Archive for June 2012

Pleural catheters as good as pleurodesis for malignant effusions

This trial of ~100 patients with malignant pleural effusions found pleural catheters and chest tube with talc pleurodesis were equally effective in reducing dyspnea in patients with malignant pleural effusions, with no difference in quality of life. Either of these options is reasonable in patients who need dyspnea relief with malignant pleural effusions (abstract)

7 as good as 14 days of cipro for acute pyelonephritis

In this trial of women with acute pyelonephritis, randomized to 7 or 14 days of ciprofloxacin, clinical cure was the same in both groups (96% and 97%). This should be a reasonable duration of treatment for women with pyelonephritis with an organism sensitive to ciprofloxacin, but should not be extrapolated to other antibiotics (abstract)

Early surgery for infective endocarditis

In this trial of patients with left-sided endocarditis, large vegetations, and severe valve disease, they were randomized to early surgical intervention, or conventional (antibiotic) therapy. The surgical group had significantly lower risk of the combined outcome (death, embolic event, recurrent) at 6months, compared to the conventional group (3% vs 28%, hazard ration 0.08, 95% CI 0.01 to 0.65, p=0.02). Early surgical referral should be made for patients with left sided infective endocarditis with large vegetations and valve disease (abstract)

What works for medication reconciliation?

In this comprehensive systematic review, different medication reconciliation strategies were evaluated, and found that medication reconciliation consistently reduces medication discrepancies, potential adverse drug events, and adverse drug events. The most successful interventions utilized heavy involvement of pharmacists, and targeted high risk patients. Medication reconciliation programs should at least incorporate these evidence based strategies to reduce discrepancies and adverse drug events (abstract)

Today’s Supreme Court Decision: My Two Cents

The United States government, for all its exasperating foibles and silliness, retains the capacity to surprise and even delight. Five years ago, who could have guessed that we would elect a centrist African-American president with a middle name of Hussein. Three years ago, who could have guessed that our deeply divided Congress would pass ambitious (albeit imperfect) legislation that moved us toward universal insurance, promoted healthcare quality, safety, and efficiency, and banned the worst offenses of the private insurance market... all in the midst of the most painful economic meltdown in a generation. And just yesterday, who could have guessed that this Supreme Court would uphold this law in a principled decision that largely steered clear of today's puerile politics. The pundits and bloviators will have a field day dissecting what today's ruling will mean in the "who's up, who's down" echo chamber that passes for news. For now, I…