Archive for December 2012

Little association between quality and cost

This large systematic review of 61 studies evaluating the association between quality and cost found ~1/3 with a positive association, ~1/3 with a negative association, and ~1/3 with no association. There is still not good evidence of the direction or magnitude of the association between health care quality and health care cost (abstract).

Don’t Pawn Off the Work: Bob’s Method for Tackling Big, Hairy Projects

In my last post, I promised – just in time for the New Year – to describe my fail-safe method for tackling overwhelmingly large projects. Please, please don’t waste this method on cleaning out a closet or writing an abstract. That would be like using a flamethrower to light a holiday candle. Rather, consider it when you find that simply thinking about starting some vast project induces a debilitating headache. While the method can work for major life projects (such as dealing with those two dozen boxes you’ve moved, unopened, to your last three residences), I find that it works best with huge writing tasks. I last used it with my wife, Katie, who was trying to finish a revision of her memoir Mother Daughter Me (which will be published by Random House in July 2013). We were in London last year on sabbatical and Katie really wanted to slay…

Restrict blood transfusions in AMI

This large systematic review of patients with AMI found blood transfusions were associated with higher risk of mortality and subsequent AMI compared to no transfusion, regardless of baseline, nadir, or change in hemoglobin. As with many other conditions, the use of blood transfusions should be minimized in patients with AMI (abstract).

Can RBC transfusions worsen UGI bleeding?

This large retrospective database analysis of patients with non-variceal UGI bleed found, after adjusting for confounders, that those who received transfusions were significantly more likely to rebleed than those that did not receive transfusions (odds ratio 1.8, CI 1.2 to 2.8). As with other conditions, RBC transfusions should only be administered when absolutely necessary, but the exact threshold will need to be further delineated with randomized trials (abstract).

Dabigatran not to used with mechanical valves

The FDA has issued a safety alert to avoid the use of dabigatran in patients with mechanical heart valves; a randomized trial was stopped early, as patients with mechanical heart valves were more likely to experience heart attack, stroke, or valve clot while on dabigatran compared to warfarin (FDA site).