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)
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)
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)
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)
In this single site study, researchers compared hand hygiene rates (captured by camera audits) before and after a continuous electronic display of compliance. The compliance rates increased from <10% to >80% (and was sustained for over a year. This is an impressive long term compliance rate for hand hygiene, based on a “big brother” approach (abstract)
The ACC/AHA just published guidelines on the diagnosis and treatment of HOCM. The highlights include screening (with echo) all first degree relatives with HOCM, and using beta blockers or verapamil for symptoms (angina or dyspnea). Recommendations on when to refer for ablation (drug-refractory symptoms, outflow gradient >50mmHg) and when to refer for ICD (prior arrest or sustained Vtach, sudden cardiac death in first degree relative, unexplained syncope, or non sustained Vtach/abnormal BP response to exercise). They also recommend against all competitive sports, regardless of prior therapy or presence of ICD (abstract)
In this small prospective evaluation of patients presenting to the ED with acute lower GI bleeding, CTA (compared to surgery, angiography, or colonoscopy) was 100% sensitive and 96% specific in finding the etiology of the bleeding. This may be a good diagnostic (but not therapeutic) test to determine bleeding location and etiology (abstract)
In this large trial of patients with acute symptomatic PE, they all received 5-10 days of LMWH (1mg/kg/dose BID), then 3-6 months of either adjusted dose warfarin, or weekly idrabiotaparinux; the new drug had equivalent risk of recurrent VTE, but lower risk of bleeding at 99 days follow up. This convenient new drug may be an attractive alternative to warfarin, pending FDA approval, and depending on price (abstract)
This large derivation and validation cohort from NSQIP found 5 factors significantly increased the risk of post-op respiratory failure; these included type of surgery, emergency surgery, low functional status, pre-op sepsis and higher ASA class, which had excellent predictive value; the online calculator can be found at this (site) (abstract)
In this large multi-center intervention in 71 Michigan hospital, widespread physician education and daily nursing foley checklist reduced the rate of foleys from 18% to 14% at 2 years, with appropriate foley rates increasing from 44% to 58% by 2 years. Large scale implementation of foley reductions is feasible and effective (abstract)
