In the Literature
Literature at a Glance
A guide to this month’s studies.
- Physiologic doses of corticosteroids provide no clear benefit to patients with septic shock.
- Endovascular vs. open repair of abdominal aortic aneurysms is associated with fewer short-term deaths but complications and higher late reinterventions.
- Neither intensive insulin nor use of colloid over crystalloid improves mortality or organ failure outcomes in sepsis.
- Surgical cure for diabetes shows promise at two-year follow-up.
- Delayed defibrillation negatively affects survival.
- Right-ventricular enlargement in patients with acute PE is not associated with increased mortality.
- Periprocedural interruption of warfarin therapy presents low risk of thromboembolism.
- Minor leg injury increases risk of developing venous thrombosis threefold.
- Oral vs. parenteral antibiotics for pediatric pyelonephritis.
VTE Prophylaxis is Underutilized
Cross-sectional chart review of 68,138 surgical (45%) and medical (55%) patients found that only 58.5% of surgical and 41.5% of medical patients received recommended VTE prophylaxis.
Citation: Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-394.
Mechanical Ventilation Weaning Protocol Improved Outcomes
Random controlled trial in four tertiary care hospital ICUs found daily spontaneous waking paired with spontaneous breathing trials in mechanically ventilated patients compared with standard care decreased mechanical ventilation days, length of ICU stay, length of hospital stay, and one-year mortality.
Citation: Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008; 371:126-134..
Idraparinux Increased Bleeding in Atrial Fibrillation Patients Requiring Anticoagulation
This random, non-inferiority trial observed that weekly subcutaneous injection of idraparinux was not worse than standard anticoagulation therapy with warfarin or acenocoumarol in preventing thromboembolism, but increased bleeding complications.
Citation: The Amadeus investigators et al. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomized, open-label, non-inferiority trial. Lancet. 2008;371:315-321.
Thrombocytopenia Associated With Death and MI in Patients on Prolonged Heparin Therapy
Prospective observational study showed increased death (OR 3.4) and myocardial infarction (OR 2.1) in hospitalized patients who develop thrombocytopenia after treatment with four or more days of heparin (unfractionated or low molecular weight).
Citation: Oliveira GBF, Crespo EM, Becker RC, et al. Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med. 2008;168:94-102.
Medicare Part D Benefit Increased Drug Use, Decreased Out-of-pocket Costs For Older Adults
Using data from a national retail pharmacy chain, study shows Medicare Part D decreased out-of-pocket expenditures by approximately $9 a month and slightly increased drug use among older adults.
Citation: Yin W, Basu A, Zhang JX, Rabbani A, Meltzer DO, Alexander GC. The effect of the Medicare Part D prescription benefit on drug utilization and expenditures. Ann Intern Med. 2008;148:169-177.
Hospital Populations Report Benefits From Chaplain Visitations
A survey of 1,500 consecutive recently hospitalized patients at one of two Minnesota facilities indicated that select populations desire and value support offered by chaplain visits during the inpatient stay.
Citation: Piderman K, Marek D, Jenkins S, Johnson M, Buryska J, Mueller P. Patients’ expectations of hospital chaplains. Mayo Clin Proc. 2008;83:58-65.
Heterogeneous Labeling of Drug Doses May Contribute to Clinically Significant Dosing Errors
A small, randomly controlled trial of physicians in simulated scenarios demonstrated overdose errors were more likely to occur when using epinephrine labeled with ratio concentrations rather than mass concentrations.
Citation: Wheeler DW, Carter JJ, Murray LJ, et al. The effect of drug concentration expression on epinephrine dosing errors. Ann Intern Med. 2008;148:11-14.
