Journal of hospital medicine最新文献_第9页

Myriad erythematous skin lesions, paresthesia, and anterior uveitis in a 34-year-old man. 一例34岁男性的皮肤红斑、感觉异常和前葡萄膜炎。

Journal of hospital medicine Pub Date : 2025-04-07 DOI: 10.1002/jhm.70044

Natasha Barton, Kathryn Mulvaney, Elizabeth Stein, Kelsey Baab, Andrés Henao-Martínez, Joshua Wissell, Sabrina Newman

引用次数: 0

Searching for the right balance: Leveraging the EHR to define hospitalist workload and optimize hospital throughput. 寻找适当的平衡：利用电子病历来定义医院医生的工作量并优化医院吞吐量。

Journal of hospital medicine Pub Date : 2025-04-06 DOI: 10.1002/jhm.70055

Ali Yazdanyar, Priya A Prasad

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Transition to oral beta-lactam therapy in uncomplicated gram-negative bacteremia: A systematic review and meta-analysis. 过渡到口服β -内酰胺治疗无并发症革兰氏阴性菌血症：系统回顾和荟萃分析。

Journal of hospital medicine Pub Date : 2025-04-04 DOI: 10.1002/jhm.70041

Michael Dore, Ryan Duffy, Laura Caputo, Lily Huang, Salvatore Sidoti, Sarah Cantrell, Blair Glasgo, Christa Kerbow

{"title":"Transition to oral beta-lactam therapy in uncomplicated gram-negative bacteremia: A systematic review and meta-analysis.","authors":"Michael Dore, Ryan Duffy, Laura Caputo, Lily Huang, Salvatore Sidoti, Sarah Cantrell, Blair Glasgo, Christa Kerbow","doi":"10.1002/jhm.70041","DOIUrl":"https://doi.org/10.1002/jhm.70041","url":null,"abstract":"Introduction: 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.Methods: 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 >18 years of age) with uncomplicated GNB from any source. Primary outcomes included 30-day all-cause mortality and 30-day antibiotic failure rate.Results: 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).Conclusions: 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.","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"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":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™: Arterial blood gas testing to screen for hypercarbic respiratory failure. 我们做的事情没有理由™：动脉血气测试筛选高碳呼吸衰竭。

Journal of hospital medicine Pub Date : 2025-04-04 DOI: 10.1002/jhm.70039

Mary E Lacy, Lisa Saa, Zachary Bruss, Leonard Noronha

引用次数: 0

The future of Pediatric Hospital Medicine fellowships: Balancing fellows' expectations with employment realities. 儿科医院医学奖学金的未来：平衡研究员的期望与就业现实。

Journal of hospital medicine Pub Date : 2025-04-02 DOI: 10.1002/jhm.70046

Rachita Gupta, Jennifer Baird

引用次数: 0

The loneliness of overnight delirium. 一夜谵妄的孤独。

Journal of hospital medicine Pub Date : 2025-03-30 DOI: 10.1002/jhm.70043

Joseph S Thomas

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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

引用次数: 0