Nosocomial Pneumonia Prevention

The  abstract provides the conclusion – “Spontaneous awakening trials, spontaneous breathing trials, head-of-bed elevation, and thromboprophylaxis appear beneficial. Oral chlorhexidine and stress ulcer prophylaxis may be harmful. Subglottic secretion drainage, probiotics, and novel endotracheal cuff designs do not clearly improve objective outcomes. Selective digestive decontamination by contrast appears to lower VAP and mortality rates”.

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Exparel (liposomal Bupivacaine)

The latest chapter in what sounded like a great advance, the sustained-release DepoFoam liposomal Bupivacaine formulation for surgical infiltration analgesia. The FDA and Pacira Pharmaceuticals have wrangled for years – first its approval only for bunions and hemorrhoidectomy, then expanded to more general surgical use, debate over its real duration of analgesia (“up to” 72 hours, some find more like 24 hours), opioid sparing properties, study design issues. Pacira’s latest attempt to market for nerve blocks has failed for now. So it’s not time to throw away continuous nerve block catheters just yet.   link

 

Cardiac ICU Delirium

Delirium in ICU is the elephant in the room linked to increased costs, prolonged ventilation, increased length of stay, discharge to an institution and cognitive decline. Not to mention mortality. Some issues specific to cardiac ICU are reviewed here, such as the cardiovascular effects of anti-psychotics and dexmedetomidine, and a great overall review of risk factors, diagnosis, and management.   link

 

General Medical News Weekly

Risks of cerebral palsy and epilepsy are inversely associated with five minute and 10 minute Apgar scores across the entire range of Apgar scores.  link

A clear infographic on recovery from laparoscopic surgery  bmj link

Adding direct acting oral anticoagulants to antiplatelets  for secondary prevention after ACS beneficial after STEMI  link

Magnetic resonance imaging–guided focused ultrasound ablation has been approved for the treatment of refractory essential tremor and is being studied for other neurological indications  link

Metabolic surgery decreases diabetes complications link

Vagus Nerve Stimulator approved for migraine   link

Dogs smell fear. And it makes them bite you! link

Seventy-two hours of perioperative gabapentin use may promote opioid cessation. Gabapentin data is never overly convincing…  link

Purdue end OxyContin marketing to doctors. Only now?   link

Drowsy driving is a problem link

We still need to screen for syphilis in pregnancy as congenital disease doubles link

UK opioid prescriptions rise link

Invasive pneumococcal disease more common with potent or long duration of opioids which are known immunosuppressives.  link

Encouraging studies for prostrate treatment and survival (but only compared to placebo?!)   link

Prazosin disappoints in a study on PTSD in military veterans   link

Prenatal ultrasound and autism? Too early to link yet link

Could it be that Beta Blockers are not that vital at all after MI?  link

Falling health in the US needs action link

Ultra processed foods linked to cancer. Observational study but eat whole foods!  link

Recommendation against routine screening for ovarian cancer in asymptomatic women. Does not apply to high risk, and we need better screening methods  link

FDA approves first concussion blood protein test that could help predict intracranial lesions or obviate CT need link

And I don’t think linking asparagus consumption to breast cancer based on enzyme studies on mice quite merits a mention…