David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Wesorick DH, Chopra V. Annals for Hospitalists - 19 July 2016. Ann Intern Med. 2016;165:HO1. doi: 10.7326/AFHO201607190
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Published: Ann Intern Med. 2016;165(2):HO1.
By illustrating that the rate of antibiotic prescription is the primary factor associated with the incidence of C difficile infection, this study provides strong support for the role of antibiotic stewardship to prevent these infections in both acute and long-term care settings.
Because many infections in long-term care facilities originate in hospitals, stringent attention to infection prevention measures, including contact isolation precautions and hand hygiene, are needed in long-term care settings.
Excessively strict “confidentiality” clauses that bar physicians from discussing anything about their work or employer could allow hospitals to hide quality and safety concerns and undermine a physician's ability to uncover and fix problems.
Physicians should be aware of “termination without cause” clauses that allow employers to fire physicians for almost any reason and “noncompete” clauses that make it difficult for physicians to leave their current employers.
Individual physicians often lack the insight or influence to challenge these clauses, raising concerns about how physicians will preserve their professional integrity in the face of the commercial practice of medicine.
Definitive gout diagnosis requires the identification of monosodium urate crystals in fluid sampled from the joint or tophus.
Elevated serum urate levels are not diagnostic of gout. Hyperuricemia is approximately 5 times more common than gout itself.
Gout may mimic septic arthritis and lead to delayed or missed diagnosis. In addition, septic arthritis can occur concomitantly with gout. Early arthrocentesis and crystal evaluation are essential to diagnosis.
Acute attacks of gout should be treated with colchicine, NSAIDs, or glucocorticoids (systemic or intra-articular) and continued for 7 to 10 days to avoid rebound attacks.
Urate-lowering therapy should be continued during the treatment of acute gout.
These results question the association between DPP-4 inhibitors and heart failure hospitalizations reported in early postmarketing trials.
This study highlights the FDA's Mini-Sentinel System, a large, multipayer, drug safety database that facilitated this robust and timely assessment of DPP-4 inhibitors. An accompanying editorial highlights the value of the Mini-Sentinel System for examining issues of drug safety.
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