Archive for February 2012

When to recommend cholecystectomy after pancreatitis

In this large cohort of patients who underwent cholecystectomy after a bout of pancreatitis, those that were most likely to have recurrent pancreatitis were those with normal LFTs and no gallbladder sludge / stone, indicating the cholecystectomy was probably not warranted. These patients should not routinely have a cholecystectomy after pancreatitis, but those with one or the other (or both) may be reasonable to refer (abstract)

Almost half of Cdiff is community acquired

In this large analysis of all Cdiff cases in Olmsted County, Minnesota from 1991 to 2005, 41% of all cases were community acquired. Compared to hospital acquired, they were more likely to occur in younger healthier women without exposure to antibiotics (22% had no history of antibiotics. There were not significant differences in community or hospital acquired with respect to severity or recurrence rates. Hospitalists should be aware of the frequency of community acquired Cdiff, 22% of which have not been exposed to antibiotics (abstract)

Swap “Doctor” for” Teacher”

If you have not heard, the NYC Dept. of Education released a report card assessing all of its 18,000 teachers.  It is making a lot of noise, particularly here in the city.  Read the story, regardless of where you live--it is interesting and a policy exercise that is no doubt, coming to a theater near you. (more…)

Enoxaparin more effective and safer than unfractionated heparin for ACS/AMI

In this large meta-analysis of randomized controlled trials, enoxaparin use with ACS/AMI was associated with lower mortality and lower bleeding risk, compared to unfractionated heparin. The use of unfractionated heparin should continue to wane for many clinical conditions where enoxaparin is more effective and safer (abstract)

Antibiotic-associated warfarin bleeding

In this large case control study of Medicare beneficiaries on warfarin, the recent receipt of any antibiotic doubled the risk of bleeding, which was highest with azole antifungals, but was elevated with all antibiotic classes. We should all be mindful of bleeding risk when starting any antibiotic in patients on warfarin (abstract)