In this single center retrospective cohort of 53,236 hospitalizations, hospital-acquired hyponatremia occurred in over 1/3 of patients, and was associated with an increased odds of in-hospital death (OR 1.7, CI 1.4-2), discharge to a facility (OR 1.6, CI 1.6-1.7), and longer length of stay (by 64%). Hospital acquired hyponatremia is common, and associated with higher mortality and LOS. A deeper understanding of the etiology and management of hyponatremia is needed, to help decrease the associated mortality and resource use (abstract).

In this retrospective cohort of a random sample of 1200 patients from 6 small community hospitals (each <300 beds), the rate of ADE’s was 15/100 admissions. Half were considered serious, and 12% life-threatening. Of those considered preventable, 82% were considered preventable through the use of computerized physician order entry (CPOE). ADE’s in community setting are common, serious, and potentially preventable by the use of CPOE (abstract)

In a news briefing, the CDC announced that influenza-like activity has been below the national baseline level for 3 weeks. Vaccination efforts should still vigorously continue, as vaccination availability is plentiful, and disease activity is still present (CDC briefing)

In this diagnostic trial of 121 samples of pleural fluid from patients with a pleural effusions and known / suspected malignancy, the sensitivity for detecting malignancy was higher with larger pleural fluid volumes. The sensitivity using direct smear/cytospin for the 10cc, 60cc, or >150cc submissions were 49%, 63%, and 69%. Adding cell blocks increased the sensitivity to 76%, 80%, and 87%. Larger pleural fluid volumes increase cytology sensitivity in patients with suspected malignancy (abstract).

Physicians who care for HIV patients should be aware of a safety warning of the association between the HIV drug didanosine and non-cirrhotic portal HTN with esophageal varices. There have been 42 reported cases and 4 deaths (FDA site)

In this unblinded trial, 167 patients with recurrent symptomatic afib despite anti-arrythmic therapy were randomized to catheter ablation or another anti-arrythmic therapy. At 9 months, 66% of the catheter group remained free of recurrent afib, compared to only 16% of the anti-arrythmic group. Treatment related major adverse effects occurred in 5% of the catheter group compared to 9% of the anti-arrythmic group at 30 days. Catheter ablation is a reasonable treatment strategy for patients with symptomatic paroxysmal afib refractory to medical therapy (abstract)

In this prospective multi-center trial of 630 ICU patients, patients were randomized to pro-calcitonin guided antibiotics or usual care. The pro-calcitonin group had antibiotics started or stopped based on pre-determined pro-calcitonin levels. There was no difference in 28 or 60 day mortality between the groups, but days of antibiotics were less in the pro-calcitonin group (12 vs 14 days). Although this study did not show any difference in outcomes measures, antibiotic use can be reduced by the use of pro-calcitonin guided therapy (abstract).

The study evaluated the long term effectiveness of a multi-faceted VTE prevention program, consisting of a risk assessment linked to a menu of VTE prophylaxis options (within order entry templates), coupled with education, audit/feedback, and identification of non-adherence. Within 3 years, rates of adequate prophylaxis increased from 58% to 93%, and the risk of hospitalized VTE significantly decreased (RR=0.69, CI 0.47-0.79). Using standard QI methodology, this VTE reduction program is both effective and generalizable (abstract).

In this database analysis from the Netherlands, researchers determined short term (28 day) mortality for open AAA surgery from 1997-2000. In men, mortality rates ranged from 3% to 27%, and for women they ranged from 4% to 54%, with a linear association with age. Although these numbers do not reflect the (lower) mortality rates with endovascular repair, they can aid in decisions about elective AAA repairs (abstract)

In this trial of 200 patients with active Cdiff infection, they were randomized to placebo or a single IV infusion of a monoclonal antibody against toxin A and B, in addition to standard treatment with either metronidazole or vancomycin. Those in the antibody group had lower risk of recurrence at 84 days (7% vs 25%) with no difference in adverse events. A single infusion of monoclonal antibody significantly reduces the risk of recurrent Cdiff infection (abstract).