1 / 11

UPDATE IN HOSPITAL MEDICINE: EVIDENCE PUBLISHED IN 2011

UPDATE IN HOSPITAL MEDICINE: EVIDENCE PUBLISHED IN 2011. Gail Wiley D.O. candidate GA-PCOM July 2011. Objective . This article summarizes some of the exciting or controversial research that has been published in 2011.

yorick
Download Presentation

UPDATE IN HOSPITAL MEDICINE: EVIDENCE PUBLISHED IN 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. UPDATE IN HOSPITAL MEDICINE: EVIDENCE PUBLISHED IN 2011 Gail Wiley D.O. candidate GA-PCOM July 2011

  2. Objective • This article summarizes some of the exciting or controversial research that has been published in 2011

  3. Continuous and Bolus Dosing of Furosemide Provide Similar Outcomes in Heart Failure • Study Design- 308 patients presenting to ED with acute decompensated heart failure (average EF of 35%) were randomized to receive furosemide administered continuously or in a daily bolus • Findings- global assessment of functioning and creatinine levels were the same in both groups at 72 hours • Implications- there is was no difference of outcomes in the two groups; bolus strategy has the advantage of ease of administration

  4. Nesiritide does not Improve Outcomes in Decompensated Congestive Heart Failure • Study design- 7141 patients were randomly assigned treatment with Nesiritide (BNP) or placebo. • Implications- There is no compelling clinical benefit to using Nesiritide in patients with acute decompensated heart failure. • Findings- there was no statisically significant differences in outcomes, including self reported overall well being, in house mortality or renal insufficiency

  5. Outpatient Treatment of Pulmonary Embolism is Safe and Effective • Study Design- 344 patients with acute PE who met criteria for low risk PE were randomised to be treated inpatient vs. outpatient • Findings- at 90 days there was one death in each group and 1 reccurent VTE in outpatient group; meeting criteria for noninferiority • Implications – Outpatient treatment of low risk PE is safe and effective

  6. Novel Oral Anticoagulant for Atrial Fibrillation • Study Design- 18, 201 pt with Afib randomized pt to recieve Factor Xa inhibitor Apaxiban vs. Warfarin • Findings- Apaxiban superior to Warfarin in preventing ischemic stroke and caused fewer iatrogenic hemmorhagic events • Implications- Warfarin is not ideal, we are looking for other options, $$$

  7. Cardiopulmonary Resuscitation- Reducing Duration of Perishock Pause is Associated with Improved Survival • Study Design- 815 patients with a shockable rhythm compared survival at differing lengths of pre and post shock pauses • Findings- perishock pause more than 20 seconds had a 10% lower survival rate than those with a perishock pause less than 10 seconds • Implications- providers should ensure that hands off intervals do not exceed CPR do not exceed 5 seconds and that compressions are continued during defibrillator charging

  8. Azithromycin Reduces Exacerbations in Patients with Moderate, Severe or Very Severe COPD • study design- 1142 patients with mean FEV1 of 40% to recieve either Azithromycin 250 mg/ day or placebo for 1 year • Findings- long term Azithromycin extended amount of time to next exacerbation • Implications- long term Azithromycin can improve quality of life in COPD, however contraindicated in pt at risk for hearing loss or prolonged QT

  9. Hospitalist Care May be Associated with Lower Inpatient Costs but Higher Costs After Discharge • Study Design- medicare claims data from 58,000 admissions to hospitals were analyzed • Findings- Hospitalist’s pt were discharged sooner but ended up costing more in followup care than those attended to in the hospital by their primary physician • Implications- Cost overall was comparable.There were many confounders in the study. Pt who do not have a primary care physician tended to be sicker, with more comorbidities.

  10. Baclofen May be a Valuable Adjunct in Controlling Symptoms of Acute Alcohol Withdrawal Syndrome • Study Design- 44 inpatients with acute alcohol withdrawal syndrome randomised to recieve Baclofen 10mg q 8 x 3 days or placebo • Findings- Pt on Baclofen required less Lorazepam to control symptoms • Implications- Baclofen may permit control of withdrawal symptoms with lower doses of benzodiazepines

  11. Source: • Steven Deitelzweg, MD; Daniel D Dressler, MS, MSc; and Brian Harte MD (2012). Update In Hospital Medicine: Evidence Published in 2011. Annals of Internal Medicine, 875-879.

More Related