Journal of Hospital Medicine via MedWorm.com

Lower extremity ulcers and the satisfied search

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Disseminated sporotrichosis

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No Abstract. (Source: Journal of Hospital Medicine)

Myelofibrosis with massive hepatosplenomegaly and osteolytic bone lesions

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Reactive erythema secondary to adult T-cell leukemia and Helicobacter cinaedi bacteremia

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

A painful rash

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Cefepime: An underrecognized cause of nonconvulsive status epilepticus

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

A case of extreme subcutaneous and peripheral insulin resistance

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

A fatal case of heparin-induced thrombocytopenia and thrombosis

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

We present a 51-year-old female treated with unfractionated heparin for acute deep venous thrombosis (DVT) and pulmonary embolism (PE). She developed extension of her thrombosis and was promptly diagnosed with heparin-induced thrombocytopenia and thrombosis (HITT). She did not, however, develop thrombocytopenia until 5 days after the extension of her thrombosis. The possible diagnosis of HITT is important for clinicians to keep in mind for all patients that are receiving any form of heparin, not only those patients who present with thrombocytopenia but also those with otherwise unexplainable thrombosis regardless of the platelet count. Journal of Hospital Medicine 2010;5:E14-E15. © 2010 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

A case of optic neuritis and transverse myelitis in a postpartum Ghanaian female

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Only practice and praxis can limit the unavoidable errors of the practice

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Antibiotic prescription patterns in hospitalized patients with nursing home-acquired pneumonia

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Considerable research has increased our understanding of antibiotic prescribing practices in hospital settings when it comes to nosocomial pneumonia. Much less is known about the antibiotic prescribing patterns for hospitalized non-critically ill patients with nursing home-acquired pneumonia (NHAP).As part of a multisite quality improvement project, we sought to examine patterns of antibiotic prescription among healthcare providers as a function of underlying comorbid, functional, and clinical factors.Three tertiary care centers.Chart reviews of 397 individual admissions were performed on patients admitted from nursing homes with the diagnosis of pneumonia between January 2005 and September 2007.Compliance with national guidelines for the treatment of NHAP was poor. Overall, the 3 most com...

Hospitalist physician leadership skills: Perspectives from participants of a leadership conference

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

To characterize how the use of behavioral contracts may serve to focus individuals' intentions to grow as leaders.Between 2007 and 2008, participants of the Society of Hospital Medicine Leadership Academy courses completed behavioral contracts to identify 4 action plans they wanted to implement based on things learned at the Academy. Contracts were independently coded by 2 investigators and compared for agreement. Content analysis identified several major themes that relate to professional growth as leaders. Follow-up surveys assessed fulfillment of personal goals.The majority of respondents were male (84; 70.0%), and most were hospitalist leaders (76; 63.3%). Their median time practicing as hospitalists was 4 years, 14 (11.7%) were Assistant Professors, and 80 (66.7%) were in private prac...

Drumstick digits: a case of clubbing of the fingers and toes

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Hyponatremia in a patient with cryptococcal meningitis: Syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting (CSW)?

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

In sight but out of mind

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

The ethics of the hospitalist model

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

The hospitalist model was founded on the premise that it could improve the quality and reduce the cost of hospital care. Many randomized studies have all but definitively proven this original assertion. Nevertheless, the hospitalist specialty raises lingering classical ethical issues: protecting the patient-physician relationship in an environment of increasing specialization and discontinuity of care, preserving patient autonomy and choice when structural changes are made in the provision of care, and ensuring that a model founded on efficiency and cost-effectiveness does not erode the public trust in hospitalists to always serve their patients' best interests. This work aims to serve as an update of these initial criticisms, showing how some questions have been answered, while some have ...

Pediatric observation units in the United States: A systematic review

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

As more efficient and value-based care models are sought for the US healthcare system, geographically distinct observation units (OUs) may become an integral part of hospital-based care for children.To systematically review the literature and evaluate the structure and function of pediatric OUs in the United States.Searches were conducted in Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Care Advisory Board (HCAB), Lexis-Nexis, National Guideline Clearinghouse, and Cochrane Reviews, through February 2009, with review of select bibliographies.English language peer-reviewed publications on pediatric OU care in the United States.Two authors independently determined study eligibility. Studies were graded using a 5-level quality assessment too...

"On the other hand [hellip]": The evidence does not support the use of hand-carried ultrasound by hospitalists

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

In the right hands, ultrasound is a safe and helpful diagnostic imaging tool. However, evidence supporting the use of hand-carried ultrasound (HCU) by hospitalist physicians has not kept pace with expanding application of these devices. In spite of its strategic point-of-care benefit, use of this technology by hospitalists may not ultimately translate into improved efficiency and better clinical outcomes. Optimal levels of training in image acquisition and interpretation remain to be established. Novelty, availability, and the results of a few small studies lacking patient-centered outcomes remain insufficient grounds to justify the expanded clinical utilization of these medical imaging devices by nonspecialists. Journal of Hospital Medicine 2010;5:168-171. © 2010 Society of Hospital Medi...

Hospitalist use of hand-carried ultrasound: Preparing for battle

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Hand-carried ultrasound (HCU) is a burgeoning technology at a critical point in its development as a general diagnostic technique. Despite the known safety and accuracy of ultrasound in radiology and echocardiography, the use of HCU to augment physical diagnosis by all physicians has yet unrealized potential. In order to incorporate ultrasound into a diagnostic model of routine bedside application, simple imaging and training protocols must first be derived and validated. Simplified cardiac ultrasound exams have already been validated to detect evidence-based targets such as subclinical atherosclerosis, heart failure, and elevated central venous pressures. However, for general examination of the acutely ill patient, it is the internist-hospitalist who should derive a full-body ultrasound e...

Reducing patient financial liability for hospitalizations: The physician role

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

With increasingly strict guidelines for insurance coverage, hospitals have adopted meticulous resource utilization review and management processes. It is important for physicians to appreciate that careful documentation of certain patient parameters may not only optimize the facility's reimbursement but have profound impact on the patient's out-of-pocket expenses. Hospital utilization teams have access to the frequently changing national payor guidelines for policy benefits, usually revolving around whether the patient meets medical necessity criteria for being classified as an "inpatient" vs. an "observation" outpatient. Those statuses are not merely time-based, and lead to marked differences in patient deductibles and coverage for medication, room, procedure, laboratory, and ancillary ch...

Impact of congenital anomalies and treatment location on the outcomes of infants hospitalized with herpes simplex virus (HSV)

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Herpes simplex virus (HSV) is a rare but costly reason for hospitalization in infants under 60 days of age. The impact of coexisting comorbid conditions and treatment location on hospital outcome is poorly understood.Determine patient and hospital factors associated with poor outcomes or death in infants hospitalized with HSV.Retrospective cohort study using the 2003 Kids' Inpatient Database (KID).U.S. hospitals.Infants under 60 days of age with a diagnosis of HSV.Treatment at different types of hospitals, younger age at admission, and presence of congenital anomalies.Serious complications, in-hospital death.A total of 10% of the 1587 identified HSV hospitalizations had a concurrent congenital anomaly. A total of 267 infants had a serious complication and 50 died. After controlling for cli...

The paradox of readmission: Effect of a quality improvement program in hospitalized patients with heart failure

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Congestive heart failure (CHF) is an increasingly common condition associated with significant hospital resource utilization. Initiating better disease management at the time of initial hospital admission has the potential to reduce readmissions.To evaluate the impact of a multifaceted quality improvement program on 12-month hospital utilization in patients admitted to hospital with CHF.Prospective longitudinal study comparing baseline and intervention cohorts.All consecutive patients with CHF discharged alive from 3 metropolitan hospitals during the baseline (October 1, 2000 to April 17, 2001) and intervention (February 15, 2002 to August 31, 2002) study periods. Active prospective case-finding identified 220 baseline and 235 intervention participants; full data was available on 197 basel...

Upper versus lower gastrointestinal bleeding: A direct comparison of clinical presentation, outcomes, and resource utilization

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

To compare prevalence, clinical outcomes, and resource utilization between subjects with lower gastrointestinal bleeding (LGIB) and upper gastrointestinal bleeding (UGIB).Using administrative data, patient surveys, and chart abstraction, comparisons between subjects admitted with LGIB and UGIB were made by employing bivariate and multivariate statistics.A total of 367 subjects were identified, LGIB = 187 and UGIB = 180. Subjects with UGIB compared to LGIB had greater admission hemodynamic instability including tachycardia and orthostasis but clinical outcomes were similar. In multivariate analyses, no significant differences were observed for in-hospital mortality transfer to the intensive care unit (ICU) or 30-day readmission rate. Resource utilization was similar in UGIB and LGIB, includ...

Continuing Medical Education Program in the Journal of Hospital Medicine

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Care by hospitalists has been associated with improved/similar clinical outcomes and efficiency. However, less is known about their effect on conditions dependent upon specialists for procedures/treatment plans. Our objective was to compare care for upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists.The study included 450 UGIH patients admitted to general medical services of 6 teaching hospitals. Outcomes included in-hospital mortality and complications (ie, recurrent bleeding, intensive care unit [ICU] transfer, decompensation, transfusion, reendoscopy, 30-day readmission). Efficiency was measured by hospital costs and length of stay (LOS).Of 450 patients, 40% (177) were cared for by hospitalists with no differences between groups by en...

The critical role of hospitalists in controlling healthcare costs

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Hospitalists and costs

Journal of Hospital Medicine — Mon, 01 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Predictors of serious injury among hospitalized patients evaluated for falls

Journal of Hospital Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Inpatient falls are common and result in significant patient morbidity.To identify predictors of serious injury being found on imaging studies of inpatients evaluated after a fall.Retrospective study.An 1171-bed urban academic medical center.All inpatients who fell on thirteen medical and surgical units from January 1 to December 31, 2006.Patient characteristics, circumstances surrounding falls, fall-related injuries, and length of stay were collected through review of incident reports and computerized medical records. Primary outcome of fall-related injury was determined by evidence of injury on imaging studies within two weeks of the fall. Univariate and multivariate logistic regression were used to calculate adjusted odds ratios (ORs) for injury after an inpatient fall.A total of 513 pa...

An uncommon etiology of small bowel obstruction: Gallstone ileus

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Gallstone ileus is a rare etiology of small bowel obstruction, occurring typically in the elderly population. The delay in diagnosis often results in significant morbidity and mortality. Here, we describe a case of 67 year old woman who presented with non specific abdominal symptoms and on evaluation was found to have small bowel obstruction caused by wedging of a large gallstone at the terminal ileum. Journal of Hospital Medicine 2010;5:E21-E22. © 2010 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Hypercalcemia and acute renal failure in milk-alkali syndrome: A case report

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Historically, the milk-alkali syndrome developed as an adverse reaction to the Sippy regimen of milk, cream and alkaline powders as treatment for peptic ulcer disease. The classic description includes hypercalcemia, metabolic alkalosis, and renal failure. Over the past 20 years, milk-alkali syndrome has had a resurgence, as consumption of supplements containing calcium has increased. A 46-year-old man presented to the emergency department after outpatient labs to evaluate his fatigue. He was found to have acute renal failure and hypercalcemia (total serum calcium was 15.9 mg/dL). Subsequent laboratory evaluation excluded both hyperparathyroidism and malignancy as causes. A detailed history led to the diagnosis of milk-alkali syndrome. With hydration and cessation of calcium carbonate inges...

Symptomatic right ventricular catheter embolization after Port-A-Cath manipulation

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Management of perioperative hypertensive urgencies with parenteral medications

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

This article reviews the management of perioperative hypertensive urgency with parenteral medications.A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search.As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources.When oral therapy cannot be administered, patients with hypertensive urgency can have their ...

Examining guideline-concordant care for acute myocardial infarction (AMI): The case of hospitalized post-acute and long-term care (PAC/LTC) residents

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Previous studies have examined differences in care for acute myocardial infarction (AMI) according to patient characteristics such as age, gender, or insurance, but little attention has been given to whether admission source is related to guideline adherence.To investigate: (1) the use of aspirin and reperfusion in the care of post-acute/long-term care (PAC/LTC) patients who are hospitalized for AMI, and (2) 30-day mortality associated with these treatments.Secondary examination of data from the Cooperative Cardiovascular Project (CCP) national baseline data.A total of 4013 U.S. hospitals.Patients hospitalized with a confirmed AMI admitted from PAC/LTC (n = 8151) or community-dwelling (n = 120,032) settings.Early administration of aspirin and reperfusion via either thrombolysis or percutan...

Reply to: Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Wearing white - right or wrong? A satirical analysis of medical attire

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Acute pancreatitis with eruptive xanthomas

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Necrotizing sarcoid granulomatosis: A case report of gastric involvement

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

A pain in the bone

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Nonphysician providers in hospital medicine: Not so fast

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Nonphysician providers in the hospitalist model: A prescription for change and a warning about unintended side effects

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

A hospitalist postgraduate training program for physician assistants

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Many hospitalist groups are hiring physician assistants (PAs) to augment their physician services. Finding PAs with hospitalist experience is difficult. Employers often have to recruit PAs from other specialties or hire new graduates who have limited hospital experience. Furthermore, entry-level PA training focuses on primary care, with more clinical rotations centered in the outpatient setting. In light of these challenges, our institution created a 12-month postgraduate training program in Hospital Medicine for 1 PA per year. It is the first reported postgraduate PA hospitalist fellowship to offer a certificate of completion. The program's curriculum is based on the Society of Hospital Medicine (SHM) "Core Competencies," and is comprised of 12 one-month rotations in different aspects of ...

Management of ischemic stroke: Part 2. The inpatient stay

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients both acutely and in secondary prevention. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally and emphasizes many elements of the inpatient stay and discharge process.After admission, the focus changes to avoidance of complications and the appropriate initiation of allied therapies and secondary prevention.Primary trials, current guidelines.The hospitalist is well-positioned to play a major role in the treatment of stroke patients as well as the systems work that aids in the management of this population. Journal of Hospital Med...

Continuing medical education program in the Journal of Hospital Medicine

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Evaluation, management, and outcome of focal bacterial infections (FBIs) in nontoxic infants under two months of age

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Well-appearing young infants with focal bacterial infections present to the emergency department (ED) and are often admitted for a sepsis evaluation of blood, urine, and spinal fluid. However, the risk of concomitant systemic infections (CSI) in this population is not well reported, specifically comparing febrile to afebrile infants. We hypothesized that afebrile, well-appearing infants under two months of age with a defined focal bacterial infection on exam have a very low risk of CSI.This retrospective study was conducted at an urban, academic, tertiary care pediatric hospital ED on patients seen from January 2000-December 2005. Eligible infants were less than 60 days of age, well-appearing on exam, and with normal-for-age vital signs who presented with a focal bacterial infection on exa...

Impact and recognition of cognitive impairment among hospitalized elders

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Older adults are predisposed to developing cognitive deficits. This increases their vulnerability for adverse health outcomes when hospitalized.To determine the prevalence and impact of cognitive impairment (CI) among hospitalized elders based on recognition by lCD-coding versus screening done on admission.Observational cohort study.Urban public hospital in Indianapolis.997 patients age 65 and older admitted to medical services between July 2006 and March 2008.Impact of CI in terms of length of stay, survival, quality of care and prescribing practices. Cognition was assessed by the Short Portable Mental Status Questionnaire (SPMSQ).424 patients (43%) were cognitively impaired. Of those 424 patients with CI, 61% had not been recognized by ICD-9 coding. Those unrecognized were younger (mean ...

Lack of patient knowledge regarding hospital medications

Journal of Hospital Medicine — Fri, 11 Dec 2009 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Decrease in as-needed sedative use by limiting nighttime sleep disruptions from hospital staff

Journal of Hospital Medicine — Fri, 18 Sep 2009 23:00:00 +0100

Hospital routines frequently interrupt nighttime sleep. Sedatives promote sleep, but increase the risk of delirium and falls. Few interventional trials have studied sleep promotion in medical-surgical units and little is known about its impact on sedative use.To determine causes of sleep disruption, and assess whether decreasing sleep disruptions lowers sedative use in medical-surgical patients.Interventional trial with historical controls on a medical-surgical unit of a community teaching hospital. Nurses, physicians, and patients were blinded to the measurement of as-needed sedative use.Consecutive eligible adults (n = 161 preintervention patients, n = 106 intervention patients).We developed the "Somerville Protocol," which included the establishment of an 8-hour "Quiet Time" that began ...

The trivialization of diagnosis

Journal of Hospital Medicine — Tue, 15 Sep 2009 23:00:00 +0100

Although it is widely recognized that diagnosis plays a central role in clinical medicine, in recent years the primacy of diagnosis has come under attack from several sources. 1. "Billable terms" are replacing traditional medical diagnoses. The former are based on International Classification of Diseases lists, which include many non-diagnoses such as symptoms and signs. 2. Diagnosis often gets short shrift because of the perceived urgency of discharge. 3. The problem oriented record, in practice, has frequently led to a shift in emphasis from synthesis of findings to fragmentation of problems. 4. Presumptive diagnoses frequently metamorphose into established diagnoses in medical records, even if incorrect. 5. A number of authors have apparently disparaged the importance of diagnosis. None...

Optimizing prevention of hospital-acquired (HA) venous thromboembolism (VTE): Prospective validation of a VTE risk assessment model (RAM)

Journal of Hospital Medicine — Mon, 14 Sep 2009 23:00:00 +0100

Hospital-acquired (HA) venous thromboembolism (VTE) is a common source of morbidity/mortality. Prophylactic measures are underutilized. Available risk assessment models/protocols are not prospectively validated.Improve VTE prophylaxis, reduce HA VTE, and prospectively validate a VTE risk-assessment model.Observational design.Academic medical center.Adult inpatients on medical/surgical services.A simple VTE risk assessment linked to a menu of preferred VTE prophylaxis methods, embedded in order sets. Education, audit/feedback, and concurrent identification of nonadherence.Randomly sampled inpatient audits determined the percent of patients with "adequate" VTE prevention. HA VTE cases were identified concurrently via digital imaging system. Interobserver agreement for VTE risk level and judg...

Prevalence of previously unknown elevation of glycosylated hemoglobin (HbA1c) in spine surgery patients and impact on length of stay and total cost

Journal of Hospital Medicine — Sun, 13 Sep 2009 23:00:00 +0100

Elevated levels of glycosylated hemoglobin (HbA1c) among spine surgery patients may have an impact on length of stay (LOS) and healthcare cost.We retrospectively reviewed the charts of 556 spine surgery patients who underwent 1 of 3 types of surgery: lumbar microdiscectomy (LMD), anterior cervical decompression and fusion (ACDF), and lumbar decompression and fusion (LDF). Information was collected about their diabetes mellitus (DM) history and HbA1c levels. We used HbA1c 6.1% as the screening cutpoint. Percentages of nondiabetic patients, those with subclinical elevation of HbA1c and those with already known DM were calculated and statistical analysis was applied.After excluding the small group of well-controlled DM (n = 14), 72.4% of patients were nondiabetic, 14.3% were subclinical patie...

Afraid in the hospital: Parental concern for errors during a child's hospitalization

Journal of Hospital Medicine — Sun, 02 Aug 2009 23:00:00 +0100

(1) To determine the proportion of parents concerned about medical errors during a child's hospitalization; and (2) the association between this concern and parental self-efficacy with physician interactions.Cross-sectional survey.Tertiary care children's hospital.Parents of children admitted to the general medical service.Parental concern about medical errors.Parents were asked their agreement with the statement "When my child is in the hospital I feel that I have to watch over the care that he/she is receiving to make sure that mistakes aren't made." We used multivariate logistic regression to examine the association between parents' self-efficacy with physician interactions and the need "to watch over a child's care," adjusting for parent and child demographics, English proficiency, pas...

Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial

Journal of Hospital Medicine — Mon, 20 Jul 2009 23:00:00 +0100

Hospital discharge software potentially improves communication and clinical outcomes.To measure patient and physician perceptions after discharge with computerized physician order entry (CPOE) software.Cluster randomized controlled trial.Tertiary care, teaching hospital in central Illinois.A total of 631 inpatients discharged to home with high risk for readmission.A total of 70 internal medicine hospital physicians randomly assigned (allocation concealed) to discharge software vs. usual care, handwritten discharge.Discharge perceptions from patients, outpatient primary care physicians, and hospital physicians.One week after discharge, 92.4% (583/631) of patients answered interviews. For 78.6% (496/631) of patients, their outpatient physicians returned questionnaires 19 days (median) postdi...

Public reporting of hospital quality: Recommendations to benefit patients and hospitals

Journal of Hospital Medicine — Wed, 10 Jun 2009 04:00:00 +0100

Public reporting of hospital performance holds tremendous promise for improving the care provided by hospitals. To date, however, consumers have failed to embrace public reporting, despite considerable efforts to promote it. We review a number of reasons that public reporting has failed to live up to expectations, and we make 10 recommendations to improve the value of public reporting for both patients and hospitals. We also review 3 leading performance reporting programs to evaluate how well they adhere to these recommendations. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Acute vertebral fracture

Journal of Hospital Medicine — Mon, 08 Jun 2009 04:00:00 +0100

This article is an evidenced based clinical update on the evaluation and management options of acute vertebral fractures, ranging from conservative treatment to surgical intervention. Hospitalists can play an influential role in the management of osteoporosis. Journal of Hospital Medicine 2009. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Predictors of ischemic stroke after hip operation: A population-based study

Journal of Hospital Medicine — Sun, 31 May 2009 04:00:00 +0100

Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older.To determine the predictors of ischemic stroke in patients who have undergone hip operation.Population-based historical cohort study, in which postoperative ischemic strokes were identified from medical record review for stroke diagnostic codes and brain imaging results and were confirmed by physician review.Tertiary care center in Olmsted County, Minnesota.Residents of Olmsted County who underwent hip surgical procedure.Incidence of ischemic stroke within 1 year of hip operation.In total, 1606 patients underwent 1886 hip procedures from 1988 through 2002 and were observed for ischemic stroke for 1 year after their procedure. Sixty-se...

Transitions of Care Consensus Policy Statement: American College Of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Journal of Hospital Medicine — Fri, 29 May 2009 04:00:00 +0100

The American College of Physicians, Society of Hospital Medicine, and Society of General Internal Medicine convened a multi-stakeholder consensus conference in July 2007 to address the quality gaps in the transitions between inpatient and outpatient settings and to develop consensus standards for these transitions. Over 30 organizations sent representatives to the Transitions of Care Consensus Conference. Participating organizations included medical specialty societies from internal medicine as well as family medicine and pediatrics, governmental agencies such as the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services, performance measure developers such as the National Committee for Quality Assurance and the American Medical Association Physician ...

Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: Cluster randomized trial

Journal of Hospital Medicine — Thu, 28 May 2009 04:00:00 +0100

One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown.To measure effects of a discharge software application of computerized physician order entry (CPOE).Cluster randomized controlled trial.Tertiary care, teaching hospital in central Illinois.A total of 631 inpatients discharged to home with high risk for readmission.Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge.Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event.A total of 59...

Stethoscope inspection

Journal of Hospital Medicine — Wed, 01 Apr 2009 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Creating a better discharge summary: Improvement in quality and timeliness using an electronic discharge summary

Journal of Hospital Medicine — Fri, 06 Mar 2009 05:00:00 +0100

Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous.To evaluate the effect of a newly-created electronic discharge summary.Pre-post evaluation of discharge summaries using a survey of outpatient physicians and a medical records review.Outpatient physicians' ratings of satisfaction with discharge summaries before and after implementation of an electronic discharge summary using a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied). Additionally, 196 randomly selected discharge summaries before and after implementation were rated for timeliness and presence of 16 key content areas by 3 internists.Two hundred and twenty-six of 416 (54%) and 256 of 397 (64%) outpatient physicians completed the baseline and postimplement...

Thrombolytic therapy for venous thromboembolism: Current clinical practice

Journal of Hospital Medicine — Thu, 05 Mar 2009 05:00:00 +0100

Venous thromboembolism (VTE) is a life-threatening condition for which thrombolytic therapy may be beneficial. The appropriate setting for the use of thrombolytic therapy remains controversial. More than 10 years ago we described the case-based practice patterns for the use of thrombolytics in VTE, and now, in the context of recent studies and guidelines, we sought to reevaluate the use of thrombolytics and to determine whether beliefs have changed.Active pulmonologists in 11 southeastern states were selected to complete a web-based questionnaire that included background questions and hypothetical case scenarios involving VTE and potential treatment with thrombolytics.Eighty-one physicians completed the survey and 84% reported using thrombolytic therapy for VTE within the last 2 years. In ...

A "routine" electrocardiogram

Journal of Hospital Medicine — Thu, 05 Mar 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Iodinated contrast prior to evaluation for thyrotoxicosis

Journal of Hospital Medicine — Wed, 04 Mar 2009 05:00:00 +0100

Radioactive iodine is useful in the diagnosis and treatment of patients with newly diagnosed thyrotoxicosis. However, in many patients these tests are not possible to obtain due to recent administration of iodinated contrast for other types of diagnostic studies, most frequently computed tomography (CT) scans.To determine the frequency of iodinated contrast use in hospital inpatients newly diagnosed with thyrotoxicosis and the utility of these studies.Retrospective chart review.Academic medical center.None.Inpatients with newly diagnosed thyrotoxicosis who were seen in consultation by the endocrinology service.The records of inpatient endocrinology consultations (n = 1171) performed by our service over a 4-year period were reviewed. Records of patients with newly diagnosed thyrotoxicosis w...

Pediatric hospitalists and primary care providers: A communication needs assessment

Journal of Hospital Medicine — Wed, 04 Mar 2009 05:00:00 +0100

Existing research on hospitalist-primary care provider (PCP) communication focuses mainly on adult hospitalist models with little known about the quality of current pediatric hospitalist-PCP communication. Our objective was to perform a needs assessment by exploring important issues around communication between pediatric hospitalists and PCPs.Six previously identified issues around hospitalist-PCP communication from the adult hospitalist literature were abstracted and incorporated into an open-ended and closed-ended questionnaire. The questionnaire was pretested, revised, and administered by phone to 10 pediatric hospitalists and 12 pediatric PCPs residing in our 5-state catchment area. Interviews were transcribed and openly coded, and themes compared using qualitative methods.The 6 identi...

Challenges and opportunities in Academic Hospital Medicine: Report from the Academic Hospital Medicine Summit

Journal of Hospital Medicine — Wed, 04 Mar 2009 05:00:00 +0100

The objective was to develop consensus around key areas limiting or facilitating hospital medicine's development as an academic discipline.The design was a consensus format conference of key stakeholders in academic hospital medicine.The consensus group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderant nonteaching roles, and demands to perform nonclinical duties (such as quality improvement) not generally viewed as academic pursuits. The consensus group developed recommendations for addressing these concerns, specifically: 1) characterizing the optimal job description for an academic hospitalist, 2) developing better local and at-a-distance opportuni...

Incidence and impact of adverse effects to antibiotics in hospitalized adults with pneumonia

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

This study sought to define the incidence, economic impact, and nature of adverse drug effects (ADEs) related to antibiotics in pneumonia hospitalizations in the US.Adult pneumonia hospitalizations were tabulated in statewide (New York) and national databases, respectively, from 2000 through 2005. The incidences of antibiotic related ADEs were determined by identifying antibiotic specific e-codes (external cause of injury codes). The modeled effect of the presence of antibiotic ADEs on length of stay (LOS) and total charges were also calculated. ADEs due to specific antibiotic classes, and the presence of certain cutaneous allergic and gastro-intestinal manifestations commonly attributable to ADEs, were tabulated.ADEs related to antibiotics were reported in a small but consistent proportio...

Critical illness polyneuromyopathy in a patient with disseminated cryptococcal infection

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

We report a case of critical illness polyneuromyopathy in a patient with disseminated cryptococcal infection in an intensive care unit. Journal of Hospital Medicine 2009;4:E3-E6. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Educational interventions alone are not sufficient to change outcomes in venous thromboembolism

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Polymorphic ventricular tachycardia?

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Chronic diarrhea and abdominal pain: Pin the pinworm

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

We report a case of an 84-year-old female patient from an assisted living facility who presented with symptoms of colitis for 2 months. On detailed history and exam, she was found to have E. vermicularis infection. All her symptoms resolved dramatically within 2 days after a single dose of albendazole. We want to emphasize the importance of including parasitic infections such as E. vermicularis in the differential diagnoses of patients presenting with symptoms of colitis. Journal of Hospital Medicine 2009;4:137-139. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

A change of heart

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Coding and documentation: Medicare severity diagnosis-related groups and present-on-admission documentation

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

This article will discuss the new payment system, the physician's role in ensuring that all clinically important diagnoses are captured by coding specialists, and strategies that can be employed to respond proactively to the challenge. Journal of Hospital Medicine 2009;4:124-130. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Blood cultures for community-acquired pneumonia: Are they worthy of two quality measures? A systematic review

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

Obtaining blood cultures (BCs) for patients hospitalized with community-acquired-pneumonia (CAP) has been recommended by experts and used as a measure of quality of care. However, BCs are infrequently positive in these patients and their effect on clinical management has been questioned.We performed a systematic review of the literature to determine the impact of BCs on clinical management in CAP requiring hospitalization and thus its appropriateness as a quality measure.We searched MEDLINE, MEDLINE In-Process, and the Cochrane databases for English-language studies that reported the effect of BCs on management of adults hospitalized with CAP. We also searched the reference lists of included studies and background articles and asked experts to review our list for completeness.Studies were ...

Clinical indications for newer antifungal agents

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

Recent years have seen the release of multiple new systemic antifungal agents, significantly increasing options for the treatment of most serious fungal infections. Newly available drugs include those in the echinocandin class, including caspofungin, micafungin, and anidulafungin, as well as the newer generation triazoles, voriconazole and posaconazole. Ordering of these agents is variably restricted, depending on a given institution's policies, and all are costly. In this review we examine the available evidence and outline the role of newer antifungal medications in several common and/or important situations, including invasive and mucocutaneous Candida infection, febrile neutropenia, invasive aspergillosis, zygomycosis, and endemic mycoses. Journal of Hospital Medicine 2008;4:102-111. �...

Assessing the impact of an educational program on decreasing prescribing errors at a university hospital

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

This study was conducted among internal medicine residents at the 320-bed University of Toledo Medical Center.The educational intervention was conducted during a 6-month period beginning in November 2006. The intervention included an initial hour-long lecture followed by biweekly and then monthly discussions that used timely, institution-specific examples of prescribing errors.Data were collected at 5 time points: month 0 (preintervention period); months 1, 3, and 6 (intervention period); and month 7 (postintervention period). Errors were identified, transcribed, coded, and entered into a database. The primary outcome was the frequency of prescribing errors during each period. A Bonferroni-adjusted chi-square analysis was conducted with an a priori experiment-wise alpha of 0.05.A reduction...

Standardized admission order set improves perceived quality of pediatric inpatient care

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

Few studies exist on the ability of standardized preprinted order forms to improve patient care.To examine resident-perceived effects of introducing a pediatric admission order set (PAOS) on the quality of inpatient care.Cross-sectional study.University of California, Los Angeles (UCLA) Children's Hospital, a nonprofit, tertiary-care teaching hospital and major referral center with approximately 3,000 admissions per year.A total of 97 pediatric residents (PL-1, n = 34; PL-2, n = 33; and PL-3, n = 30) who did the vast majority of the inpatient admissions.Residents were asked to rate the PAOS overall and with respect to 9 specific dimensions using a 5-point Likert scale.Overall, 89% of respondents approved of the PAOS, 58% reported using it [ge]90% of the time, and all said that they would r...

Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes

Journal of Hospital Medicine — Fri, 13 Feb 2009 05:00:00 +0100

The value of order sets for clinical decision support has not been established.To determine whether introduction of admission order sets increases the proportion of inpatients receiving deep venous thrombosis (DVT) prophylaxis.Before-after study.Community hospital.General medical patients admitted to hospital.Paper-based admission order sets (instead of free-text orders) for voluntary use by internists, without any education or behavior change interventions.Primary outcome was proportion of medical admissions ordered DVT prophylaxis. Secondary outcomes included overall utilization of DVT prophylaxis in medical inpatients and other admission order care quality measures.Prior to introduction of order sets, DVT prophylaxis was ordered in 10.9% of patients. Patients admitted with order sets we...

Medical admission order sets to improve deep vein thrombosis prevention: A model for others or a prescription for mediocrity?

Journal of Hospital Medicine — Sun, 01 Feb 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Doctor, my breathing is better when I lie down

Journal of Hospital Medicine — Thu, 29 Jan 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Methicillin-resistant Staphylococcus aureus bacteremia due to prostatic abscess

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

Information regarding practitioner beliefs about inpatient diabetes care is limited.To assess resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal glycemic control in an urban hospital setting.A previously developed questionnaire was modified and administered. Residents were asked about the importance of inpatient glucose control, desirable glucose ranges, and problems encountered when managing hyperglycemia.Urban teaching hospital.Of 85 resident physicians, 66 completed the survey (mean age, 31 years; 47% men; 33% in first residency year). Most respondents categorized glucose control as "very important" in critically-ill and perioperative patients but only "somewhat important" in non-critically-ill patients. Most residents said they would ...

Welcome to my world [hellip] or some loose approximation thereof

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Calcinosis universalis

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Pericardial effusion presenting with anuric acute renal failure and hepatocellular damage

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

A 50-year-old male with anuria, creatinine of 5.5 and potassium of 6.5 was referred to our hospital for hemodialysis. Before hemodialysis could be initiated, his blood pressure dropped and liver function tests were found to be increasing rapidly. This prompted us to look for cardiac causes of liver ischemia. An echocardiogram was non-diagnostic due to the patient's obese body habitus. Pericardial fluid was documented on CT scan. Pericardiocentesis was performed and nearly 1500 ml of bloody pericardial fluid was removed. This resulted in immediate urine output, with 80 ml in the first hour, and an increase in blood pressure. Journal of Hospital Medicine 2009;4:68-70. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Short of breath, not short of diagnoses

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Sleep in hospitalized medical patients, Part 2: Behavioral and pharmacological management of sleep disturbances

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

As described in Part 1 of this article, multiple factors lead to disrupted sleep in hospitalized medical patients. Recognizing and addressing these factors can help clinicians more effectively manage patients' sleep complaints.A PubMed search was conducted by cross-referencing the terms "sleep deprivation," "insomnia," and "sleep"; "hospitalized," "acutely ill," and "critically ill"; and "medication," "drugs," "hypnotics," "benzodiazepines," and "sedatives." The search was limited to English-language articles published between 1997 and 2008. Subsequent PubMed searches were performed to clarify the data described in the initial search.Few articles addressed the topic of the assessment and management of sleep problems in hospitalized medical patients. In Part 2, we propose an evaluation and ...

Limited communication and management of emergency department hyperglycemia in hospitalized patients

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.To evaluate communication and early management of emergency department (ED) hyperglycemia.This was a retrospective cohort study of patients with an initial serum glucose [ge]140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1-year period. We recorded clinical data and compared the content of inpatient and ED-written discharge instructions.Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140-199 mg/dL, and 2304 (8%) values were [ge]200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ...

Evaluation of hospital glycemic control at US Academic Medical Centers

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

To evaluate contemporary hospital glycemic management in US academic medical centers.This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics.In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosyl...

Evaluation of glycemic control following discontinuation of an intensive insulin protocol

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

This study demonstrates a significant increase in BG following discontinuation of an IIP. Higher insulin requirements during the last 12 hours of an IIP were identified as an independent risk factor for poor glycemic control following the IIP. A standardized insulin transition protocol may help better control BG after discontinuation of an IIP. Journal of Hospital Medicine 2009;4:28-34. © 2009 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: Results of a clinical trial

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

Inpatient hyperglycemia is associated with poor patient outcomes. It is unknown how best to implement glycemic management strategies in the non-intensive care unit (ICU) setting.To determine the effects of a multifaceted quality improvement intervention on the management of medical inpatients with diabetes mellitus or hyperglycemia.Before-after trial.Geographically localized general medical service staffed by physician's assistants (PAs) and hospitalists.Consecutively enrolled patients with type 2 diabetes or inpatient hyperglycemia.A detailed subcutaneous insulin protocol, an admission order set built into the hospital's computerized order entry system, and case-based educational workshops and lectures to nurses, physicians, and PAs.Mean percent of glucose readings per patient between 60 ...

Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: Effect of structured subcutaneous insulin orders and an insulin management algorithm

Journal of Hospital Medicine — Mon, 12 Jan 2009 05:00:00 +0100

Structured subcutaneous insulin order sets and insulin protocols are widely advocated. The intervention effects are not well reported.Assess the impact of these interventions on insulin use patterns, hypoglycemia, and glycemic control.Prospective observational.400-bed academic center.Adult non-critical care inpatients with diabetes or hyperglycemia and point-of-care (POC) glucose testing.Structured insulin orders, insulin management algorithm.Percent of insulin orders with basal insulin. Percent uncontrolled patient-stays (day-weighted mean glucose [ge]180 mg/dL) and uncontrolled patient-days (patient-day mean glucose [ge]180 mg/dL). Percent of monitored patient-days and patient-stays with hypoglycemia (glucose [le]60 mg/dL) and severe hypoglycemia (glucose [le]40 mg/dL).The percent slidin...

Paging goldilocks: How much glycemic control is just right?

Journal of Hospital Medicine — Thu, 01 Jan 2009 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Practical strategies for developing the business case for hospital glycemic control teams

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

Many business models may be used to make the business case for support of a multidisciplinary team to implement targeted glucose control in the hospital. Models may be hospital-supported or self-supporting. In the former, the hospital provides financial support based on improved documentation opportunities, reduction in length of stay, and improved resource utilization. In the latter, clinical revenues for diabetes management offsets costs of salary, fringe benefits, and overheads. A combination of these strategies may also be used.The business plan presented to administration must justify return on investment. It is imperative to involve hospital administration, particularly representatives from coding, billing, and finance, in the development of the business plan.The business case for ho...

Society of hospital medicine glycemic control task force summary: Practical recommendations for assessing the impact of glycemic control efforts

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Bridge over troubled waters: Safe and effective transitions of the inpatient with hyperglycemia

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Designing and implementing insulin infusion protocols and order sets

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

Influential trials and guidelines supporting the value of glucose control in hospital settings, particularly in the intensive care and postoperative settings, has led to the widespread adoption of intravenous infusions of human regular insulin. As groups have attempted to study the outcomes or to explore improved methods for improved glucose control, a number of insulin infusion protocols (IIPs) have been reported and validated. Now, many institutions are attempting to translate this experience into clinical practice in a systematic manner. The intent of this discussion is to highlight the authors' practical view of best practices in development and use of IIPs.As the implementation of IIPs has progressed, it has become apparent that this is not a simple process. It requires a carefully pl...

Subcutaneous insulin order sets and protocols: Effective design and implementation strategies

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Management of diabetes and hyperglycemia in the hospital: A practical guide to subcutaneous insulin use in the non-critically ill, adult patient

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

The case for supporting inpatient glycemic control programs now: The evidence and beyond

Journal of Hospital Medicine — Fri, 24 Oct 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Journal of Hospital Medicine — Tue, 07 Oct 2008 04:00:00 +0100

The University of Chicago Curriculum for the Hospitalized Aging Medical Patient (CHAMP) faculty development program (FDP) is targeted at hospitalists and other internists who teach residents and students in the hospital setting. The aim of CHAMP is to increase the quantity and quality of teaching of geriatric medicine pertinent to the inpatient setting.Hospitalist and general internist faculty members who attend on the University of Chicago Medicine teaching service were invited to participate. The CHAMP FDP consisted of twelve 4-hour sessions. Two hours of each session covered inpatient geriatrics content, and 2 hours addressed improving clinical teaching (both general teaching skills and challenges specific to the inpatient wards) and teaching the Accreditation Council for Graduate Medic...

Challenging family dialogues within the intensive care unit: An intensivist's perspective

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Streptococcus pneumoniae keratitis

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

No Abstract. (Source: Journal of Hospital Medicine)

Failure at the transition of care: Challenges in the discharge of the vulnerable elderly patient

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

The case of an elderly patient with mild dementia and severe depression is reviewed including analysis of the barriers to successful transition that led to readmission. Situations likely to result in failed transitions include poor social support, discharge during times when ancillary services are unavailable, uncertain medication reconciliation, depression, and patients' cognitive limitations. Evidence suggests deficits in communication by hospital physicians to primary care providers occur commonly but this is only one of many systems barriers to successful discharge. Review of the literature reveals interventions such as involvement of advance practice nurses or family members in the transition may overcome some of the difficulties inherent in discharge of the vulnerable geriatric patie...

Nerves of steal

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Critical literature 2007: Clinical topics

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Stroke remains an increasing worldwide cause of disability and mortality, and it is the second leading cause of death in industrialized countries. Patients with atrial fibrillation form a unique group with increased risk of cardioembolic stroke. Despite the widespread application of the National Institutes of Health stroke scale and guidelines, patients with atrial fibrillation represent a clinically challenging group that deserves a special approach during the acute stroke phase.The mechanism of stroke in these patients is either cardioembolic [especially with an international normalized ratio (INR) < 2.0] or hemorrhagic (especially with INR > 5.0) (Figure ). Atrial fibrillation with valvular heart disease significantly increases the risk for ischemic stroke. Specifically, patients with m...

Clinical consequences of withholding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Hospitalists involved in perioperative care either stop or continue until the day of surgery renin-angiotensin-aldosterone system antagonists (either angiotensin-converting enzyme inhibitors [ACEI] or angiotensin II receptor subtype 1 antagonists [ARA]) in patients who use these agents chronically. This practice variation reflects uncertainty regarding the risks and benefits of either approach.The purpose of this study was to assess the clinical consequences of preoperatively continuing versus withholding ACEI/ARAs in patients treated chronically with these agents.We comprehensively searched 7 major electronic databases, considered references from selected reviews, hand-searched journals, and communicated with experts. We included randomized trials and observational studies.We evaluated th...

An innovative approach to supporting hospitalist physicians towards academic success

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Academic hospitalist physicians face significant challenges that may threaten their chances for successful and timely promotions, such as heavy clinical workloads, limited training in research, and relatively few experienced mentors in their field. The appreciable growth of hospital medicine groups in recent years, as has occurred at our institution, compounds the predicament by diluting the limited resources that are available to support these physicians.A needs assessment was followed by the development of specific objectives for the division and for individual members of the division related to academic success. The resulting 3-pronged strategy to support the academic success of our group was based on securing strong mentorship, investing requisite resources, and committing to recruit f...

The University of Michigan Specialist-Hospitalist Allied Research Program: Jumpstarting hospital medicine research

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Clinical research has developed slowly in most academic hospitalist programs, possibly because of a failure to recognize the important role of specialists in the diagnosis and management of complex medical patients as well as their expertise in clinical research. Ideally, a successful hospital-based clinical research program will need to partner hospitalists with specialists.The University of Michigan's Specialist-Hospitalist Allied Research Program (SHARP) was designed to jumpstart hospital-based clinical and translational research at a major academic medical center by pairing specialists and hospitalists to ask and answer novel research questions.SHARP is codirected by a hospitalist and a subspecialist and includes key personnel such as a hospitalist investigator, a clinical research nur...

Intimate partner violence in women hospitalized on an internal medicine service: Prevalence and relationship to responses to the review of systems

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

The objective of this study was to assess the prevalence of intimate partner violence in women hospitalized on an internal medicine service and to determine whether it is associated with the number or types of positive responses to the review of systems.This was a prospective, cross-sectional survey.The setting was a university-affiliated public hospital.The patients were women, 18 to 60 years old, hospitalized on an internal medicine service.The measurements were responses to screens for intimate partner violence and a review-of-systems questionnaire.Of the 78 women asked to participate, 72 agreed (92%). The prevalences of experiencing intimate partner violence at any time in the patient's life or within the year prior to presentation were 61% and 22%, respectively. Women with a history o...

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. ...

The expanding or shrinking universe of the hospitalist

Journal of Hospital Medicine — Tue, 12 Aug 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Helping hospitalists achieve academic stature

Journal of Hospital Medicine — Tue, 01 Jul 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Cigarette smoking among health care workers at King Hussein Medical Center

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

The purpose of the study was to investigate the prevalence of smoking among health care workers (HCWs) at King Hussein Medical Center (KHMC), the biggest tertiary-care center in Jordan.Data were collected using a self-reported questionnaire on cigarette smoking distributed among 760 HCWs. Questions were designed to collect various demographic parameters and different aspects related to cigarette smoking.Six hundred HCWs returned the completed questionnaire. Responders were divided into 3 groups; physicians, 260 (43%); nurses, 250 (42%); and other HCWs, 90 (13%). Mean age (±SD) for the whole sample was 35.3 ± 6.9 years. Men constituted 52%. The overall prevalence of smoking was 65%. Fifty-six percent of smokers smoked daily, with a mean consumption of 10 cigarettes per day. Smoking was mo...

Acute paraplegia in a patient with AIDS and a normal CSF examination

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

We report a case of tuberculous myeloradiculitis in a patient with AIDS. The case highlights the difficulty in reaching a diagnosis for the neurological symptoms of a patient with a normal CSF examination and the need for HIV screening of immune-compromised patients with myeloradiculitis. Journal of Hospital Medicine 2008;3:279-280. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Cullen's sign associated with metastatic esophageal carcinoma

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

We report the case of a patient with metastatic adenocarcinoma of the esophagus who developed Cullen's sign shortly before death. Based on this case and previously reported cases, malignancy-associated Cullen's sign portends a dismal prognosis, and may be considered a pre-terminal finding. Journal of Hospital Medicine 2008;3:277-278. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Peripartum cardiomyopathy presenting as splenic infarct

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

"String-of-pearls"

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

A "Super" case of longevity

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Management of parapneumonic effusions in pediatrics: Current practice

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

Pneumonia with associated complex pleural disease is a cause of significant morbidity among hospitalized children. The management of this patient population continues to be a challenge and varies even among single institutions. The article presented here reviews the management goals for pediatric patients hospitalized with complex parapneumonic effusions and provides updated summaries of both medical and surgical therapies. Journal of Hospital Medicine 2008;3:263-270. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Esophageal perforation as a complication of esophagogastroduodenoscopy

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

Fifty years ago, esophageal perforation was common after rigid upper endoscopy. The arrival of flexible endoscopic instruments and refinement in technique have decreased its incidence; however, esophageal perforation remains an important cause of morbidity and mortality. This complication merits a high index of clinical suspicion to prevent sequelae of mediastinitis and fulminant sepsis. Although the risk of perforation with esophagogastroduodenoscopy alone is only 0.03%, this risk can increase to 17% with therapeutic interventions in the setting of underlying esophageal and systemic diseases. A wide spectrum of management options exist, ranging from conservative treatment to surgical intervention. Prompt recognition and management, within 24 hours of perforation, is critical for favorable...

Non-housestaff medicine services in academic centers: Models and challenges

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

We describe non-housestaff medicine services at 5 AMCs in order to share our experiences and outline important considerations in service development. We discuss common challenges in building and sustaining these models along with local institutional factors that affect decision making. Keys to success include ensuring an equitable system for scheduling and staffing, fostering opportunities for scholarly activities and academic promotion (defining the "academic hospitalist"), and providing compensation that supports recruitment and retention of hospitalists. With further work hour restrictions expected in the future and increased requests for surgical comanagement, the relationship between AMCs and hospitalists will continue to evolve. To succeed in developing hospitalist faculty who follow...

Underutilized time for health education of hospitalized patients

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

CONCLUSIONS:Adult medical inpatients have considerable time and strong motivation to participate in health educational activities throughout their hospitalization. The current structure for educating hospitalized patients should be supplemented to take these findings into account. Journal of Hospital Medicine 2008;3:238-246. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Work hour rules and contributors to patient care mistakes: A focus group study with internal medicine residents

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

CONCLUSION:Our focus group participants perceived that the ACGME work hour limitations had minimized the impact of resident fatigue on patient care errors. Other contributors to errors remained and were often exacerbated by methods to maintain compliance with the rules. Journal of Hospital Medicine 2008;3:228-237. (Source: Journal of Hospital Medicine)

Resource utilization of total knee arthroplasty patients cared for on specialty orthopedic surgery units

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

CONCLUSIONS:Patients on SOS units following elective TKA have a reduced LOS and decreased total and hospital costs. Our results should encourage hospitals to reevaluate postoperative patient flow to optimize resource utilization. Journal of Hospital Medicine 2008;3:218-227. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non-critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.A total of 406 patients (75%) had a...

Increasing severity of status asthmaticus in an urban medical intensive care unit

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5-year period 2002-2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the...

Sleepiness in critical care nurses: Results of a pilot study

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

The objective of the study was to assess comprehensively sleepiness levels in post-night-shift nurses.Post-night-shift nurses in the ICU and on general floors (medicine and surgery) were assessed using subjective (Epworth Sleepiness Scale [ESS]) and objective (Mean Sleep Latency Test [MSLT]) measures.ESS was abnormal (>8) in 7 of 10 ICU nurses compared with 2 of 10 floor nurses (P < .005), and mean ESS score was also higher (8.7 ± 3.9 vs. 5.6 ± 2.1, respectively; P = 0.042). MSLT values for the first nap period were in the pathologic range in the ICU nurses compared with the floor nurses (4.65 ± 5.5 vs. 10.85 ± 7.4 minutes, respectively; P < .05).Post-night-shift RNs working in the ICU have a pathologic degree of sleepiness. Journal of Hospital Medicine 2008;3:200-205. © 2008 Society ...

Nurse staffing ratios: Trends and policy implications for hospitalists and the safety net

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

CONCLUSIONS:Nurse staffing legislation may increase nurse staffing. However, mandated nurse staffing ratios without mechanisms to help achieve ratios may force hospitals, especially safety-net hospitals, to make tradeoffs in other services or investments with unintended negative consequences for patients. Nurse staffing likely influences the outcomes of hospitalist-led quality initiatives, but these effects need to be explored further. Journal of Hospital Medicine 2008;3:193-199. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Influence of physician specialty on outcomes after acute ischemic stroke

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

The objective of this study was to evaluate whether admission to the care of a neurologist is associated with improvement in outcomes of stroke patients after controlling for initial prognostic differences.This was a retrospective cohort study.Participating in the study were 113 U.S. academic hospitals.Demographic and clinical data for all ischemic stroke patients admitted through emergency departments from 1997 to 1999 were collected from an administrative database.In traditional analyses, we evaluated attending physician specialty as a predictor of in-hospital mortality. In grouped-treatment (GT) analyses, a method based on the instrumental variable approach that bypasses selection bias, the hospital rate of stroke admission to neurologists was used as the predictor. We used generalized ...

Improving nurse working conditions: Towards safer models of hospital care

Journal of Hospital Medicine — Fri, 20 Jun 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Who do you want taking care of your parent?

Journal of Hospital Medicine — Thu, 01 May 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Solifenacin-induced small bowel pseudo-obstruction

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

An 89-year-old woman was admitted to Johns Hopkins Hospital with a small bowel obstruction and symptoms of urinary retention. She had been started on solfenacin for bladder overactivity 10 days prior to her presentation. Withdrawal of the solfenacin resulted in a full recovery, which has persisted for greater than 6 months without surgical intervention. This is the first reported case report of small bowel pseudo-obstruction due to solifenacin. Journal of Hospital Medicine 2008;3:176-178. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Not the usual cardiac rhythm device infection: A fastidious pathogen with several teaching points

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

Because cardiac device infections may include fastidious pathogens, extended incubation of blood cultures is suggested. A patient with an infection of a right ventricular lead implantable cardioverter defibrillator (ICD) system is described. The device was implanted 6 months earlier. The pathogen was identified as Haemophilus parainfluenzae, which was cultured within 72 hours and was presumably from a respiratory tract infection. Extended incubation was not necessary to culture this fastidious pathogen. Two large retrospective studies suggest that prolonged incubation for fastidious organisms is generally not necessary because of advances in culture media and automated blood culture systems. Journal of Hospital Medicine 2008;3:173-175. © 2007 Society of Hospital Medicine. (Source: Journal...

Hepatitis C-associated leukocytoclastic vasculitis with anticardiolipin antibodies causing penile necrosis and deep venous thrombosis in the absence of cryoglobulinemia

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Purpuric rash of meningococcemia

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

No Abstract. (Source: Journal of Hospital Medicine)

Tuberculosis: In and out of the airways

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

A diagnosis of exclusion

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

No Abstract. (Source: Journal of Hospital Medicine)

Two hearts beating as one

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

No Abstract. (Source: Journal of Hospital Medicine)

Diagnostic and treatment delays in recurrent clostridium difficile-associated disease

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

CONCLUSIONS:Patients with recurrent disease were more likely to be treated earlier but not diagnosed earlier than those with initial disease. Because both groups had significant diagnostic and treatment delays, this is an area in which hospitalists can have a major impact on patient care. Journal of Hospital Medicine 2008;3:156-159. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

The objective of this article is to report the impact of a continuous quality improvement project on adherence with DVT prophylaxis guidelines and on the subsequent incidence of hospital-acquired DVT in medical patients at a teaching hospital between 2002 and 2005.In November 2002, Kings County Hospital Center Department of Medicine embarked on a project to increase the rate of thromboprophylaxis use. Quality improvement strategies included an active, multifaceted, layered combination of provider education, provider reminders with decision support, and audit with feedback.The DVT prophylaxis rate on the general medicine house-staff service increased from a baseline of 63% in 2002 to 96% in 2005. The number of hospital-acquired DVTs decreased from a baseline of 14 in 2002 to 1 in 2005. The ...

Use of dexmedetomidine for sedation of children hospitalized in the intensive care unit

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

CONCLUSIONS:In this cohort of children hospitalized in the ICU, dexmedetomidine appeared to be effective and to have few adverse effects. Dexmedetomidine may have a potentially useful role to play in sedating hospitalized children. Journal of Hospital Medicine 2008;3:142-147. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Cost effectiveness of an inpatient influenza immunization assessment and delivery program for children with asthma

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

Influenza is common in children. Children with asthma are underimmunized. The Centers for Disease Control recommends immunization in an acute-care hospital setting.The purpose of this study was to determine the potential clinical benefit and cost savings of delivering influenza vaccination to hospitalized children with asthma.The study was designed as a decision and cost-effectiveness analyses. A decision tree was constructed to represent an intervention to assess and deliver influenza vaccinations to hospitalized pediatric patients with asthma. A literature survey provided estimates for the decision tree assumptions. In the decision analysis, various rates of screening for influenza vaccine status were investigated to determine the effects on final up-to-date (UTD) status in a hypothetica...

Innovative web-based multimedia curriculum improves cardiac examination competency of residents

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

The objective of the study was to determine whether Web training improves CE competency, whether residents retain what they learn, and whether a Web-based curriculum plus clinical training is better than clinical training alone. Journal of Hospital Medicine 2008;3:124-133. © 2008 Society of Hospital Medicine.This was a controlled intervention study.The intervention group (34 internal and family medicine interns) participated in self-directed use of a Web-based tutorial and three 1-hour teaching sessions taught by a hospitalist. Twenty-five interns from the prior year served as controls.We assessed overall CE competency and 4 subcategories of CE competency: knowledge, audio skills, visual skills, and audio-visual integration.The over mean score of the intervention group significantly impro...

Fate of patients with obstructive jaundice

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

CONCLUSIONS:Obstructive jaundice was the cause of the severe jaundice of one third of patients. Most cases of OJ were a result of a malignancy, which carried a very poor prognosis, with a 2-year mortality rate of 95%. Journal of Hospital Medicine 2008;3:117-123. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Acute care hospital mortality of schizophrenic patients

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

CONCLUSIONS:There was a nearly significant trend toward increased mortality of schizophrenic patients receiving acute hospital care compared with that of nonschizophrenic patients. Because suicide was the most frequent cause of death, a focus on suicide prevention is needed in this population. Journal of Hospital Medicine 2008;3:110-116. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Effect of a hospitalist-care coordinator team on a nonteaching hospitalist service

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

CONCLUSIONS:Hospitalists working in a team approach with an HCC reported improved efficiency and job satisfaction compared with hospitalists working independently. These findings are important in light of growing concerns about hospitalist workload and job satisfaction. Journal of Hospital Medicine 2008;3:103-109. © 2008 Society of Hospital Medicine. (Source: Journal of Hospital Medicine)

Potentially inappropriate medication use in hospitalized elders

Journal of Hospital Medicine — Fri, 25 Apr 2008 04:00:00 +0100

The objective of the study was to determine the rate of and factors associated with potentially inappropriate medication (PIM) prescribing in a large inpatient sample.The study was a retrospective cohort of the period between September 1, 2002, and June 30, 2005. We used multivariable logistic regression to identify patient, physician, and hospital characteristics associated with PIM prescribing.The study collected data from 384 US hospitals.The sample was composed of patients aged [ge]65 years admitted with 1 or more of 7 common medical diagnoses.The percentage of patients prescribed PIMs as defined using a modified Beers list was measured. Multivariable-adjusted odds ratios for PIM use were computed.Of the 493,971 patients, 49% received at least 1 PIM, and 6% received 3 or more, most com...

ASHP-SHM joint statement on hospitalist-pharmacist collaboration

Journal of Hospital Medicine — Sat, 01 Mar 2008 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Annual reviewers list

Journal of Hospital Medicine — Wed, 06 Feb 2008 05:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)