thromboembolism (VTE) risk? Background: The relationship between surgical procedure length and VTE risk has not been vigorously assessed, although it has been postulated that longer procedures are associated with increased VTE risk. Improved understanding of this relationship may be beneficial to surgeons deciding on VTE prophylaxis… [Read More]

Mortality, Readmission Rates Unchanged by Duty Hour Reforms

Clinical question: Did the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reforms change mortality rates or readmission rates at teaching hospitals? Background: The 2011 ACGME duty hour reforms maintained the 80-hour weekly work limit for medical residents, decreased the number of continuous hours to 16 hours from 30 hours for interns, and… [Read More]

Weijen Chang, MD, SFHM, FAAP

Children with Acute Hematogenous Osteomyelitis Have Similar Outcomes When Discharged with Oral Antibiotics versus Prolonged IV Antibiotics and Escape PICC Complications

Clinical question: After hospitalization for acute hematogenous osteomyelitis (AHOM), do children discharged with oral antibiotics have similar clinical outcomes compared to those discharged with home IV antibiotics? Background: AHOM occurs in one in 5,000 children yearly and makes up approximately 1% of pediatric hospitalizations in the U.S.1 The incidence of AHOM might be increasing in… [Read More]

Emergency Department Utilization May Be Lower for Attending-Only Physician Visits versus Supervised Visits

Clinical question: Does supervised learning in the ED lead to higher rates of resource utilization? Background: Care at academic medical centers might be more expensive than nonteaching hospitals because of the increased testing and resource utilization that occurs among learners. Although there is a growing emphasis in training programs on cost-conscious care, little data has… [Read More]

Physician Spending Habits During Residency Training Can Persist for Years

Clinical question: For primary care physicians (PCPs), does residency training area affect the pattern of physician spending after training is complete? Background: Regional and system-level variations in the intensity of medical services provided are common in the U.S. Residency training practice patterns could explain these variations. This study examines the relationship between spending patterns in… [Read More]

Malpractice Reform Does Not Change Physician Practice Patterns

Clinical question: Do malpractice reform policies shift physician practice patterns toward lower utilization of healthcare resources? Background: Physician-reported fears of lawsuits lead to defensive medicine practices, which contribute to high healthcare costs. It is unclear whether malpractice reform legislation reduces these costly physician practice patterns. The ED is a high-risk environment that may promote defensive… [Read More]

Updated Guidelines for Management of Non-ST-Elevation Acute Coronary Syndrome

Clinical question: What is the recommended approach for management of non-ST-elevation acute coronary syndrome (NSTE-ACS)? Background: This is the first comprehensive update from the American Heart Association/American College of Cardiology (AHA/ACC) on NSTE-ACS since 2007 and follows a focused update published in 2012. Synopsis: This guideline provides recommendations for acute and long-term care of patients… [Read More]

New Guidelines for Platelet Transfusions in Adults

Clinical question: What is the recommended approach to platelet transfusion in several common clinical scenarios? Background: The AABB (formerly American Association of Blood Banks) developed these guidelines from a recent systematic review on platelet transfusion. Synopsis: One strong recommendation was made based on moderate-quality evidence. Four weak or uncertain recommendations were made based on low-… [Read More]