Journal of hospital medicine最新文献

{"title":"Leadership & professional development: In the conflict zone: Practical steps for navigating clinician disagreement","authors":"Diana Mancini MD,&nbsp;Lawrence A. Haber MD","doi":"10.1002/jhm.70316","DOIUrl":"10.1002/jhm.70316","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 8","pages":"918-919"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725165","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 randomized trial of I-SLEEP: A patient education and empowerment intervention on inpatient sleep duration and medical sleep disruptions","authors":"Aashna Sunderrajan PhD,&nbsp;John Cursio PhD,&nbsp;Noah Mason MD,&nbsp;Maxx Byron BA,&nbsp;Maylyn Martinez MD, MSc,&nbsp;Nicola Orlov MD,&nbsp;Kristen L. Knutson PhD,&nbsp;Babak Mokhlesi MD, MSc,&nbsp;Valerie G. Press MD, MPH,&nbsp;David O. Meltzer MD, PhD,&nbsp;Vineet M. Arora MD, MAPP","doi":"10.1002/jhm.70273","DOIUrl":"10.1002/jhm.70273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sleep is essential for recovery in hospitalized patients, yet frequent disruptions from medical care make rest difficult. Most prior efforts have focused on environmental modifications, often overlooking patients' role in advocating for their sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study evaluated the effectiveness of the Inpatient Sleep Loss: Educating and Empowering Patients (I-SLEEP) intervention in improving sleep duration and reducing medical care disruptions among hospitalized patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center randomized controlled trial (NCT04151251), general medicine patients at the University of Chicago were randomized to either I-SLEEP (sleep education, advocacy questions, and a sleep kit) or standard care (sleep kit alone) between July 2019 and March 2023. The primary outcome was patient-reported sleep duration. Secondary outcomes included actigraphy-measured sleep duration and continuity (efficiency and wake after sleep onset), as well as patient-reported sleep disruptions. Mixed effects models adjusted for covariates were used for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 194 participants were enrolled. There were no significant differences in demographic characteristics between groups. Sleep duration and continuity did not differ significantly between groups. However, patients receiving I-SLEEP reported fewer disruptions from vital sign monitoring (63% vs. 75%, <i>p</i> = .004), medication administration (49% vs. 61%, <i>p</i> = .003), and laboratory draws (57% vs. 68%, <i>p</i> = .009). These findings remained significant after adjusting for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>I-SLEEP did not increase sleep duration or continuity but reduced medical care disruptions. These findings suggest that patient education and empowerment may be effective strategies for reducing preventable care-related sleep disruptions in hospitals. Further research should examine implementation at scale and potential long-term benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"881-889"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146128054","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":"Developing, designing, and delivering more effective research and didactic presentations: A primer and recommendations","authors":"Adin Nelson MD, MHPE,&nbsp;Audrea Burns PhD,&nbsp;Jon McGreevy MD, MSPH,&nbsp;Elizabeth E. Halvorson MD, MS,&nbsp;Michelle Kiger MD, PhD,&nbsp;Su-Ting T. Li MD, MPH,&nbsp;Rebecca Hart MD","doi":"10.1002/jhm.70330","DOIUrl":"10.1002/jhm.70330","url":null,"abstract":"<p>Hospitalists frequently present to large groups of people, even though most have never received any formal training on how to teach effectively. We share research, present cases, and teach students and residents, but we do it primarily by emulating our mentors and “learning by doing”. In this article, we present simple techniques drawn from the science of communication and learning that can enhance scholarly and educational presentations to help great clinicians become great educators as well.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"946-950"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694388","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 wait for “geripsych”: Prolonged boarding of older adults awaiting inpatient psychiatry","authors":"Danilo Rojas-Velasquez MD","doi":"10.1002/jhm.70326","DOIUrl":"10.1002/jhm.70326","url":null,"abstract":"<p>Prolonged boarding of older adults with neuropsychiatric illness has become a common, yet underrecognized, feature of contemporary mental health care delivery. I highlight the ways boarding functions as a de facto stage of care that impacts the system and hospitalists tasked with caring for these patients. Boarding reflects structural vulnerabilities around psychiatric capacity, long‑term care, and community services. Boarding time should be treated as a reportable safety metric, paired with unit‑level prevention and escalation pathways to guide hospital leaders, hospitalists, and regional planners.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"943-945"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793339","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":"Incidence, contributing factors, and predictors of diagnostic errors in medical inpatients: A retrospective cohort study","authors":"Caterina E. Marx MD,&nbsp;Elena Hofmann MD,&nbsp;Martin Perrig MD, MME,&nbsp;Gurpreet Dhaliwal MD,&nbsp;Wolf Hautz MD, MME,&nbsp;Jörg P. Isenegger MD,&nbsp;Ernst Lipp MD,&nbsp;Drahomir Aujesky MD, MSc,&nbsp;Manuel R. Blum MD, MSc,&nbsp;Tobias Tritschler MD, MSc","doi":"10.1002/jhm.70268","DOIUrl":"10.1002/jhm.70268","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diagnostic error is a major patient safety concern in hospitals, yet most studies have focused on selected high-risk subgroups, leaving the broader general internal medicine inpatient population understudied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the incidence, contributing factors, resulting harm, and predictors of diagnostic error in medical inpatients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included adults admitted to internal medicine between 01/2022 and 12/2022 at one tertiary and 4 secondary care hospitals in Switzerland. Retrieved admissions were randomly ordered, and electronic medical records were reviewed sequentially by two clinicians using standardized instruments, until reaching a pre-specified target threshold of 50 patients with ≥1 diagnostic error, enabling analysis of five predictors. The primary outcome was the occurrence of a diagnostic error. The secondary outcome was the resulting level of harm. Five pre-specified predictors were analyzed using multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 347 patients (median age 73 [interquartile range, 61–81] years; 140 [40.3%] female), 52 (15%; 95% confidence interval [CI], 11.6%–19.1%) experienced ≥1 diagnostic error, causing harm in 43/52 patients (82.7%; 95% CI 70.3%–90.6%). The most common contributing factors were failures to consider the correct diagnosis (40/52, 76.9%), order appropriate tests (31/52, 59.6%), and act on critical physical exam findings (30/52, 57.7%). Neurocognitive/psychiatric disorders (odds ratio [OR], 2.20; 95% CI, 1.20–4.10) and active cancer (OR, 2.10; 95% CI, 1.01–4.20) independently predicted diagnostic error.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Diagnostic error is common among adult medical inpatients and causes harm. We identified neurocognitive/psychiatric disorders and active cancer as patient-level predictors of diagnostic error, providing a basis for future studies on targeted interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"854-863"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145308","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 antibiotic use in community acquired pneumonia: A quality improvement initiative","authors":"Claire E. Ciarkowski MD,&nbsp;Karen Howard PharmD,&nbsp;Hannah Imlay MD, MSc,&nbsp;Chaorong Wu PhD,&nbsp;Christy L. Hopkins MD, MPH, MBA,&nbsp;Valerie M. Vaughn MD, MSc,&nbsp;Emily S. Spivak MD, MHS","doi":"10.1002/jhm.70283","DOIUrl":"10.1002/jhm.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence suggests a 3-day total duration and early transition to oral therapy is safe in hospitalized patients with community acquired pneumonia (CAP)—though such care is not standard in the United States. To implement these evidence-based practices, a multidisciplinary group led by a hospitalist and antimicrobial stewardship updated an order set targeted at non-intensive care unit (ICU) patients with CAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Here, we assess the impact of our intervention on diagnostic and antibiotic treatment measures and associated clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective, pre/post, observational quality improvement study of non-ICU inpatients with CAP admitted to a single academic medical center. The order set defaulted to 1 day of ceftriaxone without empiric atypical coverage for most patients, automatic de-escalation to oral amoxicillin on Day 2, a shortened total antibiotic duration of 3 days, and appropriate laboratory utilization. Primary outcomes were antibiotic duration and azithromycin use. Clinical outcomes were also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The pre (1/2019–12/2021, <i>n</i> = 777) and post (1/2022–12/2023, <i>n</i> = 1416) intervention periods were compared using generalized linear models and interrupted time series adjusted for known confounders. After implementation of the orderset, total antibiotic duration (6–5 days, adjusted rate ratio: 0.92, 95% confidence interval [CI]: 0.89–0.95, <i>p</i> &lt; 0.01) and azithromycin use (62.4% [485/777] to 39.4% [558/1416], adjusted odds ratio: 0.39, 95% CI: 0.33–0.47, <i>p</i> &lt; 0.01) were significantly lower. Clinical outcomes were not significantly different postintervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An order set backed by stewardship and hospitalists improves appropriate antibiotic use, showing that ongoing data-driven refinements can sustain stewardship and support the safety of shorter, narrower antibiotics for CAP in real-world care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"890-897"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159789","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":"Two lectures","authors":"Samir S. Shah MD, MSCE","doi":"10.1002/jhm.70382","DOIUrl":"10.1002/jhm.70382","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 8","pages":"843-844"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355029","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":"The silence that changed everything","authors":"Arfaa Ali MD","doi":"10.1002/jhm.70230","DOIUrl":"10.1002/jhm.70230","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 8","pages":"951-952"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447005","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":"Leveraging a clinical pharmacist as part of an interprofessional addiction medicine consult service: Supporting and spreading best practices","authors":"Honora Englander MD,&nbsp;Jackie Sharpe PharmD,&nbsp;Emily Skogrand PharmD","doi":"10.1002/jhm.70197","DOIUrl":"10.1002/jhm.70197","url":null,"abstract":"<p>Beginning in March 2023, we integrated a clinical pharmacist into our interprofessional addiction medicine consult service (ACS) to improve care at our hospital and expand substance use disorder best practices regionally. Here, we share experiences from our first 18 months, describing the ACS pharmacist role and highlighting advances at the level of pharmacy care, the hospital, and the region. The ACS pharmacist enriched ACS care quality; built and implemented order sets and workflows; educated the interdisciplinary workforce; and provided training and technical assistance across regional hospitals. Healthcare leaders should consider integrating ACS pharmacists to advance and spread hospital-based addiction care.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"953-959"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282311","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: Antibiotic duration for common infections in hospitalized adults","authors":"William Aaron Manning MD,&nbsp;Matthew Miller PharmD, BCIDP","doi":"10.1002/jhm.70218","DOIUrl":"10.1002/jhm.70218","url":null,"abstract":"<p>The evidence base supporting the effectiveness of shorter antibiotic courses for a variety of common infections has grown substantially, yet many implementation barriers remain. We examine recent data evaluating shorter antibiotic courses for bacteremia, community-acquired pneumonia, ventilator-associated pneumonia, and complicated urinary tract infections/pyelonephritis.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 8","pages":"924-927"},"PeriodicalIF":1.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357354","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}