Wednesday, May 17, 2006

More Abstracts

  • Steg, P.G., et al, Chest 128(1):21, July 2005: Another study sponsored by Biosite (the company that makes BNP) from the BNP (Breathing Not Properly) data base- they state that BNP is better than echo in determing CHF (BNP averaged 683 in CHF vs. 129 in non-CHF). The bottom line is there was a lot of data mining in this study that heavily favored stats towards a pro-BNP stance. I've spoken with a cardiologist from the Cleveland Clinic who feels that BNP is a pretty worthless test in this setting. I really don't bother ordering it anymore as I feel that my clinical judgment (history, physical exam and CXR) provides more information than this one lab test. The only people who I find are still interested in its results are some hospitalists.
  • Goodacre, S., et al, Ann Intern Med 143(2):129, July 19, 2005: Clinical judgment is as good as the Wells' criteria for diagnosing DVT. The two most important questions are whether they had a prior DVT or current malignancy. Nothing horribly new here.
  • Oudega, R., et al, Ann Intern Med 143(2):100, July 19, 2005: D-dimer is only beneficial for its negative predictive value in low-risk patients for DVT.
  • Squire, B.T., et al, Acad Emerg Med 12(7):601, July 2005: Use of bed-side U/S (after a 30 minute training session) to diagnose a superficial abscess is significantly improved. This would be very helpful to determine whether there is some pus there before doing an I&D. This would be a nice adjunctive use of a SonoSite (ahem twice Evan)...
  • Murray, J.J., et al, Otolaryngol Head Neck Surg 133(2):194, August 2005: Interesting study of confirmed sinusitis (with imaging and bacteriological aspirate) randomized to either Azithromycin 2 g microsphere as a one time dose vs. 10 days of levaquin. Same efficacy between the treatment. A couple of caveats: a) drug-sponsored study and b) they didn't compare to placebo (some patients may have gotten better without treatment). My bottom line is that if I'm going to treat sinusitis (which typically is a 14 day course) it may be beneficial to do the 2 gram Azithromycin dose in the ED and no further antibiotics required. They had a slightly higher adverse effects (23% vs 15%) but not serious (GI issues).
  • Salerno, S.M., et al, Arch Intern Med 165:1686, August 8/22, 2005: Oral pseudophedrine does NOT cause a clinical increase in SBP or DBP.
  • Prescott, L., Ann Emerg Med 45(4):409, April 2005: Use of IV N-acetylcysteine is equivocal in efficacy with oral therapy in treatment of acute acetaminophen toxicity. Bottom line is to give oral N-AC if they tolerate PO, but it's ok to use IV in serious overdose or unable to tolerate PO. The maximum effects are found in the first eight hours.
  • McEvoy, S.P., et al, Br Med J 331:428, August 2005: Not so much that it'll change your practice, but the use of a cell-phone (even hands-free system) is associated with a four-fold increase in MVC's.


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