In this non-randomized trial of patients with acute biliary pancreatitis (without cholangitis), patients received either ERCP (within 72 hours) or conservative treatment (at the discretion of the treating physician). Patient characteristics were similar between the groups, and about half received ERCP. The patients were compared in groups by whether or not they had cholestasis (bili>2.3 or common bile duct dilation). Patients with cholestasis had fewer complications with ERCP (adjusted OR=0.35), but there was no significant difference in those without cholestasis. Although not randomized, patients with acute biliary pancreatitis and cholestasis appear to benefit from early ERCP (abstract).

In this large observational study of 2106 patients >65 years admitted for syncope, researchers evaluated the frequency, yield, and cost of common diagnostic tests. The most commonly performed tests included EKG (99%), telemetry (95%) and cardiac enzymes (95%). All of the following tests affected diagnosis, management, or determined etiology in <5% of cases: Echo, cardiac enzymes, CT scans, carotid USG, and EEG. Postural BP affected diagnosis or management or etiology between 15-30% of cases. EEG, CT scans and cardiac enzymes were the least cost effective, and postural BP was the most cost effective (but was only performed in 38% of cases). A step-wise approach to diagnostic testing (after careful history, exam, and postural BP testing) should be utilized in older patients with syncope (abstract).

In this large prospective cohort of 4776patients who underwent bariatric surgery, 30-day adverse outcomes (death, thromboembolism, reintervention, or continued hospitalization) occurred in 4% (30-day death was only 0.3%). Higher risk was associated with prior thromboembolism, sleep apnea, higher BMI, and impaired functional status. Overall, adverse outcomes are uncommon in most bariatric surgery patients. (abstract)

The ACIP recommendations for who should get priority to receive the novel H1N1 vaccination includes 50% of the US population: Young persons age 6mo - 24 years, household contacts of those <6 mo, pregnant women, healthcare workers, and adults age 25-64 with underlying risk conditions (such as immunosuppression or other chronic diseases such as diabetes / chronic lung disease) (website)

The ACIP recommendations for who should receive this year’s seasonal trivalent influenza vaccine includes 85% of the US population: Children age 6mo-18 years (and household contacts of children <6 months), all adults >50 years, and all patients at risk of medical complications of influenza (including their care takers or house hold contacts) (website)

It is well known that delayed defibrillation results in reduced survival in cardiac arrest patients. Researchers analyzed outcomes from 7479 adult inpatient cardiac arrests victims in 200 hospitals from the National Registry of Cardiopulmonary Resuscitation. The prevalence of delayed defibrillation (>2 minutes) varied widely between hospitals, ranging from 2-51%. There was also wide variability in survival to discharge, ranging from 5-50%. Larger hospitals and ICU location had shorter times, but no other hospital characteristics were associated with delays. Hospitals need to design systems to ensure rapid defibrillation for hospitalized cardiac arrest patients (abstract).

In this manufacturer-funded trial, 404 patients starting ASA (dose range 75mg-325mg) underwent baseline and 12-week endoscopy, and were randomized to placebo or famotidine 20mg BID. At 12 weeks, the famotidine group had significantly fewer gastric ulcers (3% vs 15%), duodenal ulcers (1% vs 9%), and erosive esophagitis (4% vs 19%) compared to placebo. Famotidine is an effective strategy to prevent ASA-associated ulcers/esophagitis (abstract).

In this small trial of 35 patients with persistent MRSA bacteremia (>7 days despite vancomycin treatment), those switched to linezolid had much higher response (negative cultures at 72 hours) than those continued on vancomycin + aminoglycosides or rifampin (75% versus 17%). Patients with persistent MRSA bacteremia despite vancomycin should be switched to linezolid, rather than adding adjuvant treatment to vancomycin (abstract)

In this diagnostic trial of 328 patients who underwent both capsule endoscopy and colonoscopy, capsule endoscopy had a sens/spec for polys of 64% and 84%, and sens/spec for advanced adenomas of 73% and 70%. The capsule “slept” through the small bowel, and “awoke” in the colon, but was significantly limited by the adequacy of the prep. Although less invasive that colonoscopy, capsule endoscopy currently suffers from similar limitations as CT colonography (diagnostic only and significantly limited by prep adequacy). Although intriguing, it is not quite ready for prime time (abstract).

In thistrial of 120 healthy volunteers, they were randomized to 12 weeks of placebo or 8 weeks of PPI followed by 4 weeks of placebo. GERD symptoms were similar in the first 8 weeks, but in weeks 9-12, symptoms were significantly higher in the former PPI group (44% versus 15%) indicating significant post-PPI rebound. This is another reason to avoid unnecessary PPIs in inpatients, as many will experience rebound symptoms after cessation (abstract).