In this multi-institutional survey of 855 physicians, when presented with hypothetical patients with either community acquired (CAP) or health care associated (HCAP) pneumonia, 78% chose correct antibiotics for CAP, but only 9% chose correct antibiotics for HCAP. Continued education is needed to improve guideline concordance for patients with HCAP (abstract).

In this single institution cross-sectional analysis of 589 chest CTA’s ordered for suspected PE, only 9% had a PE, 33% had other findings to explain the symptoms, and 24% had an incidental finding that required follow up (primarily a new nodule or new adenopathy). Given that almost a quarter of patients that receive a CTA for PE will have an incidental finding requiring follow-up, systematic procedures for ensuring this follow-up will be required (abstract).

In this observational cohort of 247 trauma patients who underwent both CTA (pulmonary arteries) and CTV (pelvic/leg veins), of the 46 with PE, only 7 (15%) also had a DVT. Possible explanations include complete embolism, insensitivity of CTV, upper extremity source, or de novo pulmonary artery thrombus. Regardless, a high percentage of trauma patients with PE will have no detectable DVT (abstract).

In this preliminary analysis of data released from a large clinical trial of sibutramine (Meridia), participants randomized to sibutramine had higher rates of cardiovascular events (MI, CVA, cardiac arrest, or death) than those randomized to placebo (11.4% vs 10%). The FDA recommends patients with a history of CAD, CHF, CVA, or arrythmias not be prescribed sibutramine (FDA site)

In a CDC press release, cautionary enthusiasm was heralded, as the first declines in influenza activity were reported last week. Given the upcoming travel season, however, there is no way to predict what activity will occur in the weeks to months ahead. As Dr. Anne Schuchat (director of the national center for immunization and respiratory diseases) espoused, “Nothing is typical about this year’s influenza” (CDC site)

In this trial of 3846 patients with class 2-4 systolic CHF (EF <40%) who were intolerant of ACE inhibitors, they were randomized to 50mg or 150mg of losartan. Those in the high dose group had a lower risk of death/CHF hospitalization than the low dose group, at a median of 4.7 years (43% vs 46%). Increasing the losartan dose of CHF patients produces a small but signficant reduction in CHF admission/deaths (abstract)

The FDA has added a warning to the clopidogrellabel, about the reduction in clinical efficacy of clopidogrel when used in combination with omeprazole. Although the clinical effects of this reduction in efficacy is unclear, the FDA has recommended to avoid the combination when possible (FDA letter). They also warn against the use of esomeprazole, but cites insufficient information to comment about using other PPIs in combination with clopidogrel. For now, omeprazole and esomeprozole should not be concomitantly adminitered with clopidogrel.

In this community cohort of 10,864 middle-age Finnish residents, early repolarization (J-point elevation) was present on 6% of EKGs. J-point elevation of 0.1mV and 0.2mV in the inferior leads was significantly associated with cardiac death (ARR 1.28 and 2.98, respectively). Inferior J-point elevation is a risk factor for cardiac death (abstract).

The CDC has released a health advisory, reminding physician to vaccinate all patients >age 65, and all patients age 2-64 with high risk conditions, with the pneumococcal polysaccharide vaccine. Vaccination rates in the latter group are low, and these patients may be at high risk for pneumococcal superinfection following an influenza illness (CDC site)

In this multi-center trial of 342 adults intubated with ARDS who were randomized to supine or prone positioning, there was no difference in mortality (28 day, 6 month, or ICU discharge) between the groups. The prone group also had higher rates of complications related to prone positioning. This RCT does not support prone positioning for intubated patients with ARDS (abstract).