News You Can Use

Evidence for a standardized preadmission showering regimen to achieve maximal antiseptic skin surface concentrations of chlorhexidine gluconate, 4%, in surgical patients” and editorial “Chlorhexidine gluconate, 4%, showers and surgical site infection reduction”

by jmiller on December 14, 2015

Concludes, “A standardized preadmission shower regimen that includes 18 ml of aqueous chlorhexidine gluconate, 4%, per shower; a minimum of 2 sequential showers; and a 1-minute pause before rinsing results in maximal skin surface concentrations of chlorhexidine gluconate that are sufficient to inhibit of kill gram-positive or gram-negative surgical wound pathogens.  This showering regimen corrects deficiencies present in current non-standardized preadmission shower protocols for patients undergoing elective surgery.  (JAMA Surg, Nov.)  Click here for full-text.

“Understanding variation in 30-day surgical readmission in the era of accountable care: effect on the patient, surgeon and surgical subspecialties” and editorial “Variation reduction to reduce readmission: a figment of imagination or reality of the future?”

by jmiller on December 14, 2015

The article concludes,  “Readmission occurred in more than 1 in 10 patients, with considerable variation across surgical subspecialties.  Variation in readmission was overwhelmingly owing to patient-level factors while only a minority of the variation was attributable to factors at the surgical subspecialty and individual surgeon levels.  The invited commentary reveals “that variability is primarily due to the common cause of patient-related factors (including race/ethnicity, insurance status, comorbidity, complications, and length of stay) rather than surgeon-or surgical subspecialty-specific factors.” (JAMA Surg, Nov.) Click here to read full-text.

Medicine Dept. Grand Rounds: featuring Dr. Seth Martin: PCSK9 Inhibitors: A new era in lipid management, Dec. 16, 5:30 – dinner; 6:00 presentation.

by jmiller on December 7, 2015

Click here to read Dr. Martin’s Editorial in the April 28th online first publication in Ann Intern Med:  PCSK9 Inhibitors:  A new era in lipid-lowering treatment.

Also, read featured review:  “Effects of proprotein convertase subtilisin/Kexin type 9 antibodies in adults with hypercholesterolemia:  A systematic review and meta-analysis.

Practice guidelines for perioperative blood management: an updated report by the ASA task force on perioperative blood management

by jmiller on November 13, 2015

“The purposes of these updated Guidelines are to improve the perioperative management of blood transfusion and adjuvant therapies and to reduce the risk of adverse outcomes associated with transfusions, bleeding or anemia.  The updated ASA practice guidelines differ from those published by other organizations in that: they include greater use of pharmacologic therapies to minimize blood transfusions, such as erythropoietin for the anemic patient, prothrombin complex concentrates for urgent reversal of warfarin, and intraoperative antifibrinolytic therapy during selected cardiac and noncardiac procedures having a  high risk for bleeding.  They advocate the use of transfusion algorithms, especially those based on thromboelastographic testing, blood-ordering schedules, and restrictive transfusion strategies.  Why does this statement differ from existing guidelines?  These ASA guidelines differ from the existing guidelines because they provide new evidence obtained from recent scientific literature along with findings from new surveys of expert consultants and randomly selected ASA members.   Click here to read full-text.

“Diagnostic accuracy of digital screening mammography with and without computer-aided detection” and accompanying editorial, “Is it time to stop paying for computer-aided mammography?”

by jmiller on November 12, 2015

Article concludes “Computer-aided detection does not improve diagnostic accuracy of mammography.  These results suggest that insurers pay more for CAD with no established benefit to women.”  (JAMA Intern Med, Nov)  Click here to read full text.

“Redefining blood-pressure targets – SPRINT starts the marathon,” “A SPRINT to the finish” and original article “A randomized trial of intensive versus standard blood-pressure control”

by jmiller on November 12, 2015

Article concludes “Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.”  (NEJM, articles in press)  Click here to read full text.

Society for ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery

by jmiller on October 12, 2015

“Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial.  Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery.  It was revealed that there is insufficient evidence to provide strong evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment.  (Anesth Analg )  Click here to read full text.

Ginkgo biloba in the treatment of attention-deficit/hyperactivity disorder in children and adolescents.

by jmiller on September 9, 2015

Article concludes:  The ginkgo biloba is an effective and safe complementary tratment for ADHD.  It resulted in significant increase in overall clinical treatment response.  (Complementary Therapies in Clinical Pracitice, August)  Click here to read full-text.

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