Bottom line: Niacin is superior to ezetimibe in reducing CIMT and raising HDL levels and might be more efficacious in reducing cardiovascular risk.
Citation: Taylor AJ, Villines TC, Stanek EJ, et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009;361(22):2113-2122.
Pharmacist-Facilitated Hospital Discharge Program Didn’t Reduce Post-Discharge Healthcare Resource Utilization
Clinical question: Does pharmacist-facilitated hospital discharge reduce hospital readmission rates?
Background: Medication discrepancies at the time of discharge often lead to confusion, medical errors, and readmission to the hospital. Patients who are at high risk of medication errors often are on multiple medications and experience adverse drug events upon discharge.
Study design: Prospective cohort study.
Setting: Tertiary-care, academic teaching hospital in Michigan.
Synopsis: One pharmacist alternated between the resident service and hospitalist service every month. The pharmacist monitored the patients being discharged for appropriateness and accuracy of medications. The pharmacist assessed medication therapy, reconciled medications, screened for adherence concerns, counseled and educated patients, and performed post-discharge telephone follow-up.
Primary outcomes were ED visits within 72 hours and readmission rates by day 14 and day 30.
The study found high numbers of medication discrepancies in the control (33.5%) and intervention (59.6%) groups, and these discrepancies were resolved prior to discharge; however, there was no significant impact on post-discharge ED visits, or 14- and 30-day readmission rates. Post-discharge telephone calls reduced 14-day readmission rates.
Bottom line: Pharmacist-facilitated hospital discharge did not significantly reduce post-discharge ED visits or readmissions.
Citation: Walker PC, Bernstein SJ, Jones JN, et al. Impact of a pharmacist-facilitated hospital discharge program. Arch Intern Med. 2009;169(21):2003-2010.
Questionable Antibiotic Benefit for Patients with Acute COPD Exacerbations
Clinical question: Does the addition of antibiotics to systemic corticosteroids provide additional benefits for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)?
Background: The role of antibiotics in the treatment of AECOPD is unclear, particularly in addition to systemic corticosteroids. Many of the studies demonstrating the benefit of antibiotics were conducted several decades before systemic steroids were used routinely for the treatment of AECOPD.
Study design: Randomized, double-blinded, placebo-controlled study.
Setting: Two academic teaching hospitals in the Netherlands.
Synopsis: Two hundred sixty-five acute exacerbations of COPD were enrolled in the study, and patients were randomized to a seven-day course of 200 mg/day of doxycycline or placebo. All patients received systemic corticosteroids, nebulized bronchodilator therapy, and physiotherapy. The study found that doxycycline was equivalent to placebo for the primary endpoint of clinical success on day 30; however, doxycycline was superior to placebo for secondary outcomes of clinical success, clinical cure, symptomatic improvement, microbiological success, and reducing open label antibiotic use on day 10, but not on day 30.
Because the population studied had low levels of advanced antimicrobial resistance, the findings might not be generalizable. Results suggested a difference of treatment effect between subgroups based on C-reactive protein values, but further research is needed.
Bottom line: Patients treated with doxycycline for acute exacerbation of COPD had improved clinical outcomes at day 10, but the benefits were not significant at day 30. Data are still equivocal regarding benefits of antibiotics in patients with acute exacerbations of COPD.
Citation: Daniels JM, Snijders D, de Graaff CS, Vlaspolder F, Jansen HM, Boersma WG. Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;181(2):150-157. TH