Journal of hospital medicine最新文献

{"title":"Our purpose, our voice: Navigating uncertain times","authors":"Samir S. Shah MD, MSCE, MHM","doi":"10.1002/jhm.70024","DOIUrl":"10.1002/jhm.70024","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"331-332"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing for the unthinkable: The resurgence of vaccine-preventable diseases","authors":"Samir S. Shah MD, MSCE, MHM,&nbsp;Erin E. Shaughnessy MD, MSHCM,&nbsp;Benjamin Kinnear MD, MEd","doi":"10.1002/jhm.13589","DOIUrl":"10.1002/jhm.13589","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"333-334"},"PeriodicalIF":2.4,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of using an assistive listening device in a hospital setting","authors":"Marissa Merrifield BS,&nbsp;Sharon A. Brangman MD,&nbsp;Toni Pacioles MD,&nbsp;Karen A. Doherty PhD","doi":"10.1002/jhm.13573","DOIUrl":"10.1002/jhm.13573","url":null,"abstract":"<p>High levels of noise in hospital settings can make communication difficult, especially for older adults. Assistive Listening Devices (ALDs) are personal amplifiers that can improve hearing in background noise. This study investigated the impact of providing ALDs to hospitalized patients 60 years of age and older without using hearing screenings to determine eligibility. Results indicated that 96% of the patients reported that ALD was easy to use and 88% found it helpful. The ALD was used to communicate with family, hospital staff, and physicians. This suggests ALDs can be distributed to patients 60 years and older without any hearing screenings.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"424-429"},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13573","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waiting to be seen: Understanding the experience of waiting in hospital settings through a patient-created digital story","authors":"Michael Lang PhD,&nbsp;Daniel Piller,&nbsp;Christopher Roach BSc","doi":"10.1002/jhm.13566","DOIUrl":"10.1002/jhm.13566","url":null,"abstract":"&lt;p&gt;Few healthcare experiences are as ubiquitous as waiting. Conversations at any social gathering will unearth stories of wait times and waiting rooms, waiting for referrals, appointments, test results, treatments, or medications. A common quip in patient advocacy circles is that the experience of waiting is why “people” become “patients” when they interact with the healthcare system.* After an accident at the age of 20 led to quadriplegia, Daniel is “good at waiting” as a recurrent user of the acute care system. His years of lived experience provided extensive material to draw upon as he created a short-film titled, &lt;i&gt;Waiting to be Seen&lt;/i&gt;, on which this interpretive article is based (Click Here to View).&lt;/p&gt;&lt;p&gt;In Canada, provincial healthcare systems across the country are infamous for their time-to-treatment metrics, with surgery and emergency department (ED) wait times being challenges in acute care.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; As a result, improving patient flow in hospital contexts is a focus of many quality improvement (QI) initiatives, including the “Know Your Data” Physician Audit and Feedback pilot project with Alberta Health Services. Audit and feedback (AF) is a method of providing performance data to physicians to help them translate knowledge into practice&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and this particular initiative aimed to help hospitalists and internal medicine physicians understand their practices using operational data.&lt;/p&gt;&lt;p&gt;Led by the Hospital Medicine Section of the Medicine Strategic Clinical Network, the pilot project used physician AF literature&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and internal data and analytics to provide individual and service-level data to physicians and highlight data availability in the new province-wide Clinical Information System, called Connect Care. Data provision (e.g., acute length of stay:expected length of stay ratio, readmission rates, etc.) was coupled with QI approaches to cultivate change at the individual physician level, through self-reflection on their own data, and by reviewing data at an aggregated level in facilitated physician group discussions. It was noted during the initial phase of this project that these group conversations lacked context, specifically, the impact that patient flow had on the lives of patients and their families. In other words, &lt;i&gt;why did the numbers matter&lt;/i&gt;? It was clear that lived experiences were needed to contextualize the AF group conversations, and five patient advisors were recruited to create their own short-film, called a Digital Story, about their acute care encounters. The remainder of this interpretive article will explore three ideas that emerge from the story Daniel created for the Know Your Data project.&lt;/p&gt;&lt;p&gt;The imagery emphasizes these words with a slowly dissolving image of Daniel in his wheelchair that reappears as the doctor apologizes and Daniel “feels seen.” By admitting a mistake and accepting responsibility, the ED physician demonstrated that he un","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"430-432"},"PeriodicalIF":2.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Streamlining diuresis: A quality improvement approach to implementing a sodium-based predictive diuresis protocol","authors":"Karan Rai MD, MHA,&nbsp;Hillary Landau Western MD, MBA,&nbsp;Moksha Patel MD,&nbsp;Samuel Porter MD","doi":"10.1002/jhm.13560","DOIUrl":"10.1002/jhm.13560","url":null,"abstract":"<p>Diuresis for hospitalized patients with acute decompensated heart failure is a routine clinical practice but one that remains reliant on error-prone and resource-intensive intake and output and weight measurements and is subject to wide provider variation. We sought to use quality improvement approaches to implement a data-driven predictive diuresis protocol based on natriuresis using the electronic health record to titrate dosing. Our initiative did not result in significant reductions in length of stay but did demonstrate a significant increase in the use of urine studies to guide diuresis and signals toward more aggressive diuretic dosing without an increase in adverse outcomes.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"321-326"},"PeriodicalIF":2.4,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital at Home: Time to define the home-based care continuum and establish standards for research","authors":"Richard D. Rothman MD,&nbsp;Jessica A. Hohman MD, MSc, MSc,&nbsp;Michael J. Maniaci MD","doi":"10.1002/jhm.13551","DOIUrl":"10.1002/jhm.13551","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"420-421"},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Journal of Hospital Medicine turns 20","authors":"Samir S. Shah MD, MSCE, MHM,&nbsp;The Journal of Hospital Medicine Editorial Leadership Team","doi":"10.1002/jhm.13548","DOIUrl":"10.1002/jhm.13548","url":null,"abstract":"&lt;p&gt;We are honored to lead the &lt;i&gt;Journal of Hospital Medicine&lt;/i&gt; into its 20th year, continuing our commitment to publishing high-quality research and commentary that advance the field, influence policy, and improve patient care. Enhancing clinical knowledge also remains integral to our mission, hence the many forums to which our readers can avail themselves, including &lt;i&gt;Clinical Progress Notes, Clinical Guideline Highlights for the Hospitalist, Things We Do for No Reason™, Clinical Care Conundrums&lt;/i&gt;, and, most recently, &lt;i&gt;Visual Vignettes&lt;/i&gt;, a column focused on physical diagnosis.&lt;/p&gt;&lt;p&gt;We have also adapted to and shaped new ways of consuming medical information as we build a community around the journal. Our redesigned website and active engagement by our expanded digital media team on a variety of platforms, including LinkedIn, X (formerly Twitter), Instagram, and Threads, allow readers to engage with us in ways that best meet their needs. Moreover, our pioneering editorial and digital media fellowship programs play a key role in developing academic leaders. Notably, our commitment extends beyond research and education to embracing the dynamic ways healthcare intersects with society. Thus, we have published research and perspectives on vulnerable populations, such as Veterans, LGBTQ+ individuals, the elderly, children, and incarcerated individuals, and perspectives on voting rights, climate change, reproductive rights, and gun violence, issues that inevitably affect our patients and colleagues.&lt;/p&gt;&lt;p&gt;Healthcare, by its nature, intersects with policy and legislation. Decisions made by lawmakers—whether at the federal or state level—have a tangible effect on patient health. For example, changes to child labor laws in some states place some of our most vulnerable populations at risk of exploitation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Permissive gun laws in one state are associated not only with higher within state gun-related suicides and homicides but also with other states' firearm-related deaths.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Decisions surrounding women's healthcare, including abortion access, contraception, and reproductive rights, are being made in statehouses across the country.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The consequences of these decisions are not abstract: we see them in the lives of real people—in children and adolescents, like the more than 1200 killed in gun-related violence in 2024, and in women who experienced life-threatening septic abortions due to delayed care in restrictive states.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As healthcare providers, we are caregivers and advocates for our patients first and foremost. As a journal, our responsibility is to acknowledge and inform our readers about broader societal issues, including those shaped by political discourse, that directly influence our patients' health. The decisions those of us in healthcare make—from how to console grieving parents, counsel a pregnant woman whose fetus has chromosomal abno","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"5-7"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our futile charades","authors":"Ella Eisinger BS","doi":"10.1002/jhm.13553","DOIUrl":"10.1002/jhm.13553","url":null,"abstract":"&lt;p&gt;&lt;i&gt;Let's go down on the midaz, up on the fent&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;&lt;i&gt;First peel off the vaso, then pull back on the levo&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Dial down the FiO2, titrate the PEEP&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;There is so much titrating and tinkering in the ICU that at some point the patient is rendered seemingly passive, a recipient weathering the pressor escalations and opioid boluses until they meet the observational and objective parameters of comfort and clinical stability.&lt;/p&gt;&lt;p&gt;I think that it is because of this subliminally perceived passivity that I am so taken aback when an intubated patient breaks through the fog of sedation and begins pointing at my watch and at his mouth. Residents and I gather around his bed as the room is suddenly transformed into an enormous episode of charades in which we feverishly guess at what he is trying to say.&lt;/p&gt;&lt;p&gt;“It's 4:16 in the afternoon on July 22, 2024,” we say repeatedly alongside, “yes, we want to try and take that tube out soon.”&lt;/p&gt;&lt;p&gt;He scowls in exasperation, giving us a much-deserved eye roll.&lt;/p&gt;&lt;p&gt;We try to explain that there are a few more conditions we need to optimize before he can be extubated—that he has fluid in his lungs and a new pneumonia that we are now treating, that we had tried extubation once already and wanted to offer him the best second chance possible. But he keeps pointing at his mouth and throwing his hands up in the air, his composure adopting a new flavor of attitude and rightful frustration.&lt;/p&gt;&lt;p&gt;“Oh, we know,” we sympathize. “We really want that tube out, too.”&lt;/p&gt;&lt;p&gt;He throws his hands up in the air one more time, pleading for divine intervention to knock some sense into our heads.&lt;/p&gt;&lt;p&gt;As I meanwhile find wonder in the emotions now alighting a face that had been rendered expressionless for days, my attending puts an end to our futile charades. She holds out a piece of paper with a grid of letters and guides a pointing tool into his hand, bridging the chasm between patient and provider.&lt;/p&gt;&lt;p&gt;His hand tremulously crawls across the sheet. W-A-T-E-R.&lt;/p&gt;&lt;p&gt;Our room falls silent, our reassurances of the imminence of extubation melting to the ground.&lt;/p&gt;&lt;p&gt;By my final week of my first month in the ICU as a trainee, I had come to understand how the agency of a critically ill patient is temporarily contained in favor of that same agency's long-term preservation. Holding beneficence in the highest esteem, we ask patients to ascribe to our lab draws, treatments, and procedures; more often than not, consent is provided by surrogate decision makers in lieu of the patients themselves. And so it can provoke a sense of discomfort when a patient rouses from the sedation spell and begins to soulfully inhabit the body that until then had been rolled, stuck, and proceduralized. I wanted them to agree with the care they had been receiving, to continue along with the gameplan that we had so meticulously outlined through hours upon hours of rounds, albeit absent their direct participation. I found that any reluctan","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"327-328"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership & professional development: Strategies to disagree productively: Persuasive DISNT","authors":"Josué Zapata MD, MBA,&nbsp;Katie Raffel MD","doi":"10.1002/jhm.13531","DOIUrl":"10.1002/jhm.13531","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 3","pages":"271-272"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision fatigue in hospital settings: A scoping review","authors":"Kelsey Perry MD,&nbsp;Sarah Jones PA-C,&nbsp;Julia C. Stumpff MSLIS,&nbsp;Rachel Kruer BCCCP, PharmD,&nbsp;Lauren Czosnowski PharmD,&nbsp;Deanne Kashiwagi MD, MS,&nbsp;Areeba Kara MD, MS","doi":"10.1002/jhm.13550","DOIUrl":"10.1002/jhm.13550","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>“Decision Fatigue” (DF) describes the impaired ability to make decisions because of repeated acts of decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We conducted a scoping review to describe DF in inpatient settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, and be published in English in or after the year 2000. Six databases were searched. Retrieved citations were screened and retained studies were reviewed against the inclusion criteria. References of included studies were manually searched, and forward citation searches were conducted to capture relevant sources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search retrieved 12,781 citations, of which 41 were retained following screening. Following review, 16 studies met the inclusion criteria. Half were conference abstracts and none examined hospitalists. Emergency medicine and intensive care settings were the most frequently studied clinical environments (<i>n</i> = 13, 81%). All studies were observational. The most frequently examined decisions were about resource utilization (<i>n</i> = 8, 50%), however only half of these examined downstream clinical outcomes. Decision quality against prespecified standards was examined in four (25%) studies. Work environment and patient attributes were often described but not consistently accounted for in analyses. Clinician attributes were described in four (25%) investigations. Findings were inconsistent: both supporting and refuting DF's role in the outcome studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The role of clinician, patient, and work environment attributes in mediating DF is understudied. Similarly, the context surrounding the decision under study require further explication and when assessing resource use and decision quality, adjudication should be made against prespecified standards.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 4","pages":"385-395"},"PeriodicalIF":2.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}