Archive for January 2012

ED patients with deliberate self harm not routinely followed up

In this single center study of patients presenting to an ED with deliberate self harm, almost 2/3 were discharged home (not admitted). Of these, only half received a mental health evaluation in the ED before discharge, and only half were seen by a mental health professional within 30 days. Patients with deliberate self harm are at high risk for future harm and should be evaluated by a mental health professional within a timely fashion (abstract)

Below knee as good as thigh high stockings to prevent post-thrombotic syndrome

In this large trial of patients with a lower extremity DVT, with follow up for 2 years, they were randomized to below the knee or thigh length stockings; the incidence of post thrombotic syndrome was the same between the groups (~33-36%), but stocking related adverse effects were much more common in the thigh high group (41% versus 27%). There is no advantage to thigh high stockings to prevent post thrombotic syndrome in patients with lower extremity DVT (abstract)

Triple therapy better than double therapy for COPD

In this large retrospective analysis of COPD patients, those on 3 inhaled drugs (steroid, long acting beta agonist and tiotropium) has worse baseline lung function, but 35% lower all cause mortality, compared to those on 2 drugs (steroid and long acting beta agonist).  This adds good evidence of benefit for 3 inhaled versus 2 inhaled drugs in lowering COPD mortality, although it has not been proven in a randomized controlled trial (abstract)

No benefit to levalbuterol in ICU patients

There is growing evidence that levalbuterol is not associated with any cardiac benefit. In this small study of ICU patients, they were randomized to albuterol or levalbuterol every 4-6 hours; mean increases in heart rates were only ~1 beat per minute after either drug, and rates of arrhythmias were very small (only 1 patient with non-sustained Vtach of 5 beats). The use of levalbuterol in ICU patients to avoid tachycardia or arrhythmias is not warranted (abstract)