Now treating aymptomatic hypertension is out?

The world keeps on changing -- maybe there is no evidence for hypertension treatment (mild) in patients without other risks?

https://webvpn.mcgill.ca/http/jama.jamanetwork.com/article.aspx?articleid=1367504

ITP - Guidelines

In case I ever need to read them again, I am linking them here:
http://bloodjournal.hematologylibrary.org/content/117/16/4190.full

Predicting relapse of C. difficile

Recent article in CID:

http://cid.oxfordjournals.org/content/55/suppl_2/S77/T3.expansion.html

Resistant organisms cost healthcare systems more

A further impetus to control the emergence of resistance.

http://cid.oxfordjournals.org/content/55/6/807.full

Oh strongyloides, are you now the great mimic?

http://www.nejm.org/doi/full/10.1056/NEJMcpc1109275

Why we should be judicious about medical imaging

IOM report on CT scans and cancer risk
http://archinte.jamanetwork.com/article.aspx?articleid=1182553

Another nail in the colloid coffin

http://www.nejm.org/doi/full/10.1056/NEJMoa1204242

Second RCT to show members of this family of compounds causing harm...

Prognosis in Invasive Aspergillosis

Nice study in CID demonstrating that platelet count and baseline creatinine clearance can identify patients at higher risk of poor outcomes in newly diagnosed IA

http://cid.oxfordjournals.org/content/54/12/e173/

On the proper use of colistin

Nice article in CID which will be useful in providing the dosing

http://cid.oxfordjournals.org/content/54/12/1720.full

Interesting editorial further highlighting the harms of tube feeding in advanced cognitive impairment

http://archinte.jamanetwork.com/article.aspx?articleid=1151405

Polypharmacy in dialysis

An interesting read... Similar to other articles on rationalizing (NOT RATIONING) medication use in our patients.
http://archinte.ama-assn.org/cgi/content/full/172/7/593

Also interesting to look at issues around end of life care and aggressive medical intervetions in dialysis patients
http://archinte.ama-assn.org/cgi/content/full/172/8/663

Anticoagulation Guidelines 2012 link below

Chest 2012:
http://chestjournal.chestpubs.org/content/141/2_suppl/e152S.full

Challenging the modern concept of pulmonary embolism

Very interesting editorial on the history (and future) of PE

https://webvpn.mcgill.ca/http/archinte.ama-assn.org/cgi/content/full/archinternmed.2012.195

I have previously blogged about PE/DVT (see search function).

On the treatment of VRE

https://webvpn.mcgill.ca/http/cid.oxfordjournals.org/content/54/suppl_3/

A nice suppliment to CID on the "new hope" oritavancin.  This table shows US data on enterococcal resistance.

The world turns upside down..

Another dogma is challenged -- the use of epinephrine in cardiac arrest

jama.ama-assn.org/content/307/11/1198.full

End of life care and decision making

Interesting editorial in JAMA here:
jama.ama-assn.org/content/307/9/917.full

PFO and Cryptogenic Stroke

I read this with interest, having seen more and more PFOs closed in the absence of trial evidence, I am glad to see such an editorial hammer home the key point -- not without more study.

http://www.nejm.org/doi/full/10.1056/NEJMe1201173

An interesting concept... The "nocebo" effect

jama.ama-assn.org/content/307/6/567.full

or for McGill people here.

A rethink on supplimental oxygen by rote...

Or -- why the "Harvard oxygen saturation" (i.e. 100%) is not required and potentially dangerous...

The death of the statin in primary prevention...

Will this change practice?  It should (for low risk patients)...

Don't order a test if you don't know how to act on the result...

Nice editorial of providing high quality cost-conscious care...

Harnessing the placebo effect...

Sounds like medicine is beginning to embrace it again... take that, homeopathy.

We are in an outbreak of RSV

1) Isolation recommended - CDC guidelines
https://webvpn.mcgill.ca/http/www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm

"Patient placement in acute-care facilities

1) Place a patient with diagnosed RSV, parainfluenza, adenovirus, or other viral respiratory tract infection in a private room when possible or in a room with other patients with the same infection and no other infection (IB) (37,367--369, 376,377).
2) Place a patient with suspected RSV, parainfluenza, adenovirus, or other viral respiratory tract infection in a private room (II).

a) Promptly perform rapid diagnostic laboratory tests on patients who are admitted with or who have symptoms of RSV infection after admission to the health-care facility to facilitate early downgrading of infection-control precautions to the minimum required for each patient's specific viral infection (IB) (364,376).
b) Promptly perform rapid diagnostic laboratory tests on patients who are admitted with or who have symptoms of parainfluenza or adenovirus infection after admission to the health-care facility to facilitate early downgrading of infection-control precautions to the minimum required for each patient's specific viral infection and early initiation of treatment when indicated (II)."

So -- I personally would isolate all RSV (or cohort).

2)Disease outcome of RSV in elderly is similar to that of non pandemic influenza (NEJM 2005)
https://webvpn.mcgill.ca/http/www.ncbi.nlm.nih.gov/pubmed/15858184