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Sunil Kripalani, MD, MSc; Christianne L. Roumie, MD, MPH; Anuj K. Dalal, MD; Courtney Cawthon, MPH; Alexandra Businger, BA; Svetlana K. Eden, MSc; Ayumi Shintani, PhD, MPH; Kelly Cunningham Sponsler, MD; L. Jeff Harris, MD; Cecelia Theobald, MD; Robert L. Huang, MD, MPH; Danielle Scheurer, MD, MSc; Susan Hunt, MD; Terry A. Jacobson, MD; Kimberly J. Rask, MD, PhD; Viola Vaccarino, MD, PhD; Tejal K. Gandhi, MD, MPH; David W. Bates, MD, MSc; Mark V. Williams, MD; Jeffrey L. Schnipper, MD, MPH, for the PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group

Medication errors are common after hospital discharge. This trial studied a pharmacist-led intervention to improve use of medications after hospitalization that included inpatient pharmacist involvement to reconcile prescriptions and improve prescription appropriateness, low literacy patient education adherence aids, and telephone follow-up after hospital discharge. About half of the patients had a clinically important medication error in the month after discharge; almost one quarter of the errors were serious. However, clinically important medication errors and adverse drug events did not differ between the intervention and control groups.

Topics: medication errors, patient discharge, pharmacist
Shannon M. Dunlay, MD, MSc; Susan A. Weston, MS; Jill M. Killian, BS; Malcolm R. Bell, MBBS; Allan S. Jaffe, MD; and Véronique L. Roger, MD, MPH

Hospital readmissions are being used as a quality-of-care measure and are common after acute myocardial infarction (MI). To identify the reasons for readmission within 30 days after hospital discharge, this study examined patients discharged from one hospital between 1987 and 2010 after MI. Approximately 40% of readmissions were related to the MI, whereas the others seemed unrelated. Comorbid conditions; longer length of stay; and complications of angiography, revascularization, and reperfusion therapy were associated with an increased risk for rehospitalization. Strategies to prevent readmission might target patients with these characteristics.

Topics: myocardial infarction, acute, hospitalization, revascularization, reperfusion therapy, angiogram
Gavin D. Perkins, MD; Peter K. Kimani, PhD; Ian Bullock, PhD; Tom Clutton-Brock, MB; Robin P. Davies; Mike Gale, MSc; Jenny Lam, BA; Andrew Lockey, MMEd; Nigel Stallard, PhD, on behalf of the Electronic Advanced Life Support Collaborators

Training health care providers in advanced life support is important but is time- and resource-intensive. This randomized trial compared a conventional 2-day in-person advanced life support course with a 1-day course supplemented by electronic learning (e-learning). More participants in the conventional group (80%) than in the e-learning group (75%) passed an initial cardiac arrest simulation test after their course. After remedial teaching, the final pass rate was greater than 94% in both groups. Other skill and knowledge tests were similar between the groups, but costs were higher for conventional training ($935 vs. $438 per candidate).

Topics: resuscitation, advanced life support, cardiac arrest
Tiffani J. Bright, PhD; Anthony Wong, MTech; Ravi Dhurjati, PhD; Erin Bristow, BA; Lori Bastian, MD, MS; Remy R. Coeytaux, MD, PhD; Gregory Samsa, PhD; Vic Hasselblad, PhD; John W. Williams, MD, MHS; Michael D. Musty, BA; Liz Wing, MA; Amy S. Kendrick, RN, MSN; Gillian D. Sanders, PhD; and David Lobach, MD, PhD

Evidence to support widespread use of clinical decision-support systems (CDSSs) is lacking. This review summarizes trials of CDSSs implemented in clinical settings to aid decision making at the point of care or for a specific care situation. Among the trials reviewed, 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Available evidence suggests that both commercially and locally developed CDSSs improved health care process measures related to performing preventive services, ordering tests, and prescribing therapies. However, evidence that CDSSs improve clinical, economic, or efficiency outcomes is sparse.

Topics: decision making encouragement, decision support systems, clinical, chronic disease, economics, laboratory techniques ...
Norton J. Greenberger, MD; and Prateek Sharma, MD

This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of gastroenterology and hepatology. Topics include esophageal disorders, proton-pump inhibitors, hyperemesis, mast cell disorders, treatment of Clostridium difficile infections, and pancreatitis and hepatitis.

Topics: clopidogrel, esophageal achalasia, barrett's esophagus, gastroesophageal reflux disease, gastroenterology, peptic ulcer, laparoscopic ...
Jeffrey L. Carson, MD; Brenda J. Grossman, MD, MPH; Steven Kleinman, MD; Alan T. Tinmouth, MD; Marisa B. Marques, MD; Mark K. Fung, MD, PhD; John B. Holcomb, MD; Orieji Illoh, MD; Lewis J. Kaplan, MD; Louis M. Katz, MD; Sunil V. Rao, MD; John D. Roback, MD, PhD; Aryeh Shander, MD; Aaron A.R. Tobian, MD, PhD; Robert Weinstein, MD; Lisa Grace Swinton McLaughlin, MD; Benjamin Djulbegovic, MD, PhD, for the Clinical Transfusion Medicine Committee of the AABB

Approximately 85 million units of red blood cells are transfused annually worldwide, but transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that should trigger red blood cell transfusions in hemodynamically stable adults and children.

Topics: hemoglobin, erythrocyte transfusion, transfusion, blood transfusion, clinical practice guideline
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force

This recommendation on counseling to prevent skin cancer from the U.S. Preventive Services Task Force considers evidence that has become available since its 2003 recommendation. The Task Force recommends counseling children, adolescents, and young adults aged 10 to 24 years who have fair skin about minimizing exposure to ultraviolet radiation to prevent skin cancer but concludes that the current evidence is insufficient to assess the balance of benefits and harms of counseling adults older than 24 years.

Topics: behavior therapy, counseling, ultraviolet rays, skin cancer, behavioral change, skin cancer prevention, ...

Dabigatran has received much attention after its approval for prevention of thromboembolic stroke in the setting of atrial fibrillation in the United States and for prevention and treatment of venous thromboembolism in Europe. This commentary discusses emerging reports of dabigatran-related adverse events, including bleeding and thromboembolic events, and unanticipated safety risks. The author urges physicians considering dabigatran for individual patients to be conservative in considering whether it is an appropriate replacement for warfarin.

Topics: dabigatran etexilate

In this issue, Perkins and colleagues compare the effectiveness of 2 days of conventional, face-to-face training in advanced life support with that of a blended approach incorporating e-learning and a 1-day face-to-face course. The editorialists believe that the study blazes the trail for a less expensive, more efficient way of training health care providers.

Topics: advanced life support

In this issue, the AABB presents a clinical practice guideline for red blood cell transfusion and reports the risks associated with transfusions. The editorialist disputes the guideline's strict transfusion triggers and concludes that the decision to transfuse is too complex and important to be guided by a single number.

Topics: blood transfusion
Kimberly D. Manning, MD
Includes: Audio/Video

“Did you get a chance to see him?” I slumped in shame. You were my friend after all. I should have been there by now. “It's just not him anymore,” I whispered. “It's always going to be him,” she responded. “Go.” That afternoon, I coached myself to stop at the ward and see you. Go, I kept telling myself. Go.

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Helena W. Rodbard, MD; and Paul S. Jellinger, MD
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Thibault Richard, MD; Dany Brohee, PhD; Alain Van Meerhaeghe, MD; and Michel Vanhaeverbeek, MD
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Amir Qaseem, MD, PhD, MHA; Linda Humphrey, MD, MPH; and Paul Shekelle, MD, PhD
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Hiroshi Yamamoto, MD, PhD; Toshiro Fukushima, MD; Hitoshi Yokoyama, MD, PhD; Akihko Yoshizawa, MD, PhD; and Hideaki Hamano, MD, PhD
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Faiz Subzposh, MD; Steven Kutalek, MD; and Ole Vielemeyer, MD
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Jason David Eubanks, MD
Includes: Audio/Video
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Michael T. McDermott, MD
Includes: CME
Topics: hyperthyroidism
Topics: medication errors, patient discharge
Topics: preventive medicine, counseling, skin cancer prevention
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