Welcome to the inpatient modules for evidence-based medicine, where we review the literature that informs our clinical practice.  This month, we review the research behind our blood transfusion goals and CURB-65 clinical prediction rule.

Review these with your ward team this month!

• Trial of Transfusion Requirements in Critical Care (TRICC)
• Defining Community-Acquired Pneumonia Severity on Presentation to Hospital

This month’s articles focus on pharmacotherapy for two common diseases in Cardiology and Nephrology: Heart Failure with Reduced Ejection Fraction (HFrEF) and Diabetic Nephropathy.

• COMET: Comparing beta-blocker to beta-blocker
• RENAAL: Addition of Angiotensin II receptor blockers (ARB) to antihypertensive therapy

This month, we look at the common use of benzodiazepines for alcohol withdrawal and rituximab for ANCA-associated vasculitis.

• Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis (RAVE)
• Symptom-triggered versus Fixed-schedule Doses of Benzodiazepine for Alcohol Withdrawal

Here are this month’s articles in hematology and gastroenterology, looking at treatments to decrease complications in these diseases:

• Effect of Hydroxyurea on the Frequency of Painful Crises in Sickle Cell Anemia
• Norfloxacin Prevents Bacterial Infection in Cirrhotics with Gastrointestinal Hemorrhage

Just one landmark article this month touching on Palliative Care Medicine in oncology patients.  Is it ever too early to address palliation in these patients? Read on.

• Early Palliative Care for Patients with Metastatic Lung Cancer

This month, we look at glycemic control in the hospitalized patient.  While this landmark article evaluates patients in the ICU, how have you integrated the findings of this research into your practice?

• Intensive versus Conventional Glucose Control in Critically Ill Patients

Remember, insulin is a high-alert medication, meaning it’s tied closely to patient safety.  When ordering insulin for inpatient use, remember to:

• Cut back on the patient’s insulin dose to adjust for changes in clinical condition (renal failure, sepsis, diuresis, etc.) and diet (NPO).
• Discontinue mealtime insulin and if the patient will be ordered NPO – and discontinue the insulin order rather than using a communication order.
• Use lispro (instead of regular) administered when the patient starts eating – it is shorter acting than regular insulin and appropriate to administer when the patient is ready to eat (rather than before the meal)

Here are this month’s articles:

• Dexamethasone in Adults with Bacterial Meningitis
• Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure

This month, we discuss a prognostic tool and treatment protocol in severely ill patients: liver failure and cardiac arrest.

• Model to Predict Survival in Pateints with End-Stage Liver Disease (the MELD Score)
• Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest

This month we touch on topics about hypertension and kidney diseases.

• Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia
• Clinical Trial of the Effects of Dietary Patterns on Blood Pressure (DASH)

• Rosuvastatin to Prevent Vascular Events in Men and Women (JUPITER)
• Initial Treatment of Immune Thrombocytopenic Purpura with High-Dose Dexamethasone