Researchers analyzed all randomized controlled trials listed in pubmed in 2008 in 3 clinical area (GI, cardiology, and rheumatology) in 10 high impact clinical journals. They found that of the 323 trials, only 46% were adequately registered (registered before the end of the trial with the primary outcome cleared stated). Among those adequately registered, 31% had a discrepancy in the registered primary outcome and the published primary outcome (including omission of the primary outcome, reporting a secondary outcome as primary, and reporting unregistered outcomes as primary). Despite registration requirements for most high impact journals, many trials are not publishing the intended primary outcomes measures (abstract)

In this case-control study of dialysis and non-dialysis patients with UGI bleeding, all had endoscopic control of their bleeding, and received 3 days of IV PPI (40mg IV BID), then oral PPI (20mg qday) for 2 months. The rate of re-bleeding at 7 days was about the same in the 2 groups, but between 7-30 days, the dialysis group had significantly higher rates of re-bleeding (10% vs 0%). Higher PPI doses in dialysis patients at discharge may be necessary to reduce the intermediate risk of re-bleeding (abstract).

In this large retrospective cohort of 88,074 patients admitted with a COPD flare, researchers determined 3 variables (BUN>25, HR>109, and acute mental status change) predicted risk of mortality and intubation. In those with all 3 factors, mortality was 13%-15% (in the derivation and validation cohorts). In those with none of those factors and <age 65, mortality was 0.3% in both cohorts. The AUROC for mortality and intubation ranged from 0.71 to 0.77. This simple risk score can predict mortality and intubation risk in patients admitted with COPD flares (abstract).

In this trial of 92 patients with creatinine >1.7 mg/dl undergoing cardiac catheterization, they were randomized to saline hydration, or euvolemic forced diuresis (with saline, mannitol, and furosemide). The forced diuresis group had a significantly higher rate of CIN (50% vs 28%). The same study did a meta-analysis (including 2 other studies with a total of 251 patients) and found the relative risk of harm of forced diuresis (compared to saline hydration) was 2.15 (CI 1.37 to 3.37). Forced diuresis to prevent CIN is harmful (abstract).

In trial of 106 patients with respiratory failure, immediately post-extubation they were randomized to non-invasive ventilation (for 24 hours) or conventional oxygen. Those in the non-invasive ventilation group were less likely to have respiratory failure at 72 hours (15% vs 48%), and had lower 90 day mortality (11% vs 31%) (where most of the causes of death were due to respiratory failure). A 24 hour trial of non-invasive ventilation post-extubation may reduce respiratory failure and mortality (abstract).

In this large cohort of 13,559 patients with non-valvular afib in an integrated health care system, researchers determine the net clinical benefit of warfarin. They calculated benefit by the annual risk of CVA/emboli - the annual risk of intracranial hemorrhage (times a 1.5 “impact factor”). They found no net clinical benefit for those with CHADS2 scores of 0-1, but a 2.2% annual benefit for those with CHADS2 scores 4-6. The greatest benefit was found in those with a history of CVA and age >85 (abstract).

In this prospective cohort of 301 ICU patients who died, 77% had autopsies performed to determine the percentage with histopathologic evidence of candida pneumonia. Half of those autopsied had histopathological evidence of pneumonia, and half of those also had prior evidence of candida in lung secretions (either tracheal aspirate or BAL). None of the patients had evidence of candida pneumonia (yeast invasion in lung tissue). The isolation of candida from the lung secretions of critically ill patients rarely indicates candida pneumonia (abstract).

In this industry sponsored randomized trial of 1952 healthy adults (aged 18 to 49), the inactivated (intramuscular) vaccine outperformed the live-attenuated (nasal spray). Overall 6% of participants had lab-confirmed influenza, and there was a 50% reduction in influenza cases in the inactivated vaccine group compared to the live-attenuated group. Inactivated seasonal influenza vaccination reduces lab-confirmed influenza more than live-attenuated in healthy adults (abstract).

In this before-after observational study in an intensive care unit, the introduction of a multi-faceted checklist improved most bedside care practices (including DVT prophylaxis, restraint ordering, stress ulcer prophylaxis, oral care, electrolyte repletion, and PT evaluations). This adds to the existing literature that standardized checklists can improve the quality and consistency of care delivery (abstract).

In this randomized trial of 144 patients with mild renal insufficiency (creatinine 1.1-2.0) undergoing elective cardiac catheterization, they were randomized to a single 20meq HCO3 bolus before contrast, and all received hydration. The incidence of nephropathy within 3 days (25% or 0.5 increase from baseline creatinine) was significantly lower in the HCO3 group (1% vs 13%). A single HCO3 bolus before contrast (added to hydration) appears to be effective in reducing post-procedure nephropathy in patients with mild renal insufficiency (abstract).