Journal of hospital medicine最新文献

{"title":"Supporting graduate medical trainees through parental leave: Best practices for program success","authors":"Jessica E. Zimo MD,&nbsp;Sarah E. Yentz MD,&nbsp;Maria E. Theodorou MD, FACP, FHM","doi":"10.1002/jhm.70386","DOIUrl":"10.1002/jhm.70386","url":null,"abstract":"<p>Becoming a parent during medical training poses unique challenges. Programs and institutions vary widely in the time away from training and support offered in the peripartum period. Here, we offer four key strategies to support graduate medical trainees through parental leave and upon return to work: program specific policy development, transparent dissemination of policies, flexible peripartum elective offerings, and support of workplace lactation if desired by the trainee. Proactive support from program leadership before, during, and after parental leave can greatly improve trainee wellbeing and help establish a physician workforce well-equipped to balance the competing priorities experienced by practicing physicians.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1063-1066"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371458","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":"Scheduling early primary care follow-up after pneumonia: A retrospective target trial emulation in five hospitals","authors":"Andrew J. Davis MD,&nbsp;Stephanie P. Taylor MD, MS,&nbsp;Catherine L. Hough MD, MS,&nbsp;Mari Armstrong-Hough PhD, MPH,&nbsp;Li Yan PhD, MS,&nbsp;Catherine K. Ettman PhD,&nbsp;Katy Sadowski BS,&nbsp;Khyzer B. Aziz MD,&nbsp;Patrick G. Lyons MD,&nbsp;Katrina E. Hauschildt PhD, MA,&nbsp;Marc Kowalkowski PhD,&nbsp;Eliana M. Perrin MD, MPH,&nbsp;Theodore J. Iwashyna MD, PhD","doi":"10.1002/jhm.70281","DOIUrl":"10.1002/jhm.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current guidelines make no recommendations on discharge interventions or scheduling outpatient follow-up after hospitlization for commnity-acquired pneumonia (CAP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the impact of scheduling early primary care follow-up prior to discharge home among survivors of hypoxemic CAP hospitalizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an observational target trial emulation of 3332 adults (age ≥18 years) with hypoxemic CAP (requiring ≥2 liters oxygen) admitted to a 5-hospital system and discharged home between 2019 and 2024. Treated and control patients were propensity score-matched with replacement on 30 prespecified confounders. Treated patients had early primary care follow-up (to occur within 14 days of discharge) scheduled predischarge. The Average Treatment effect on the Treated (ATT) on a primary composite outcome of postdischarge mortality or readmission was assessed 90 days postdischarge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After weighting, the matched cohort included 894 patients with equal treated and control groups (median age 66 [interquartile range [IQR]: 54–77]). Treated patients completed 14-day follow-up more frequently compared with controls (85% vs. 36%). The observed reduction in the incidence of the primary outcome in the treated group was not statistically significant (ATT: −1.1% [CI: −7.3, 5.1], <i>p</i> = 0.72). In a post-hoc analysis of 301 treated patients who subsequently completed scheduled follow-up, there was a statistically significant reduction in the incidence of the primary outcome in the treated group (ATT: −7.0% [CI: −13.9, –0.01], <i>p</i> = 0.049).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Scheduling early primary care follow-up after hospitalization for hypoxemic CAP was associated with reduced 90-day readmission and mortality only among patients who completed follow-up. Future work is needed to enhance the completion of scheduled primary care follow-up for hypoxemic CAP survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"971-981"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204489","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":"Things We Do for No Reason™: Routine use of unfractionated heparin for initial anticoagulation in venous thromboembolism","authors":"Youssef Saklawi MD,&nbsp;Mohamad Ali Tfaily MD, MSc,&nbsp;Bhargav Marthambadi MD,&nbsp;Adrian Umpierrez MD","doi":"10.1002/jhm.70331","DOIUrl":"10.1002/jhm.70331","url":null,"abstract":"<p>Venous thromboembolism is common among hospitalized patients. Current guidelines recommend direct oral anticoagulants and low-molecular-weight heparin (LMWH) as first-line therapy for most patients based on superior efficacy and ease of use. Compared with unfractionated heparin (UFH), LMWH provides more predictable anticoagulation, achieves therapeutic levels rapidly with weight-based dosing, and requires minimal laboratory monitoring. Randomized trials and observational studies demonstrate that LMWH is associated with lower rates of recurrent venous thromboembolism (VTE), bleeding, and heparin-induced thrombocytopenia. For most patients requiring parenteral anticoagulation, routine use of UFH should be avoided in favor of LMWH.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1047-1050"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725163","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":"Food insecurity and hospital resource utilization","authors":"Adolfo L. Molina MD, MSHQS,&nbsp;Ariel Carpenter MD,&nbsp;Mary Orr MD, MPH,&nbsp;Samantha L. Hanna MD, MPH,&nbsp;Dana Woodruff MPH,&nbsp;Cynthia Deerman LBSW,&nbsp;Cassi Smola MD,&nbsp;Erin E. Shaughnessy MD, MSHCM,&nbsp;Chang L. Wu MD, MSCR","doi":"10.1002/jhm.70362","DOIUrl":"10.1002/jhm.70362","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Food insecurity (FI) is an important pediatric social risk factor associated with worse health outcomes. However, there is a paucity of data on FI's effects on hospitalized children and hospital-based reutilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective cohort study included children admitted between 2020 and 2023 to evaluate the effect of FI on hospital utilization (length of stay [LOS], emergency department [ED] revisits, and readmission). FI was identified using the two-question Hunger Vital Sign^TM at admission, with patients categorized as food secure, food insecure, or missed/refused screening. Multivariable generalized estimating equations, utilizing binomial and negative binomial distributions, were employed to calculated adjusted odds ratios (aOR) and incidence rate ratios (aIRR), respectively, while accounting for patient-level clustering. Models were adjusted for age, sex, race, ethnicity, language, and insurance type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 31,553 pediatric hospitalizations in the analysis. Results demonstrated that patients in the missed/refused screening group had a significantly increased LOS, with a 73% increase in expected hospital duration (aIRR: 1.73; 95% confidence interval [CI]: (1.60–1.89) <i>p</i> &lt; .0001) compared with the food-secure group. In contrast, no significant associations were found between documented FI and LOS, ED revisit, and 30-day readmission after adjusting for patient clustering.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the relationship between FI and utilization is multifactorial, these findings suggest that patients who are missed by or refuse screening represent a high-acuity cohort with significantly higher resource utilization. Addressing social risk during hospitalization remains an important opportunity for resource connection, and the high utilization among the unscreened population highlights a critical area for improving screening equity and clinical outreach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1002-1007"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213829","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":"Clinical guideline: ACG clinical guideline on hepatic encephalopathy","authors":"Nilesh Patel MD","doi":"10.1002/jhm.70391","DOIUrl":"10.1002/jhm.70391","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":"21 9","pages":"1028-1030"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354927","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":"A multi-institutional rapid qualitative assessment of factors supporting diagnostic excellence in hospital medicine","authors":"Katie E. Raffel MD,&nbsp;Chase J. Webber DO,&nbsp;Maya Narayanan MD,&nbsp;Michael Tozier MD,&nbsp;Matthew Cerasale MD, MPH,&nbsp;Tiffany M. Lee BA,&nbsp;Marisha Burden MD, MBA,&nbsp;Andrew Auerbach MD,&nbsp;Jeffrey L. Schnipper MD, MPH,&nbsp;Angela Keniston PhD, MSPH","doi":"10.1002/jhm.70401","DOIUrl":"10.1002/jhm.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diagnostic errors among hospitalized adults are prevalent and costly. Traditional approaches that focus on identifying and fixing mistakes (Safety-I) may fall short in the dynamic and complex hospital environment. Instead, focusing on approaches that emphasize the understanding of how things go right and adapt to challenges (Safety-II) may offer better insights into what contributes to accurate and timely diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We sought to characterize hospitalists' perceptions of diagnostic excellence and the factors and adaptations needed to achieve it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, researchers, and patient representatives about (1) recognition of diagnostic excellence, (2) what makes diagnostic journeys go well, and (3) factors that facilitate diagnosis in difficult situations. Rapid qualitative methods including templated summaries and matrix analysis were applied to analyze these focus groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We conducted five focus groups with 36 individuals from 23 unique institutions. Participants shared three factors that facilitate a successful diagnostic journey: clinical reasoning that is structured yet adaptive, collaborative diagnosis through teamwork, and systems-level support for diagnostic capacity. Participants readily recognized diagnostic excellence, though noted the challenge in systematically identifying these cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While diagnostic excellence case identification is seen as a challenge, providers do note people, process, and technology opportunities to support better diagnosis. Optimization of diagnosis in hospital medicine may benefit from a focus on team and communication redesign, adaptive technology development, and workload management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1008-1016"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427629","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 my Teta′s coffee cup taught me about prognostication","authors":"Carla Khalaf McStay MD, MS","doi":"10.1002/jhm.70235","DOIUrl":"10.1002/jhm.70235","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":"21 9","pages":"1071-1072"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515226","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":"Leadership & professional development: Mitigating assessment bias as a hospitalist","authors":"Christina M. McKinney MD,&nbsp;Madison Archer MD","doi":"10.1002/jhm.70343","DOIUrl":"10.1002/jhm.70343","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":"21 9","pages":"1026-1027"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876957","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":"Safety steps: A framework for promoting safe trainee autonomy in clinical emergencies","authors":"Kathryn Grace Kompa MD,&nbsp;Janet Monroe MD,&nbsp;Virginia Brady MD,&nbsp;Roberto Gonzalez MD,&nbsp;James Lyon MD,&nbsp;Rachel Porth MD,&nbsp;Daniel Smithers MD,&nbsp;C. Christopher Smith MD","doi":"10.1002/jhm.70368","DOIUrl":"10.1002/jhm.70368","url":null,"abstract":"<p>Balancing trainee autonomy with patient safety during clinical emergencies is an enduring challenge faced by hospitalists. In this article, we propose a framework to be used in urgent medical situations, such as hypotension or acute hypoxic respiratory failure. These strategies can be used to enhance early career trainee learning, confidence, and independence in such challenging situations by fostering a supportive learning environment while emphasizing both patient safety and trainee growth.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1059-1062"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311157","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":"Guides, algorithms and other support tools to improve neonatal and pediatric venous access care: A scoping review","authors":"Alina G. Burek MD,&nbsp;Katie Butler MD,&nbsp;Tracey Liljestrom MD,&nbsp;Erin Weber MSN, RN,&nbsp;Grayce Endres MSN, MBA, RN,&nbsp;Libby Stutzman MSN, RN,&nbsp;Kelsey Porada MA,&nbsp;Ahmed Mohammed,&nbsp;Hayley E. Severson MLIS,&nbsp;Kathryn E. Flynn PhD,&nbsp;Amanda Ullman RN, PhD,&nbsp;Mary Beth Hovda Davis RN, PhD","doi":"10.1002/jhm.70407","DOIUrl":"10.1002/jhm.70407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objective</h3>\u0000 \u0000 <p>Despite the ubiquitous need of venous access in children, care is often highly variable, lacking standardization. Our objective was to review current venous access guides, algorithms, and other tools available for clinical implementation; map out their focus (device type, population); and identify quality gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review with a systematic search of Ovid MEDLINE and other databases was completed on January 24, 2025. All study designs describing the development of venous access guides/algorithms/tools for patients aged &lt;18 years in the emergency department or inpatient units published after 2013 in English were included. Descriptive analysis was used to summarize the results. Quality of studies was assessed using the Appraisal of Guidelines for Research Evaluation (AGREE II) tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 105 studies included, 18% (<i>n</i> = 19) involved peripheral access, 66% (<i>n </i>= 69) involved central access, and 16% (<i>n</i> = 17) involved both. Neonates were the population of focus in half the publications (<i>n</i> = 52), and reduction in central line-associated bloodstream infections (CLABSI) was the primary aim of 56% (<i>n</i> = 59) of publications. Device selection and removal were two components of care with the lowest representation, particularly for peripheral access. Based on AGREE II scoring, 50% (<i>n</i> = 53) of identified guides/algorithms/tools were recommended for use. The lowest scoring quality domains were rigor of development and applicability, with 25% (<i>n</i> = 26) and 28% (<i>n</i> = 29) of studies, respectively, scoring in the lowest quintile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most venous access guides/algorithms/tools focus on CLABSI reduction and neonates, leaving gaps in guidance for other components of the care process and other populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 9","pages":"1035-1046"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665411","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}