Hospital Medicine Alert – January 1, 2009
January 1, 2009
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Is Clot Burden on CT Angiogram Predictive of Mortality in Pulmonary Thromboembolism?
A prospective study comparing angiographic clot burden score and ECG score in 105 patients with PE found no correlation between the two, and neither predictor correlated with 12-month mortality. In a second retrospective study of 33 consecutive patients with massive PE by conventional clinical criteria, there was also no correlation between findings on CT angiography and mortality. -
IV Valproic Acid vs Phenytoin: Old Standby or the New Challenger?
Valproic acid and phenytoin were equally effective in the treatment of acute repetitive seizures and status epilepticus. -
Quality Improvement Interventions and Surgical Antimicrobial Prophylaxis
Forty-four acute care hospitals participated in a prospective study over four years to determine the effect of quality improvement (QI) interventions on appropriate prescribing of surgical antimicrobial prophylaxis. Hospitals were randomly assigned to either feedback on the results of the ongoing audit vs feedback plus an intensive collaborative intervention group. Both groups showed improvement in most quality indicators, but there appeared to be no benefit of the intensive QI collaborative intervention over performance feedback. -
Bridging Anticoagulant Therapy for Mechanical Valve Patients
Unfractionated heparin (UFH) is the standard bridging therapy for patients with mechanical heart valves who need to temporarily stop oral anticoagulants. Small case series have suggested that low molecular weight heparin (LMWH) may be useful for this purpose. -
It's Time to Have the Talk
Terminally ill cancer patients who had end-of-life discussions with their physician had better quality of life during their last week, and their caregivers had an easier bereavement.