Journal of hospital medicine最新文献

{"title":"The sepsis coding intensity measure: Is this the scalpel that will dissect out illness severity or is it still too blunt for the task?","authors":"Harris L. Carmichael MD, MSHP, Ajay Bhasin MD, MS, Gregory W. Ruhnke MD, MS, MPH","doi":"10.1002/jhm.13410","DOIUrl":"10.1002/jhm.13410","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"866-867"},"PeriodicalIF":2.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946068","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 promises and limitations of artificial intelligence for quality improvement, patient safety, and research in hospital medicine","authors":"Stephen P. Ma MD, PhD, Nidhi Rohatgi MD, MS, Jonathan H. Chen MD, PhD","doi":"10.1002/jhm.13404","DOIUrl":"10.1002/jhm.13404","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"85-88"},"PeriodicalIF":2.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946039","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":"Breaking barriers, building faculty: A qualitative analysis to exploring faculty development in academic hospital medicine","authors":"Jack Badawy MD,&nbsp;Matthew Sakumoto MD,&nbsp;Elizabeth Murphy MD,&nbsp;David Schmit MD,&nbsp;Christine Davis MS,&nbsp;Ankur Segon MD, MPH,&nbsp;Andrew Auerbach MD,&nbsp;Marisha Burden MD, MBA","doi":"10.1002/jhm.13406","DOIUrl":"10.1002/jhm.13406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital medicine (HM) continues to be primarily composed of junior hospitalists and research has highlighted a paucity of mentors and academic output. Faculty advancement programs have been identified as a means to support junior hospitalists in their career trajectories and to advance the field. The optimal approach to supporting faculty development (FD) efforts is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand hospitalist groups' approaches to FD, including efforts that were perceived to be effective, and to identify barriers as well as potential future directions for FD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Rapid qualitative methods were utilized including templated summaries and matrix analysis to identify major themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Virtual focus groups with hospitalists in the Hospital Medicine Reengineering Network (HOMERuN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Qualitative themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen individuals from 17 unique institutions from across the United States in May 2022 participated in seven focus groups. Four key themes emerged from the study and included (1) academic hospitalist programs face multifaceted challenges and barriers to FD in HM, (2) groups have embraced a diversity of structures and frameworks, (3) due to clinical volumes, FD programs have had to adapt and evolve to meet FD needs, and (4) participants identified multiple areas for improvement, including defining tangible outcomes of FD programs and creating a repository of FD material which can be shared widely.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"787-793"},"PeriodicalIF":2.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945969","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":"New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19","authors":"Samantha Harrison MS,&nbsp;Krystal Capers MPH,&nbsp;Guanqing Chen PhD,&nbsp;Ji T. Liu PharmD,&nbsp;Ameeka Pannu MD,&nbsp;Valerie Goodspeed MPH,&nbsp;Akiva Leibowitz MD,&nbsp;Somnath Bose MD, MPH, FASA","doi":"10.1002/jhm.13408","DOIUrl":"10.1002/jhm.13408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Single center retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42–4.12; <i>p</i> = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 10","pages":"877-885"},"PeriodicalIF":2.4,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922487","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":"What do patients and families observe about pediatric safety?: A thematic analysis of real-time narratives","authors":"Christine Studenmund MD,&nbsp;Audrey Lyndon PhD, RNC,&nbsp;James R. Stotts PhD, RN,&nbsp;Caroline Peralta-Neel MPS,&nbsp;Anjana E. Sharma MD, MAS,&nbsp;Naomi S. Bardach MD, MAS","doi":"10.1002/jhm.13388","DOIUrl":"10.1002/jhm.13388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Data on inpatient safety are documented by hospital staff through incident reporting (IR) systems. Safety observations from families or patients are rarely captured. The Family Input for Quality and Safety (FIQS) study created a mobile health tool for pediatric patients and their families to anonymously report safety observations in real time during hospitalization. The study objectives were to describe these observations and identify domains salient to safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational study, we analyzed pediatric patient safety reports from June 2017 to April 2018. Participants were: English-speaking family members and hospitalized patients ≥13 years old. The analysis had two stages: (1) assessment of whether narratives met established safety event criteria and whether there were companion IRs; (2) thematic analysis to identify domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 248 enrolled participants, 58 submitted 120 narrative reports. Of the narratives, 68 (57%) met safety event criteria, while only 1 (0.8%) corresponded to a staff-reported IR. Twenty-five percent of narratives shared positive feedback about patient safety efforts; 75% shared constructive feedback. We identified domains particularly salient to safety: (1) patients and families as safety actors; (2) emotional safety; (3) system-centered care; and (4) shared safety domains, including medication, communication, and environment of care. Some domains capture data that is otherwise difficult to obtain (#1–3), while others fit within standard healthcare safety domains (#4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients and families observe and report salient safety events that can fill gaps in IR data. Healthcare leaders should consider incorporating patient and family observations—collected with an option for anonymity and eliciting both positive and constructive comments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"765-776"},"PeriodicalIF":2.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917588","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":"Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections","authors":"Jessica L. Markham MD, MSc,&nbsp;Alaina Burns PharmD, BCPPS,&nbsp;Matthew Hall PhD,&nbsp;Matthew J. Molloy MD, MPH,&nbsp;John R. Stephens MD,&nbsp;Elisha McCoy MD,&nbsp;Irma T. Ugalde MD, MBE,&nbsp;Michael J. Steiner MD, MPH,&nbsp;Jillian M. Cotter MD, MSCS,&nbsp;Samantha A. House DO, MPH,&nbsp;Megan E. Collins MD,&nbsp;Andrew G. Yu MD,&nbsp;Michael J. Tchou MD, MSc,&nbsp;Samir S. Shah MD, MSCE","doi":"10.1002/jhm.13390","DOIUrl":"10.1002/jhm.13390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting and Participants</h3>\u0000 \u0000 <p>We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome and Measures</h3>\u0000 \u0000 <p>We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from &lt;1% to 25%. Approximately 80% of hospital antibiograms demonstrated &gt;80% <i>Escherichia coli</i> susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 [95% confidence interval; CI]: 30.8–35.4] h vs. broad-spectrum: 46.1 [95% CI: 44.1–48.2] h) and reduced costs (narrow-spectrum: $4570 [$3751–5568] versus broad-spectrum: $5699 [$5005–$6491]). There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible <i>E. coli</i>. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"777-786"},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909604","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":"Aging on distant shores","authors":"Sujatha Sankaran MD","doi":"10.1002/jhm.13407","DOIUrl":"10.1002/jhm.13407","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 2","pages":"185-186"},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909574","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":"Maintaining public trust in organ donation while expanding the organ pool","authors":"Brendan Parent JD","doi":"10.1002/jhm.13409","DOIUrl":"10.1002/jhm.13409","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 9","pages":"863-865"},"PeriodicalIF":2.4,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909600","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 promise and peril of generative artificial intelligence for daily hospitalist practice","authors":"Adam Rodman MD, MPH,&nbsp;Zahir Kanjee MD, MPH","doi":"10.1002/jhm.13363","DOIUrl":"10.1002/jhm.13363","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":"19 12","pages":"1188-1193"},"PeriodicalIF":2.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900489","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":"Sex concordance between physicians and patients and discharge opioid prescribing","authors":"Aksharananda Rambachan MD, MPH,&nbsp;Mihir Joshi MD,&nbsp;Andrew D. Auerbach MD,&nbsp;Margaret C. Fang MD, MPH","doi":"10.1002/jhm.13389","DOIUrl":"10.1002/jhm.13389","url":null,"abstract":"<p>Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician–patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: −4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 7","pages":"605-609"},"PeriodicalIF":2.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900486","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}