In this trial of 300 patients s/p surgery for hip fracture, they were randomized to 1 month of iron or no iron. At 6 week f/u, mean Hb levels were not significantly different between the groups (increased 2.1 g/dL in the iron group and 1.8 g/dL in the no iron group), but 17% of the iron group reported GI side effects. Given an absence of clinical benefit, routine iron after hip fracture surgery is probably not necessary (abstract).

In this trial of 1679 patients in shock, they were randomized to norepinephrine or dopamine as first line therapy (with open-label second-line pressors as needed). There was no difference in the primary outcome between the groups (28 day mortality), but the dopamine group had higher rates of arrythmias, and higher rates of 28 day mortality in the cardiogenic shock subgroup. Norepinephrine should be considered for first line therapy for shock patients, especially those with cardiogenic shock (abstract)

In this single center retrospective cohort, 70% of general medical patients were on acid suppressive therapy during their hospital stay, of which 73% were considered unwarranted. Of those inappropriately started, 63% of them were also discharged home on acid suppressive therapy. Overuse of acid suppressive medications is commonplace during hospitalization and at the time of discharge (abstract).

In this comparison of the diagnostic accuracy of 3 monoclonal antibody stool tests for Hpylori, sensitivity ranged from 69% to 92%, and specificity ranged from 76% to 90%. The take home message is there is significant variability of diagnostic performance of various Hpylori stool tests, but they all perform better than the older polyclonal tests, and will be used more frequently over time (abstract).

In this long-term follow up of the effectiveness of a central-line care bundle, originally published in 2006 (abstract), the rate of catheter associated blood stream infections (CA-BSIs) was sustained from 18 months to 36 months of follow up. This is encouraging that such drastic reductions in CA-BSIs can be sustained (abstract)

In this retrospective cohort of 338 patients undergoing emergency PCI for ACS, 28% developed CIN, which was significantly more common in women, those with an LAD lesion, a contrast volume >200cc, or an end-diastolic pulmonary artery pressure > 15mmHg. Mortality in the CIN group was significantly higher than the non-CIN group (10% vs 3%). CIN is common and associated with high mortality post-emergency PCI. Better peri-procedural management is required to reduce the associated morbidity and mortality (abstract)

In this large statewide retrospective database analysis, adjusted ICU mortality was lowest in units which had daily multi-disciplinary rounds. When stratified by intensivist staffing, those with daily rounds and high staffing had the lowest mortality, followed by those with daily rounds and low staffing. Multi-disciplinary rounds are vital to good patient outcomes (abstract)

In this large retrospective database analysis of Medicare fee for service patients undergoing 1 of 15 surgical procedures, the % of them that received co-management (>70% of hospital days had a charge from a medical doctor) increased 11% / year from 2001 to 2006. Co-management was more likely to occur in non-teaching, for-profit hospitals, and in older patients with more co-morbidities. Co-management will likely continue to undergo rapid expansive growth (abstract).

In this meta-analysis of 24 studies involving 6605 thoracentesis, the overall rate of pneumothorax was 6%, and 1/3 of them required a chest tube. Protective factors were the use of USG and more user experience. Pneumothorax was more likely to occur during therapeutic thoracentesis and in patients with periprocedural symptoms. More experience and the use of USG can reduce the incidence of pneumothorax (abstract)

In this large retrospective database analysis of 8302 patients re-admitted with a culture confirmed SSI from 2003-2007, the % of MRSA infections increased from 16% to 21% over the 5-year period. Compared to non-MRSA infections, MRSA infections were associated with higher mortality, LOS, and cost. Continued efforts to reduce MRSA SSIs are needed to reduce associated morbidity and mortality (abstract)