Bottom line: Placement of ICDs in heart failure patients with a high risk of sudden cardiac death does not appear to decrease quality of life.
Citation: Mark DB, Anstrom KJ, Sun JL, et al. Quality of life with defibrillator therapy or amiodarone in heart failure. N Engl J Med. 2008;359:999-1008.
CLINICAL SHORTS
SERIAL 2-POINT ULTRASONOGRAPHY PLUS D-DIMER IS EQUIVALENT TO WHOLE-LEG ULTRASONOGRAPHY FOR DIAGNOSING DVT
Randomized trials show that when comparing serial 2-point ultrasonography plus D-dimer testing with whole-leg ultrasonography, the strategies were equivalent in excluding a first episode of suspected DVT in outpatients.
Citation: Bernardi E, Camporese G, Buller HR, et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis. JAMA. 2008;300(14):1653-1659.
DAILY HEMODIALYSIS IS COST-EFFECTIVE IN ICU PATIENTS WITH ACUTE KIDNEY INJURY (AKI)
Markov model based on prospective trial data shows daily hemodialysis is cost-effective for AKI in the ICU compared with alternate-day hemodialysis.
Citation: Desai AA, Baras J, Berk BB, et al. Management of acute kidney injury in the intensive care unit. Arch Intern Med. 2008;168(16):1761-1767.
THROMBOLYSIS FOR IN-HOSPITAL STROKE IS SAFE, BUT ASSOCIATED WITH DELAYS
Prospective observational trial shows thrombolysis is safe and effective for in-hospital stroke, but statistically significant delays exist compared with out-of-hospital strokes.
Citation: Masjuan J, Simal P, Fuentes B, et al. In-hospital stroke treated with intravenous tissue plasminogen activator. Stroke. 2008;39:2614-2616.
ALGORITHM CAN IDENTIFY HIGH-RISK HEART FAILURE PATIENTS
Prospective observational study identifies clinical variables for a bedside algorithm, which stratifies the risk of hospitalized heart failure patients for early mortality or readmission to identify those who might benefit from closer follow-up.
Citation: O’Connor CM, Abraham WT, Albert NM, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156(4):662-673.
IN-HOSPITAL SMOKING-CESSATION INTERVENTIONS WITH FOLLOW-UP CAN WORK
Meta-analysis of 33 trials shows in-hospital smoking-cessation counseling followed up with more than one month of outpatient support can be effective.
Citation: Rigotti NA, Munafo MR, Stead LF. Smoking cessation interventions for hospitalized smokers. Arch Intern Med. 2008;168(18):1950-1960.
OMISSION OF KEY INFORMATION DURING SIGN-OUT LEADS TO ADVERSE CONSEQUENCES
An audio-taped study of sign-out among internal medicine house staff teams revealed omission of key information during sign-out resulted in delays in diagnosis or treatment.
Citation: Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755-1760.
HOSPITAL PALLIATIVE CARE CONSULTATION TEAMS ARE ASSOCIATED WITH HOSPITAL COST SAVINGS
Analysis of administrative data from eight diverse hospitals with palliative-care programs revealed consultation with palliative care saved $1,696 (p<0.001) per hospital admission in patients discharged alive, and $4,098 (p=0.003) per hospital admission in patients who died in the hospital.
Citation: Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with U.S. hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790.
HIGHER EDUCATIONAL DEBT INFLUENCES INTERNAL MEDICINE RESIDENT CAREER PLANS
U.S. medical graduates with a debt of $50,000 to $99,999 are more likely than those with no debt to choose a hospitalist career, and this preference increased with increased debt level.
Citation: McDonald FS, West CP, Popkave C, Kolars JC. Educational debt and reported career plans among internal medicine residents. Ann Intern Med. 2008;149:416-420.
BRAIN IMAGING IMPORTANT IN IDENTIFYING VASCULAR TERRITORY AFTER TIA OR MINOR STROKE
Neurologists were only moderately reliable at identifying the vascular territory of a TIA or motor stroke, highlighting the fact brain imaging is needed to accurately identify the vascular territories of these events.
Citation: Flossmann E, Redgrave JN, Briley D, Rothwell PM. Reliability of clinical diagnosis of the symptomatic vascular territory in patients with recent transient ischemic attack or minor stroke. Stroke. 2008;39:2457-2460.
HIGH-DOSE VITAMIN B SUPPLEMENTATION DOES NOT SLOW COGNITIVE DECLINE IN ALZHEIMER’S DISEASE
Multicenter, randomized, placebo-controlled trial finds no difference in the rate of cognitive decline in patients with Alzheimer’s disease treated with high-dose vitamin B supplements for 18 months.
Citation: Aisen PS, Schneider LS, Sano M, et al. High-dose B vitamin supplementation and cognitive decline in Alzheimer’s disease. JAMA. 2008; 300(15):1774-1783.