Journal of hospital medicine最新文献_第2页

Paracentesis outcomes from a medicine procedure service at a tertiary care transplant center. 一家三级医疗移植中心的药物手术服务的腹腔穿刺结果。

Journal of hospital medicine Pub Date : 2025-03-27 DOI: 10.1002/jhm.70037

Pete Meliagros, Benjamin Chopski, Matthew Ambrosio, Stanley Liu, Somaya Albhaisi, Lana Petrova, Evan Ritter, Adam Garber

{"title":"Paracentesis outcomes from a medicine procedure service at a tertiary care transplant center.","authors":"Pete Meliagros, Benjamin Chopski, Matthew Ambrosio, Stanley Liu, Somaya Albhaisi, Lana Petrova, Evan Ritter, Adam Garber","doi":"10.1002/jhm.70037","DOIUrl":"https://doi.org/10.1002/jhm.70037","url":null,"abstract":"Background: 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.Objectives: We aimed to evaluate complication rates and outcomes of paracentesis in patients in the inpatient setting of a large tertiary transplantation center.Methods: 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).Results: Of 1746 patients, 12% of patients receiving small volume (≤5 L) and 10% receiving large volume paracentesis (>5 L) developed a post procedural AKI (OR 0.857, 95% CI: 0.633-1.154) with no significant difference between groups (p = .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, p < .001) as well as patients who were noted to be receiving paracentesis due to clinical deterioration (OR 2.48 CI 1.08-5.7, p < .03). Of 2034 patients, 94% of patients had no significant drop in hemoglobin (<2 g/dL). There was no significant difference in BMI (12.73 vs. 16.68, p = .6), INR (1.6 vs. 1.6, p = .8), or platelet count (114 vs. 106, p > .9) between groups.Conclusion: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of acamprosate versus gabapentinoids with hospitalization and total mortality in alcohol use disorder. 阿坎酸与加巴喷丁与酒精使用障碍患者住院治疗和总死亡率的关系。

Journal of hospital medicine Pub Date : 2025-03-27 DOI: 10.1002/jhm.70033

Raj Shah, Kirsten A Zelneronok, Richard Henriquez, Ishak A Mansi

{"title":"Association of acamprosate versus gabapentinoids with hospitalization and total mortality in alcohol use disorder.","authors":"Raj Shah, Kirsten A Zelneronok, Richard Henriquez, Ishak A Mansi","doi":"10.1002/jhm.70033","DOIUrl":"https://doi.org/10.1002/jhm.70033","url":null,"abstract":"Importance: 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.Objective: To examine the association of acamprosate and gabapentinoids on healthcare utilization and total mortality in patients with AUD.Methods: Two propensity score (PS)-matched retrospective cohort studies.Participants: 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.Main outcomes: Co-primary outcomes were admission for alcohol withdrawal (AW-admission) and annual rate of acute care events. Secondary outcome was total mortality.Results: 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 [β]: 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.Conclusion: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Systematic in-hospital screening and treatment for osteoporosis in a geriatric population with hip fractures. 老年髋部骨折患者骨质疏松症的系统院内筛查和治疗。

Journal of hospital medicine Pub Date : 2025-03-20 DOI: 10.1002/jhm.70036

Jeppe B Rosenbæk, Line B Dalgaard, Anne Grauballe, Stella J Wilfred, Mikkel W Ibsen, Lene R Madsen

{"title":"Systematic in-hospital screening and treatment for osteoporosis in a geriatric population with hip fractures.","authors":"Jeppe B Rosenbæk, Line B Dalgaard, Anne Grauballe, Stella J Wilfred, Mikkel W Ibsen, Lene R Madsen","doi":"10.1002/jhm.70036","DOIUrl":"https://doi.org/10.1002/jhm.70036","url":null,"abstract":"Background: 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.Objectives: To investigate an in-hospital approach to secure treatment, screening and follow-up of osteoporosis.Methods: 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.Results: 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 not receiving ZOL were vitamin D deficiency (24%) and renal impairment (7%). In total, 35% (n = 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.Conclusion: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Things We Do for No Reason: Failing to consider primary aldosteronism in the initial evaluation of hypertension, hypertensive urgency, and hypertensive emergency. 我们无缘无故做的事情：在高血压、高血压急症和高血压急症的初步评估中未能考虑原发性醛固酮增多症。

Journal of hospital medicine Pub Date : 2025-03-20 DOI: 10.1002/jhm.70035

Michael C Shih, Tessa R Lavorgna, Prerna Dogra, Christina N Hirner, Kristen Payne

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That's usually what happens… I think. 我想通常都是这样。

Journal of hospital medicine Pub Date : 2025-03-20 DOI: 10.1002/jhm.70034

Shamini Selvakumar, Andrew P J Olson

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Tophaceous gout. Tophaceous痛风。

Journal of hospital medicine Pub Date : 2025-03-18 DOI: 10.1002/jhm.70032

Tyler B Larsen, Michael E Lazarus

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Chocolate brown ascites. 巧克力棕色腹水。

Journal of hospital medicine Pub Date : 2025-03-18 DOI: 10.1002/jhm.70017

Manpreet S Malik, TaRessa K Wills

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Evaluating the evaluation: A qualitative analysis to understand faculty evaluation programs in hospital medicine. 评价评价：以定性分析了解医院医学教师评价项目。

Journal of hospital medicine Pub Date : 2025-03-18 DOI: 10.1002/jhm.70028

Anupama Goyal, Shrestha Sachita, David Bozaan, Trevor Denton, Stephanie Taylor

{"title":"Evaluating the evaluation: A qualitative analysis to understand faculty evaluation programs in hospital medicine.","authors":"Anupama Goyal, Shrestha Sachita, David Bozaan, Trevor Denton, Stephanie Taylor","doi":"10.1002/jhm.70028","DOIUrl":"https://doi.org/10.1002/jhm.70028","url":null,"abstract":"Little is known about the structure and desired outcomes of hospitalist performance evaluations at academic medical centers. We conducted a multicenter open-ended survey study with theory-guided qualitative analysis to summarize essential components and key outcomes for successful hospital medicine (HM) faculty evaluation programs. Twenty-two of 107 (20.6%) HM leaders responded to the survey. Frequently identified inputs were human, organizational, and financial resources. The main areas of evaluation were clinical performance and teaching. Performance evaluation or self-assessment forms were the most often utilized evaluation tools. Half of the respondents highlighted faculty appreciation as a main output of the evaluation. Important faculty-level outcomes were academic promotion, while retention and faculty engagement were salient organizational outcomes. Our multi-site study identified important pathways that shape the implementation and maintenance of successful HM faculty evaluation processes. These findings provide a strategic framework for evaluating and refining faculty evaluation programs over time.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coming back to our senses! 我们又清醒过来了！

Journal of hospital medicine Pub Date : 2025-03-17 DOI: 10.1002/jhm.70029

Lauren D Spaeth, Bruno Álvarez Concejo

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Clinical guideline highlights for the hospitalist: Management of Helicobacter pylori infection in children and adolescents. 医院医生的临床指南重点：儿童和青少年幽门螺杆菌感染的管理。

Journal of hospital medicine Pub Date : 2025-03-17 DOI: 10.1002/jhm.70030

Marisa Román, Michelle W Parker

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