Journal of hospital medicine最新文献

{"title":"Data to decisions: Enhancing mortality predictions as a step toward precision medicine","authors":"Michael Osnard MD, MS, MPH, Gregory W. Ruhnke MD, MS, MPH","doi":"10.1002/jhm.70038","DOIUrl":"10.1002/jhm.70038","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"901-902"},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813006","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":"Myriad erythematous skin lesions, paresthesia, and anterior uveitis in a 34-year-old man","authors":"Natasha Barton BS, BA,&nbsp;Kathryn Mulvaney NP,&nbsp;Elizabeth Stein MD,&nbsp;Kelsey Baab MD,&nbsp;Andrés Henao-Martínez MD, PhD,&nbsp;Joshua Wisell MD,&nbsp;Sabrina Newman MD","doi":"10.1002/jhm.70044","DOIUrl":"10.1002/jhm.70044","url":null,"abstract":"<p>A 34-year-old man recently immigrated from Guam to Colorado presented with a 3-year history of skin lesions and months of worsening eye irritation and vision loss. Examination revealed leonine facies, tender erythematous nodules, corneal neovascularization, and granulomatous anterior uveitis. Diagnosed with multibacillary leprosy complicated by erythema nodosum leprosum, he responded well to multidrug therapy and immunosuppressive treatment, with significant improvement in systemic symptoms, ocular inflammation, and skin lesions at follow-up.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"909-911"},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805148","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 guideline highlights for the hospitalist: Acute respiratory distress syndrome update","authors":"Divyajot Sadana MD,&nbsp;Shewit Giovanni MD, MS,&nbsp;Heather Torbic PharmD, FCCM, BCPS, BCCCP,&nbsp;Abhijit Duggal MD, MPH, MSc, FACP","doi":"10.1002/jhm.70040","DOIUrl":"10.1002/jhm.70040","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 7","pages":"733-735"},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797291","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":"Transition to oral beta-lactam therapy in uncomplicated gram-negative bacteremia: A systematic review and meta-analysis","authors":"Michael Dore MD,&nbsp;Ryan Duffy MD,&nbsp;Laura Caputo MD,&nbsp;Lily Huang MD,&nbsp;Salvatore Sidoti PhD,&nbsp;Sarah Cantrell MLIS,&nbsp;Blair Glasgo MD,&nbsp;Christa Kerbow MD","doi":"10.1002/jhm.70041","DOIUrl":"10.1002/jhm.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gram-negative bacteremia (GNB) is associated with significant morbidity and mortality. Transition to oral therapy has traditionally utilized fluoroquinolones or trimethoprim-sulfamethoxazole rather than beta-lactams due to concerns about pharmacokinetics and bioavailability despite a dearth of clinical data. The purpose of this meta-analysis is to evaluate the clinical efficacy of transition to oral beta-lactam therapy in uncomplicated GNB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a meta-analysis of published articles in MEDLINE, Embase, and Web of Science databases from inception to September 2024. Inclusion criteria included any study with adults (age &gt;18 years of age) with uncomplicated GNB from any source. Primary outcomes included 30-day all-cause mortality and 30-day antibiotic failure rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight retrospective cohort studies were reviewed comprising 7500 patients. Twice as many patients were in the fluoroquinolones/trimethoprim-sulfamethoxazole group compared with the beta-lactams group (4998 vs. 2482). Patients in each group had similar average age (70 vs. 71), percent male (54% vs. 56%), percent urinary source (78% vs. 80%), duration of IV antibiotics (4.2 vs. 4.5), Pitt bacteremia score (1.1 vs. 1.4) and Charleston comorbid index (2 vs. 2). There was no statistically significant difference in the 30-day all-cause mortality rate between the fluoroquinolones/trimethoprim-sulfamethoxazole and the beta-lactams group: 2.06% versus 1.89% with a weighted relative risk ratio of 1.24 (95% confidence interval [CI]: 0.86–1.77) or the 30-day antibiotic failure rate: 2.08% vs. 3.42%, weighted relative risk ratio of 1.29 (95% CI: 0.97–1.71).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is no statistically significant difference in 30-day mortality or antibiotic failure rates between BL and FQ/TMP-SMX as transition to oral therapy in treating uncomplicated GNB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 8","pages":"866-873"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782371","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":"Things We Do for No Reason™: Arterial blood gas testing to screen for hypercarbic respiratory failure","authors":"Mary E. Lacy MD,&nbsp;Lisa Saa MD,&nbsp;Zachary Bruss DO,&nbsp;Leonard Noronha MD","doi":"10.1002/jhm.70039","DOIUrl":"10.1002/jhm.70039","url":null,"abstract":"<p>Venous blood gases (VBGs) are safe and effective at screening for hypercarbic respiratory failure. Multiple studies have validated that a VBG with a PvCO₂ less than 45 reliably rules out hypercarbia. The use of VBGs for the initial screening of hypercarbia when hypercarbic respiratory failure is suspected can reduce the overall use of arterial blood gases which are more painful and take more time and expertise to perform.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"1002-1004"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782370","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":"BELIEVE in psychological safety: The Richmond way","authors":"Sanjay A. Patel MD, FACP, SFHM,&nbsp;Laura Paletta-Hobbs MD, FHM","doi":"10.1002/jhm.70048","DOIUrl":"10.1002/jhm.70048","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 7","pages":"731-732"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766224","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":"Paracentesis outcomes from a medicine procedure service at a tertiary care transplant center","authors":"Pete Meliagros MD, MS,&nbsp;Benjamin Chopski DO,&nbsp;Matthew Ambrosio MS,&nbsp;Stanley Liu MD,&nbsp;Somaya Albhaisi MBBCh, MPH,&nbsp;Lana Petrova BS,&nbsp;Evan Ritter MD,&nbsp;Adam Garber MD, FACP, SFHM","doi":"10.1002/jhm.70037","DOIUrl":"10.1002/jhm.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Paracentesis is a commonly performed procedure with overall low complication rates. There is a paucity of modern data investigating outcomes for inpatients using standardized point of care ultrasound.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to evaluate complication rates and outcomes of paracentesis in patients in the inpatient setting of a large tertiary transplantation center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified patients with ascites of multiple etiologies undergoing paracentesis by a medicine procedure service at a university center. Univariate and multivariate analyses were conducted to identify clinical and demographic factors associated with kidney injury (AKI) or significant HGB drop (≥2 g/dL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1746 patients, 12% of patients receiving small volume (≤5 L) and 10% receiving large volume paracentesis (&gt;5 L) developed a post procedural AKI (OR 0.857, 95% CI: 0.633–1.154) with no significant difference between groups (<i>p</i> = .30). In multivariable analysis, Model for End-Stage Liver Disease Sodium (MELD-Na) score as a continuous variable had a more significant impact in the development of AKI (OR 1.15 CI 1.08–1.22, <i>p</i> &lt; .001) as well as patients who were noted to be receiving paracentesis due to clinical deterioration (OR 2.48 CI 1.08–5.7, <i>p</i> &lt; .03). Of 2034 patients, 94% of patients had no significant drop in hemoglobin (&lt;2 g/dL). There was no significant difference in BMI (12.73 vs. 16.68, <i>p</i> = .6), INR (1.6 vs. 1.6, <i>p</i> = .8), or platelet count (114 vs. 106, <i>p</i> &gt; .9) between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regardless of volume of ascites removed, paracentesis is associated with a low risk of AKI, however there was an increased risk in the clinically decompensating patient. The bleeding risk was also found to be low when performed by experienced proceduralists on a procedure service.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"943-952"},"PeriodicalIF":2.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733778","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":"Association of acamprosate versus gabapentinoids with hospitalization and total mortality in alcohol use disorder","authors":"Raj Shah MD,&nbsp;Kirsten A. Zelneronok PharmD,&nbsp;Richard Henriquez MD,&nbsp;Ishak A. Mansi MD","doi":"10.1002/jhm.70033","DOIUrl":"10.1002/jhm.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Importance</h3>\u0000 \u0000 <p>Alcohol use disorder (AUD) significantly increases hospitalizations and death. US Food and Drug Administration (FDA)-approved medications for AUD are underutilized. Gabapentinoids are not FDA-approved for AUD but are frequently prescribed by physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association of acamprosate and gabapentinoids on healthcare utilization and total mortality in patients with AUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two propensity score (PS)-matched retrospective cohort studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Veterans diagnosed with AUD (years 2003–2021) initiating acamprosate or gabapentinoids in an AUD-related encounter and not on chronic opioid therapy (AUD-cohort). Another PS-cohort of veterans who were hospitalized for AUD diagnoses (AUD-admission cohort). Subgroup analysis included people with chronic obstructive lung diseases, opioid use, and age categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>Co-primary outcomes were admission for alcohol withdrawal (AW-admission) and annual rate of acute care events. Secondary outcome was total mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We matched 16,072 pairs of acamprosate and gabapentinoid users in AUD-cohort. AW-admission occurred in 35.4% of the acamprosate users and 30.0% of the gabapentinoid users (odds ratio [OR]: 1.28, 95% confidence interval [95% CI]: 1.22–1.34). Annual rate of acute care events in acamprosate and gabapentinoid users were 1.84 and 1.64, respectively (coefficient of regression [<i>β</i>]: 0.20, 95% CI: 0.12–0.28). There was no difference in total mortality (hazard ratio: 0.96, 95% CI: 0.91–1.005). In subgroup analysis, acamprosate use was associated with less total mortality in subgroups of people using opioids and older than 60 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gabapentinoids are associated with reduced AW-admission and lower annual rates of acute care events compared to acamprosate. Gabapentinoids may offer a viable alternative for AUD in carefully selected populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"919-934"},"PeriodicalIF":2.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733776","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":"Things We Do for No Reason™: Failing to consider primary aldosteronism in the initial evaluation of hypertension, hypertensive urgency, and hypertensive emergency","authors":"Michael C. Shih MD,&nbsp;Tessa R. Lavorgna BS,&nbsp;Prerna Dogra MBBS, FACP,&nbsp;Christina N. Hirner MD,&nbsp;Kristen Payne MD","doi":"10.1002/jhm.70035","DOIUrl":"10.1002/jhm.70035","url":null,"abstract":"<p>Hypertension is frequently treated as essential hypertension. However, secondary causes of hypertension should be considered, because distinct treatments are used for different causes of hypertension. Primary aldosteronism is considered a candidate for the most common cause of secondary hypertension. Despite the effects of many antihypertensive agents on the renin–angiotensin–aldosterone system, ongoing efforts to manage hypertension should not be discontinued solely for the purposes of screening. If a patient presents with new or untreated hypertension, screening should be considered before starting antihypertensive agents that could affect the renin–angiotensin–aldosterone system.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"998-1001"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672133","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":"Systematic in-hospital screening and treatment for osteoporosis in a geriatric population with hip fractures","authors":"Jeppe B. Rosenbæk PhD,&nbsp;Line B. Dalgaard PhD,&nbsp;Anne Grauballe MD,&nbsp;Stella J. Wilfred MD,&nbsp;Mikkel W. Ibsen MD,&nbsp;Lene R. Madsen PhD","doi":"10.1002/jhm.70036","DOIUrl":"10.1002/jhm.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low-trauma fractures of the hip signify osteoporosis and increase the risk of a second fracture. However, screening for secondary osteoporosis and initiating osteoporosis treatment can be challenging in a geriatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate an in-hospital approach to secure treatment, screening and follow-up of osteoporosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated the feasibility of a clinical approach to osteoporosis treatment with in-hospital zoledronic acid (ZOL) infusion, screening for secondary osteoporosis, and dual-energy X-ray absorptiometry (DXA) with a vertebral fracture assessment (VFA) in a cohort of 128 patients. We compared this cohort to a historic cohort of 135 patients, where screening and treatment were provided by general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the intervention cohort, 58% of the patients received anti-osteoporosis treatment within 6 months of admission. Forty-eight patients (38%) received ZOL during admission, while nine continued their usual treatment. An additional 17 patients received ZOL or another anti-osteoporosis treatment within 6 months. The most common reasons for <i>not</i> receiving ZOL were vitamin D deficiency (24%) and renal impairment (7%). In total, 35% (<i>n</i> = 43) had a DXA within 6 months of admission; VFA revealed nine cases of vertebral fractures. Screening for secondary osteoporosis revealed vitamin D deficiency with and without secondary hyperparathyroidism (48%) and subclinical hyperthyroidism (8%) as the most common findings. Together, biochemical screening and VFA changed the treatment strategy in less than five cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Administering ZOL in-hospital following a hip fracture in combination with a systematic follow-up secured treatment in 6 out of 10 patients. However, compliance with DXA was low, which might not be of major concern, since DXA only individualized treatment in a few patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 9","pages":"935-942"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://shmpublications.onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672129","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}