Hospital Medicine Alert – January 1, 2008

January 1, 2008

• Multi-Faceted Approach to Hypervirulent C. difficile Control

  Early identification, coupled with appropriate control measures, reduces the rate of C. difficile infection and the frequency of adverse events.

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• Should We Continue Using Erythropoietin in the ICU?

  This randomized, double-blind, placebo-controlled trial demonstrates that administration of erythropoietin once a week for three weeks does not reduce the incidence of red blood cell transfusion in a mixed population of critically ill patients but is associated with an increased incidence of thrombotic events and a possible decrease in mortality in trauma patients.

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• Weight Gain: Predictor of Heart Failure Hospitalization

  Weight gain has long been used as a marker of fluid retention in heart failure patients. It is a cheap, simple test that can be performed daily in patients' homes.

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• Resolution of Chest X-ray Abnormalities for Pneumonia

  Two hundred eighty-eight patients hospitalized with severe community-acquired pneumonia (CAP) were followed for 28 days in a prospective multicenter study.

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• Barriers to Implementing the Leapfrog Recommendations

  In this survey of US hospitals, more than half did not have an identifiable ICU director. Loss of autonomy and income for admitting primary physicians were perceived as important barriers to implementation of the Leapfrog Group's ICU physician staffing guidelines.

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