In this comparison of the diagnostic accuracy of 3 monoclonal antibody stool tests for Hpylori, sensitivity ranged from 69% to 92%, and specificity ranged from 76% to 90%. The take home message is there is significant variability of diagnostic performance of various Hpylori stool tests, but they all perform better than the older polyclonal tests, and will be used more frequently over time (abstract).

In this long-term follow up of the effectiveness of a central-line care bundle, originally published in 2006 (abstract), the rate of catheter associated blood stream infections (CA-BSIs) was sustained from 18 months to 36 months of follow up. This is encouraging that such drastic reductions in CA-BSIs can be sustained (abstract)

In this retrospective cohort of 338 patients undergoing emergency PCI for ACS, 28% developed CIN, which was significantly more common in women, those with an LAD lesion, a contrast volume >200cc, or an end-diastolic pulmonary artery pressure > 15mmHg. Mortality in the CIN group was significantly higher than the non-CIN group (10% vs 3%). CIN is common and associated with high mortality post-emergency PCI. Better peri-procedural management is required to reduce the associated morbidity and mortality (abstract)

In this large statewide retrospective database analysis, adjusted ICU mortality was lowest in units which had daily multi-disciplinary rounds. When stratified by intensivist staffing, those with daily rounds and high staffing had the lowest mortality, followed by those with daily rounds and low staffing. Multi-disciplinary rounds are vital to good patient outcomes (abstract)

In this large retrospective database analysis of Medicare fee for service patients undergoing 1 of 15 surgical procedures, the % of them that received co-management (>70% of hospital days had a charge from a medical doctor) increased 11% / year from 2001 to 2006. Co-management was more likely to occur in non-teaching, for-profit hospitals, and in older patients with more co-morbidities. Co-management will likely continue to undergo rapid expansive growth (abstract).

In this meta-analysis of 24 studies involving 6605 thoracentesis, the overall rate of pneumothorax was 6%, and 1/3 of them required a chest tube. Protective factors were the use of USG and more user experience. Pneumothorax was more likely to occur during therapeutic thoracentesis and in patients with periprocedural symptoms. More experience and the use of USG can reduce the incidence of pneumothorax (abstract)

In this large retrospective database analysis of 8302 patients re-admitted with a culture confirmed SSI from 2003-2007, the % of MRSA infections increased from 16% to 21% over the 5-year period. Compared to non-MRSA infections, MRSA infections were associated with higher mortality, LOS, and cost. Continued efforts to reduce MRSA SSIs are needed to reduce associated morbidity and mortality (abstract)

In this single center retrospective cohort of a med/surg ICU over 4 years, researchers found higher mortality in patients with the highest mean glucose change per hour (a measure of variability). The odds of ICU death was higher for each quartile of mean glucose change per hour, compared to each quartile of mean glucose, indicating that glucose variability may be more important a factor for death than the mean glucose. Consistency of glucose control may be more important than absolute control (abstract)

There are several conditions which have shown to have lower mortality in high volume centers. In this retrospective analysis of the Nationwide Inpatient Sample of patients admitted with acute pancreatitis, adjusted mortality, LOS, and charges were all lower in high volume centers compared to low volume centers. The specific attributes of the high volume hospitals which contribute to lower mortality is not clearly outlined, but are likely due to readily available specialty and procedural services (abstract).

A new international consensus guideline has been published on the management of non-variceal upper GI bleeding (guidelines). Among the highlights, the guidelines stress the use of prognostic staging and early endoscopy. Post endoscopy, low risk patients should be candidates for early discharge, while high risk patients should be observed for re-bleeding on high-dose IV PPIs for 72 hours. ASA should be restarted within 7 days for those who require it (and ASA+PPI is preferred over clopidogrel). For those requiring NSAIDs, a PPI with a COX-2 inhibitor is preferred. In peptic ulcers, test (and treat) for Hpylori