Intensive glucose control in non-critically ill hospitalized patients is associated with decreased risk for infection but a trend toward increased hypoglycemia.

Hyperglycemia is common in hospitalized patients and is associated with higher morbidity and mortality. However, intensive glycemic control can lead to hypoglycemia, which is also associated with poor outcomes. The American College of Physicians recently published guidelines that recommend against intensive insulin therapy for hospitalized patients, but none of the reviewed studies included non-intensive care unit (non-ICU) general medicine patients (JW Hosp Med Apr 4 2011).

Does Hospital-Based Pay for Performance Affect Mortality?

Results from the largest program to date convincingly show that it doesn't.

The efficacy and safety of rivaroxaban was similar to that of enoxaparin plus a vitamin K antagonist.

In a previous study, the oral factor Xa inhibitor rivaroxaban was as effective as standard enoxaparin-warfarin therapy for patients with proximal deep venous thrombosis (JW Gen Med Dec 21 2010). Now, industry-supported researchers have conducted a similar open-label, randomized trial involving nearly 5000 adults with acute symptomatic pulmonary embolism. Patients received either oral rivaroxaban (15 mg twice daily for 3 weeks, followed by 20 mg once daily) or standard therapy (subcutaneously injected enoxaparin followed by warfarin or acenocoumarol). Treatment duration was 3, 6, or 12 months, depending on the treating physician's preference. Exclusion criteria included creatinine clearance <30 mL/minute, clinically significant liver disease, severe hypertension, and need for thrombolytic therapy. Although the trial was open-label, endpoints were adjudicated by a committee blinded to treatment assignment.

Hospital Readmissions Common Among Patients with Decompensated Cirrhosis

Many such readmissions are predictable and — perhaps — preventable.

Decompensated cirrhosis is associated with high morbidity and mortality. In a recent retrospective study, researchers examined the frequency, cost, predictors, and preventable causes of hospital readmission among individuals with this condition.