In this before-after study of ventilated patients, an oral care protocol (q4 hours) reduced the incidence of ventilator-associated pneumonia from 12.6 to 1.3 cases / 1000 ventilator days. This adds to the literature that evidence-based protocols can improve quality (abstract).

In this cross sectional analysis of salmonella typhi samples submitted to the Centers for Disease Control, 79% of patients had traveled within 30 days, and 73% were hospitalized (mean age 22). Susceptibility testing showed that 13% were multi-drug resistant, and 97% had decreased susceptibility to ciprofloxacin. Multi-drug resistance was more common in travelers to the Indian continent (abstract). Salmonella typhi in recent travelers is likely to have a high incidence of drug resistance.

There are now expected to only be 45 million vaccine dose available by October (short of the initial 120 million expected), but the full 195 million are expected to be available by December (full story)

In this population-based cohort, researchers found 70% of K.pneumonia was either nosocomial or health-care associated, with an overall mortality rate of 20%. Higher mortality was associated with advance age, co-morbid conditions, nosocomial acquisition, and non-urinary/non-biliary source. K.pneumonia bacteremia is commonly health-care associated and carries a poor prognosis (abstract).

In this meta-analysis, researchers attempted to compare different MRSA screening methods (active-rapid by PCR, active-usual by culture, or no active screening), to outcomes (incidence of MRSA acquisition, MRSA blood stream infections, or MRSA surgical site infections). They found PCR versus culture screening did not affect rates of MRSA acquisition, but that PCR versus no screening significantly reduced MRSA blood stream infections. This implies that some screening is better than no screening, but that the type of screening (PCR vs culture) is less important (abstract).

In this single center study of patient presenting with acute UGI bleeding, those with stable CAD were compared to those without CAD. On continuous EKG monitoring, those with CAD has significantly more procedural ventricular ectopy (42% vs 16%), and more sub-clinical ischemia (18% vs 2%). However, clinical outcomes were not significantly different (length of stay or mortality). Although ventricular arrhythmias and sub-clinical ischemia is common in patients with stable CAD undergoing EGD, it’s clinical significance is not yet clear (abstract).

In this single center study, researchers examined the prevalence of prolonged shedding of influenza virus in hospitalized patients (detected by culture and PCR). Of 147 patients, viral RNA was detectable 1 week after symptom onset in 26% of oseltamivir-treated patients, and 57% of untreated patients. Prolonged clearance was associated with co-morbidities and systemic steroids (for asthma or COPD). In these high risk patients, prolonged viral shedding should be expected (abstract).

In this before-after study, a 24 bed surgical ICU introduced a checklist of 14 quality items. It was first made available for use, then its use mandated. Verbal consideration of the items improved from 91% to 100% after the mandate. Clinical care improvements occurred with DVT prophylaxis, stress ulcer prophylaxis, oral care for ventilated patients, electrolyte repletion, initiation of physical therapy, and restraint orders. This adds to the literature that standardized care check lists can improve care quality in many different settings and patient populations (abstract).

In this meta-analysis of atrial flutter and SVT ablations, these procedures were found to be both safe (mortality <1% and adverse events <3%) and effective (single ablation success rates were 92-93%). Ablations for aflutter or SVT are safe and effective (abstract)

In this trial of patients with advanced cancer, they were randomized to usual care, or a nurse-led multi-component palliative care intervention (weekly for 4 weeks, then monthly). Those in the intervention group had higher quality of life and mood scores, but there was no difference in symptom intensity or intensity of treatment. A nurse-led palliative care program may improve quality of life and mood, but it’s effect on symptoms or treatment intensity is less clear (abstract)