Journal of hospital medicine最新文献

{"title":"BEDSIDE2-R: A framework for team-based, patient-centered bedside rounds","authors":"Ryan E. Nelson MD, FHM, FACP, Zahir Kanjee MD, MPH, Jason Freed MD, Catherine J. Cichon MD, MPH, Daniel N. Ricotta MD","doi":"10.1002/jhm.13481","DOIUrl":"10.1002/jhm.13481","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 2","pages":"200-204"},"PeriodicalIF":2.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141895101","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":"Antibiotic Diversity Index: A novel metric to assess antibiotic variation among hospitalized children","authors":"Jessica L. Markham MD, MSc,&nbsp;Matt Hall PhD,&nbsp;Samir S. Shah MD, MSCE,&nbsp;Alaina Burns PharmD, BCPPS,&nbsp;Jennifer L. Goldman MD, MSCR","doi":"10.1002/jhm.13470","DOIUrl":"10.1002/jhm.13470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite nationally endorsed treatment guidelines and stewardship programs, variation and deviation from evidence-based antibiotic prescribing occur, contributing to inappropriate use and medication-related adverse events. Measures of antibiotic prescribing variability can aid in quantifying this problem but are not adequate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to develop a standardized metric to quantify antibiotic prescribing variability (diversity) within and across children's hospitals, and to examine its association with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional study of empiric antibiotic exposure among children hospitalized during 2017–2019 with one of 15 common pediatric infections using the Pediatric Health Information System database. Encounters for children with complex chronic conditions, transfers in, and birth hospitalizations were excluded. Using the Shannon–Weiner entropy index, we quantified antibiotic diversity for each infection type using the <span>d</span>-measure of diversity. Generalized linear mixed-effects models were used to examine the association between hospital-level antibiotic diversity and risk-adjusted length of stay and costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 79,515 hospitalizations for common pediatric infections were included. Antibiotic diversity varied within and across hospitals. Infections with low mean antibiotic diversity included appendicitis (mean diversity [mDiv] = 4.9, SD = 2.5) and deep neck space infections (mDiv = 5.9, SD = 1.9). Infections with high mean antibiotic diversity included pneumonia (mDiv = 23.4, SD = 5.6) and septicemia/bacteremia (mDiv = 28.5, SD = 12.1). There was no statistically significant association between hospital-level antibiotic diversity and risk-adjusted LOS or costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed and applied a novel metric to quantify diversity in antibiotic prescribing that permits comparisons across hospitals and can be leveraged to identify high-priority areas for local and national stewardship interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"8-16"},"PeriodicalIF":2.4,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891397","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":"Point-of-care ultrasound in skin and soft tissue infections","authors":"Bryan M. Koppa MD,&nbsp;Christopher T. Kelly MD","doi":"10.1002/jhm.13467","DOIUrl":"10.1002/jhm.13467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Skin and soft tissue infections (SSTIs) are commonly encountered in clinical practice. Point-of-care ultrasound (POCUS) is becoming an increasingly valuable tool in hospital medicine, especially with advancements in ultrasound technology that make it easier to perform. POCUS can augment the history and physical exam in patients with suspected SSTIs. POCUS can detect deeper infections, such as abscesses, and expedite time to surgical debridement for life-threatening infections such as necrotizing fasciitis (NF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This review provides an introduction on how to perform and interpret a skin and soft tissue POCUS exam, the key sonographic findings for SSTIs, and how to incorporate these findings into clinical reasoning and management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>SSTI POCUS literature was reviewed using PubMed. All relevant studies with a defined protocol and reported sensitivity and specificity pertaining to the use of POCUS to diagnose SSTIs in adults were included. The authors provide additional input based on their ultrasound expertise and clinical experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of seven studies met the criteria to be included in this review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Soft tissue POCUS is a valuable tool for hospitalists to improve diagnostic accuracy and patient care when assessing suspected SSTIs. Access to equipment, POCUS training, and experience are barriers to widespread use. However, performing a soft tissue POCUS exam is straightforward. It requires less training compared to other POCUS exams, and it has notable potential for routine future practice in the evaluation and management of suspected SSTIs and other dermatologic conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 10","pages":"938-944"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857493","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":"Stigmatizing and affirming provider language in medical records on hospitalized patients with opioid use disorder","authors":"Rachel Hirshman MSW, LCSW-A,&nbsp;Shavone Hamilton PhD, LCSW,&nbsp;Melissa Walker MSW, LCSW,&nbsp;Alan R. Ellis PhD, MSW,&nbsp;Noel Ivey MD,&nbsp;Dana Clifton MD","doi":"10.1002/jhm.13472","DOIUrl":"10.1002/jhm.13472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stigma within the healthcare environment limits access to treatment for opioid use disorder (OUD), even as OUD results in significant morbidity and mortality. Language in clinical documentation affects patient experience and future care through the transmission of stigma or positive regard. With the passage of the 21st Century Cures Act, patients have full access to their medical records online.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of our study was to understand providers' use of stigmatizing and affirming language in the electronic health record (EHR) for OUD patients with long hospital stays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We selected patients with a first-time referral to the Duke University Hospital OUD consult service who met diagnostic criteria for OUD with a hospital stay ≥28 days from July 2019 to February 2022. Two reviewers independently evaluated each admission and discharge note for stigmatizing or affirming language and the group met weekly to validate coding reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight patients (96 notes) met our inclusion criteria. We identified 434 occurrences of stigmatizing and 47 occurrences of affirming language. One-third (34%) of stigmatizing language appeared in system-generated fields (drop-down categories and diagnosis codes) and the rest was authored by providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stigmatizing language was present in both provider- and system-generated language and was nine times more frequent than affirming language in the medical records of hospitalized patients with OUD. While provider education may reduce stigmatizing language, institutional level changes to the EHR and International Classification of Disease codes are necessary to decrease stigmatizing language within medical records.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"26-32"},"PeriodicalIF":2.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857494","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 beginner's guide to manuscript publication: How to launch your academic manuscript","authors":"Rachel Peterson MD,&nbsp;Ajay Bhasin MD,&nbsp;Charlie M. Wray DO, MS,&nbsp;Samir S. Shah MD, MSCE,&nbsp;Gregory W. Ruhnke MD, MS, MPH","doi":"10.1002/jhm.13461","DOIUrl":"10.1002/jhm.13461","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 10","pages":"953-956"},"PeriodicalIF":2.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857492","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: The tension in transition: Moving from trainee to hospitalist","authors":"Whitney Cameron DO, MSc, MSCTR,&nbsp;Daniel Herchline MD, MSEd","doi":"10.1002/jhm.13465","DOIUrl":"10.1002/jhm.13465","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 11","pages":"1035-1036"},"PeriodicalIF":2.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794432","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":"Clinical progress note: Steroids in severe community-acquired pneumonia","authors":"Madison Hibshman MD,&nbsp;Mel L. Anderson MD","doi":"10.1002/jhm.13473","DOIUrl":"10.1002/jhm.13473","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"58-61"},"PeriodicalIF":2.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794431","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 impact of Medicaid expansion on hospital readmission rates: Too small an effect, or big sigh of relief?","authors":"V. Ram Krishnamoorthi MD, MPH,&nbsp;Harold A. Pollack PhD","doi":"10.1002/jhm.13476","DOIUrl":"10.1002/jhm.13476","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1201-1202"},"PeriodicalIF":2.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794434","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":"Patient and care team perspectives on an app to support Hospital at Home admission decision making","authors":"Justin Kramer PhD, MAT,&nbsp;Marc Kowalkowski PhD,&nbsp;Kelly Reeves MSN,&nbsp;Tara Eaton PhD,&nbsp;Shih-Hsiung Chou PhD,&nbsp;Stephanie Murphy DO,&nbsp;Colleen Hole BSN, MHA,&nbsp;Asha Ganesan PhD,&nbsp;Andrew McWilliams MD, MPH","doi":"10.1002/jhm.13475","DOIUrl":"10.1002/jhm.13475","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital at Home (HaH) programs are used throughout the United States and are beneficial in both providing patients care in environments most comfortable to them and freeing up inpatient beds. Better informing patients about HaH programs, while promoting shared decision-making (SDM), should be prioritized by health systems. SDM apps may promote increased patient agency and understanding of complex HaH care decisions. We previously developed, usability tested, and refined a HaH SDM app.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the utility of SDM apps in assisting pneumonia patients with HaH admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Usability surveys (<i>N</i> = 16) and semistructured interviews with patients (<i>N</i> = 9) and nurse navigators (<i>N</i> = 3) were utilized to evaluate our app in assisting pneumonia patients as they contemplated HaH admission. Recruitment occurred at three hospitals in the southeastern United States. Surveys were analyzed consistent with their validated measures, while interviews were analyzed using inductive coding methodologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients supported receiving HaH information via an app, with many noting that presenting content via multiple modalities (e.g., videos, pictures, text) was helpful and that the app assisted their care decision. App-guided inquiries into patients' care preferences helped patients visualize their priorities and promoted feelings of agency, while providing important information to care teams. Participants found visuals effective at conveying program details, for example, HaH's in-home setup, which may assist with health literacy challenges. Potential barriers included the need to expand app accessibility for vision impaired and non-English speaking patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SDM apps may better inform patients' HaH care decisions, allowing patients self-directed access to information and engagement with visual content, which may address challenges related to health literacy and navigating complex, time-sensitive decisions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 1","pages":"42-50"},"PeriodicalIF":2.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794433","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":"Validity of different algorithmic methods to identify hospital readmissions from routinely coded medical data","authors":"Michael M. Havranek MD, PhD,&nbsp;Yuliya Dahlem MD, PhD,&nbsp;Selina Bilger MSc,&nbsp;Florian Rüter MD,&nbsp;Daniela Ehbrecht MD,&nbsp;Leonel Oliveira MSc,&nbsp;Rudolf M. Moos MD,&nbsp;Christian Westerhoff MD,&nbsp;Armin Gemperli PhD,&nbsp;Thomas Beck MD","doi":"10.1002/jhm.13468","DOIUrl":"10.1002/jhm.13468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospital readmission rates are used for quality and pay-for-performance initiatives. To identify readmissions from administrative data, two commonly employed methods are focusing either on unplanned readmissions (used by the Centers for Medicare &amp; Medicaid Services, CMS) or potentially avoidable readmissions (used by commercial vendors such as SQLape or 3 M). However, it is not known which of these methods has higher criterion validity and can more accurately identify actually avoidable readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A manual record review based on data from seven hospitals was used to compare the validity of the methods by CMS and SQLape.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven independent reviewers reviewed 738 single inpatient stays. The sensitivity, specificity, positive predictive value (PPV), and F1 score were examined to characterize the ability of an original CMS method, an adapted version of the CMS method, and the SQLape method to identify unplanned, potentially avoidable, and actually avoidable readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both versions of the CMS method had greater sensitivity (92/86% vs. 62%) and a higher PPV (84/91% vs. 71%) than the SQLape method, in terms of identifying their outcomes of interest (unplanned vs. potentially avoidable readmissions, respectively). To distinguish actually avoidable readmissions, the two versions of the CMS method again displayed higher sensitivity (90/85% vs. 66%), although the PPV did not differ significantly between the different methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Thus, the CMS method has both higher criterion validity and greater sensitivity for identifying actually avoidable readmissions, compared with the SQLape method. Consequently, the CMS method should primarily be used for quality initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1147-1154"},"PeriodicalIF":2.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763609","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}