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Hospital Medicine SUMMARY AND COMMENT Best Method to Manage Malignant Pleural Effusions Neil H. Winawer, MD, SFHM reviewing Thomas R et al. JAMA 2017 Nov 21. Indwelling pleural catheters and talc pleurodesis are equivalent — with tradeoffs in hospital length of stay and complications. SUMMARY AND COMMENT Are Follow-Up Blood Cultures Necessary for Gram-Negative Bacteremia? Neil M. Ampel, MD reviewing Canzoneri CN et al. Clin Infect Dis 2017 Nov 13. Despite the authors' conclusions, it may be reasonable to repeat blood cultures in patients who become or remain febrile. SUMMARY AND COMMENT Adjunctive Rifampicin Does Not Improve Outcomes for Staphylococcus aureusBacteremia in Adults Mary E. Wilson, MD reviewing Thwaites GE et al. Lancet 2017 Dec 14. Adding rifampicin to standard treatment for Staphylococcus aureus bacteremia provided no overall benefit and complicated treatment with other drugs. SUMMARY AND COMMENT An Oncologic Technique for Ablating Ventricular Arrhythmias Mark S. Link, MD reviewing Cuculich PS et al. N Engl J Med 2017 Dec 14. Stereotactic body radiation therapy was used to successfully target refractory ventricular tachycardia in five patients. SUMMARY AND COMMENT Hospitalist: De Facto Intensivist Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Sweigart JR et al. J Hosp Med 2018 Jan . Hospitalists are providing critical care to many U.S. intensive care patients — a sometimes uncomfortable and undersupported situation. SUMMARY AND COMMENT Costs and Outcomes of Treating Acute Myocardial Infarction Harlan M. Krumholz, MD, SM reviewing Likosky DS et al. JAMA Cardiol 2017 Dec 20. Hospitals with high use of early percutaneous coronary intervention had better mortality and higher costs, but costs were balanced by lower 180-day expenditures. SUMMARY AND COMMENT Granulocyte Colony-Stimulating Factor Associated with Improved Survival in Decompensated Cirrhosis Atif Zaman, MD, MPH reviewing Verma N et al. Hepatology 2017 Dec 26. Probability of transplant-free survival at 1 year was over 90% in patients receiving G-CSF versus 57% in those receiving standard medical therapy only. SUMMARY AND COMMENT Another Look at Dual Therapy in Patients with Established Atherosclerosis Frederick A. Masoudi, MD, MSPH, FACC, FAHA reviewing Connolly SJ et al. Lancet 2017 Nov 10. Secondary analyses of the COMPASS trial point to similar benefits and risks for two diagnostic subgroups. SUMMARY AND COMMENT Timing of Hip Fracture Repair Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Pincus D et al. JAMA 2017 Nov 28. Repair within 24 hours was associated with lower complication rates and lower 30-day mortality. SUMMARY AND COMMENT When Should Biologics Be Stopped Prior to Joint Replacement Surgery? Jonathan S. Coblyn, MD reviewing George MD et al. Arthritis Care Res (Hoboken) 2017 Dec . Infliximab timing did not affect postsurgical infection risk in patients undergoing knee or hip replacement.

FREE FULL-TEXT ARTICLE SUMMARY AND COMMENT | HOSPITAL MEDICINE, GENERAL MEDICINE January 8, 2018 Best Method to Manage Malignant Pleural Effusions

Neil H. Winawer, MD, SFHM reviewing Thomas R et al. JAMA 2017 Nov 21. Indwelling pleural catheters and talc pleurodesis are equivalent — with tradeoffs in hospital length of stay and complications. Malignant pleural effusions often are managed by either talc pleurodesis or placing an indwelling pleural catheter. Both methods provide symptom relief, but which approach should be preferred? In this international trial, researchers randomized 146 patients (mean age, 71) with malignant pleural effusions to talc pleurodesis or catheter placement. Patients in the catheter group spent significantly less time in the hospital (median, 10 days vs. 12 days); experienced significantly fewer hospital days related to pleural fluid management (median, 1 days vs. 4 days), and required fewer pleural fluid drainage procedures (3 vs. 16) compared with patients who received talc pleurodesis. Breathlessness scores, quality-of-life measures, and 12-month mortality were similar in the two groups. Adverse events (e.g., cellulitis, catheter blockage) were more common in the catheter group (30% vs. 18% of patients).

COMMENT Similar to a prior study on this topic (NEJM JW Hosp Med 2012 Aug and JAMA 2012; 307:2383), this study showed no clear winner between these two treatment options; both provide symptomatic benefit. Indwelling pleural catheters are a less-invasive approach associated with fewer hospital days, at the cost of more adverse events. Although patient preference should help guide decision making, time spent out of the hospital is a major consideration, since more than half of the patients in this study died within 1 year of their procedures.