The ability of intensive care units to maintain zero central line-associated bloodstream infections.
Arch Intern Med. 2011 May 9;171(9):856-8
Authors: Lipitz-Snyderman A, Needham DM, Colantuoni E, Goeschel CA, Marsteller JA, T…

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Effect of admission medication reconciliation on adverse drug events from admission medication changes.
Arch Intern Med. 2011 May 9;171(9):860-1
Authors: Boockvar KS, Blum S, Kugler A, Livote E, Mergenhagen KA, Nebeker JR, Sig…

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Career satisfaction and burnout in academic hospital medicine.
Arch Intern Med. 2011 Apr 25;171(8):782-5
Authors: Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, Auerbach A

PMID: 21518949 [PubMed – in p…

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The Efficacy of Proton Pump Inhibitors for the Treatment of Asthma in Adults: A Meta-analysis.
Arch Intern Med. 2011 Apr 11;171(7):620-9
Authors: Chan WW, Chiou E, Obstein KL, Tignor AS, Whitlock TL
Gastroesophageal re…

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Physicians recommend different treatments for patients than they would choose for themselves.
Arch Intern Med. 2011 Apr 11;171(7):630-4
Authors: Ubel PA, Angott AM, Zikmund-Fisher BJ
Patients facing difficult decisions…

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Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study.
Arch Intern Med. 2011 Apr 11;171(7):669-76
Authors: Wu BU, Bakker OJ, Papachristou GI, Besselink MG, Repas K, van Santvoort …

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Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.
Arch Intern Med. 2011 Apr 11;171(7):678-84
Authors: O’Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami …

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Opioid dose and drug-related mortality in patients with nonmalignant pain.
Arch Intern Med. 2011 Apr 11;171(7):686-91
Authors: Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN
Opioids are widely prescribed for …

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Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome.
Arch Intern Med. 2011 Mar 14;
Authors: Planer D, Lev I, Elitzur Y, Sharon N, Ouzan E, Pugatsch T, Chasid M, Rom M, Lotan C
BACKGROUND: Smokers h…

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Ontario Multidetector Computed Tomographic Coronary Angiography Study: Field Evaluation of Diagnostic Accuracy.
Arch Intern Med. 2011 Mar 14;
Authors: Chow BJ, Freeman MR, Bowen JM, Levin L, Hopkins RB, Provost Y, Tarride JE, …

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Potentially inappropriate treatment of urinary tract infections in two rhode island nursing homes.
Arch Intern Med. 2011 Mar 14;171(5):438-43
Authors: Rotjanapan P, Dosa D, Thomas KS
The aim of this study was to determ…

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Recovery Expectations and Long-term Prognosis of Patients With Coronary Heart Disease.

Arch Intern Med. 2011 Feb 28;

Authors: Barefoot JC, Brummett BH, Williams RB, Siegler IC, Helms MJ, Boyle SH, Clapp-Channing NE, Mark DB

BACKGROUND: Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited. METHODS: At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status. RESULTS: Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an interquartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71-0.82) and 0.76 (95% CI, 0.69-0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76-0.91) and 0.79 (95% CI, 0.70-0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P < .001) were observed for functional status. CONCLUSION: Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease.

PMID: 21357800 [PubMed - as supplied by publisher]

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Decreased Antibiotic Utilization After Implementation of a Guideline for Inpatient Cellulitis and Cutaneous Abscess.

Arch Intern Med. 2011 Feb 28;

Authors: Jenkins TC, Knepper BC, Sabel AL, Sarcone EE, Long JA, Haukoos JS, Morgan SJ, Biffl WL, Steele AW, Price CS, Mehler PS, Burman WJ

BACKGROUND: Cellulitis and cutaneous abscess are among the most common infections leading to hospitalization, yet optimal management strategies have not been adequately studied. We hypothesized that implementation of an institutional guideline to standardize and streamline the evaluation and treatment of inpatient cellulitis and abscess would decrease antibiotic and health care resource utilization. METHODS: A retrospective preintervention-postintervention study was performed to compare management before and after implementation of the guideline (January 1, 2007-December 31, 2007, and July 9, 2009-July 8, 2010). RESULTS: A total of 169 patients (66 with cellulitis, 103 with abscess) were included in the baseline cohort, and 175 (82 with cellulitis, 93 with abscess) were included in the intervention cohort. The intervention led to a significant decrease in use of microbiological cultures (80% vs 66%; P = .003) and fewer requests for inpatient consultations (46% vs 30%; P = .004). The median duration of antibiotic therapy decreased from 13 days (interquartile range [IQR], 10-15 days) to 10 days (IQR, 9-12 days) (P < .001). Fewer patients received antimicrobial agents with broad aerobic gram-negative activity (66% vs 36%; P < .001), antipseudomonal activity (28% vs 18%; P = .02), or broad anaerobic activity (76% vs 49%; P < .001). Clinical failure occurred in 7.7% and 7.4% of cases (P = .93), respectively. CONCLUSION: Implementation of a guideline for the management of inpatient cellulitis and cutaneous abscess led to shorter durations of more targeted antibiotic therapy and decreased use of resources without adversely affecting clinical outcomes.

PMID: 21357799 [PubMed - as supplied by publisher]

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Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?

Curr Opin Anaesthesiol. 2010 Dec;23(6):687-90

Authors: Smith I, Jackson I

As day surgery continues to expand, more patients will be encountered who are chronically taking a range of cardiovascular medications for the management of hypertension and ischaemic heart disease. This review will consider the available evidence relating to whether or not these medications should be continued throughout the perioperative period in ambulatory surgical patients.

PMID: 20805745 [PubMed - indexed for MEDLINE]

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Acid-Suppressive Medication Use and the Risk for Nosocomial Gastrointestinal Tract Bleeding.

Arch Intern Med. 2011 Feb 14;

Authors: Herzig SJ, Vaughn BP, Howell MD, Ngo LH, Marcantonio ER

BACKGROUND: Acid-suppressive medications are increasingly prescribed for noncritically ill hospitalized patients, although the incidence of nosocomial gastrointestinal (GI) tract bleeding (GI bleeding) and magnitude of potential benefit from this practice are unknown. We aimed to define the incidence of nosocomial GI bleeding outside of the intensive care unit and examine the association between acid-suppressive medication use and this complication. METHODS: We conducted a pharmacoepidemiologic cohort study of patients admitted to an academic medical center from 2004 through 2007, at least 18 years of age, and hospitalized for 3 or more days. Admissions with a primary diagnosis of GI bleeding were excluded. Acid-suppressive medication use was defined as any order for a proton pump inhibitor or histamine-2-receptor antagonist. The main outcome measure was nosocomial GI bleeding. A propensity matched generalized estimating equation was used to control for confounders. RESULTS: The final cohort included 78 394 admissions (median age, 56 years; 41% men). Acid-suppressive medication was ordered in 59% of admissions, and nosocomial GI bleeding occurred in 224 admissions (0.29%). After matching on the propensity score, the adjusted odds ratio for nosocomial GI bleeding in the group exposed to acid-suppressive medication relative to the unexposed group was 0.63 (95% confidence interval, 0.42-0.93). The number needed to treat to prevent 1 episode of nosocomial GI bleeding was 770. CONCLUSIONS: Nosocomial GI bleeding outside of the intensive care unit was rare. Despite a protective effect of acid-suppressive medication, the number needed to treat to prevent 1 case of nosocomial GI bleeding was relatively high, supporting the recommendation against routine use of prophylactic acid-suppressive medication in noncritically ill hospitalized patients.

PMID: 21321285 [PubMed - as supplied by publisher]

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