The latest research you need to know

The Hospitalist. 2008 September;2008(09):

September 1, 2008|The Hospitalist

Kenneth Epstein, MD;Brian Donovan, MD;Augustine Osagie, MD;Richard Otto, MD;Marium Steele, MD;Ipc

Literature at a Glance

ICU management by critical care physicians may increase the odds of hospital mortality
Iatrogenic drug overdose common among patients with renal insufficiency
An educational effort lowers hospital mortality for severe sepsis and septic shock
SSRI and problem-solving therapy prevents post-stroke depression
Stop orders for Foley catheters reduce the duration of inappropriate urinary catheterization
No thromboembolism risk with interrupting anticoagulation in atrial fibrillation patients undergoing surgery
Obese patients may be initially under-dosed with vancomycin
Antipsychotic therapy is associated with short-term serious events in older adults with dementia
Cardiac troponin is associated with worse outcome in acute heart failure

Does management of ICU patients by critical care physicians reduce mortality?

Background: There is variation in the extent of involvement by critical care physicians in managing patients in ICUs. Several small studies have demonstrated improved outcomes when patients are managed by critical care physicians. This study expanded these findings by examining a national database of multiple ICUs.

Study design: Retrospective database analysis.

Setting: 123 ICUs in 100 U.S. hospitals

Synopsis: Using a national database of ICU patients, 101,832 admissions were analyzed. Controlling for ICU characteristics, patient demographics, and severity of illness (SOI), the impact of critical care management (CCM) on the primary outcome of hospital mortality was analyzed. Patients who received CCM had higher SOI, received more procedures, and had higher mortality rates than those who did not receive CCM. After adjustment for these variables, hospital mortality rates were higher for those patients who received CCM.

CLINICAL SHORTS

By Bradley Sharpe, MD, Rachael Lucatorto, MD, Lindsay Mazotti, MD, Nima Afshar, MD, Diane Sliwka, MD, University of California, San Francisco Division of Hospital Medicine

EVEROLIMUS STENTS REDUCE RESTENOSIS

Randomized trial comparing everolimus- to paclitaxel-eluting stents in coronary artery disease showed decreased restenosis (nine month angiography) and fewer major adverse cardiac events at one year in the everolimus group.

Citation: Stone GW, Midei M, Newman W, et al. Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial. JAMA. 2008;299(16):1903-1913.

INVASIVE GROUP B INFECTION RATES LOWER IN INFANTS, HIGHER IN ADULTS

In a population-based surveillance study, the incidence of invasive group B streptococcal disease in the United States decreased in newborns but increased and remains substantial in adults.

Citation: Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008;299(17):2056-2065.

Beta-lactams Equivalent to Non-beta-lactams for Cellulitis

Retrospective observational study of 861 veterans with uncomplicated cellulitis showed oral beta-lactams had a failure rate (14.7%) equal to that of oral non-beta-lactams (17%) with fewer adverse effects.

Citation: Madaras-Kelly KJ, Remington RE, Oliphant CM, et al. Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis. Am J Med. 2008;121:419-425.

DON’T TRANSFUSE OLD BLOOD IN CARDIAC SURGERY

A single-center, retrospective study showed transfusion of red blood cells that had been stored more than 14 days was associated with worse outcomes, including sepsis, longer intubation, renal failure, and short- and long-term mortality, after cardiac surgery.

Citation: Koch C, Li L, Sessler D, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358:1229-1239.

ALENDRONATE USE ASSOCIATED WITH ATRIAL FIBRILLATION

In a case-control study of women in a clinical practice setting, every use of alendronate was associated with a higher risk of incident atrial fibrillation (OR 1.86).

Citation: Heckbert SR, Li G, Cummings SR, Smith NI, Psaty BM. Use of alendronate and risk of incident atrial fibrillation in women. Arch Intern Med. 2008;168(8):826-831.

MEDICARE D BENEFICIARIES DON’T UNDERSTAND COST SHARING

A telephone survey of Medicare beneficiaries revealed limited knowledge of Part D cost sharing and evidence of frequent behavioral change to pay for gaps in coverage.

Citation: Hsu J, Fung V, Price M, et al. Medicare beneficiaries’ knowledge of Part D prescription drug program benefits and responses to drug costs. JAMA. 2008;299(16);1929-1936.

MEDICARE D DECREASES NON-ADHERENCE

This observational study demonstrated decreases in cost-related medication non-adherence and reduced prevalence of foregoing food and basic needs to pay for medications one year after the implementation of Medicare Part D.

Citation: Madden JM, Graves AJ, Zhang F, et al. Cost-related medication non-adherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299(16):1922-1928.

LONG-ACTING BETA-AGONISTS SAFE, EFFECTIVE IN COPD

Meta-analysis of randomized controlled trials found that, compared with placebo, long-acting beta-agonists reduce severe exacerbations and improve airflow, quality of life, and rescue medication use in COPD.

Citation: Gustavo JR, Nannini LJ, Rodriguez-Roisin R. Safety of long-acting beta-agonists in stable COPD. Chest. 2008;133:1079-1087.