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Cellulitis is Frequently Misdiagnosed
Clinical question: How accurate is the initial diagnosis of cellulitis in adult patients compared to subsequent specialist consultation? Dr. Lessing Background: Diagnosis of cellulitis leads to an estimated 650,000 hospital admissions annually. As a clinical diagnosis—with no definitive confirmatory laboratory, microbiologic, or imaging result—cellulitis is frequently misdiagnosed, leading to diagnostic delay, as well as unnecessary cost, antibiotics, and hospitalization. The authors sought to determine how often the initial diagnosis of cellulitis might be incorrect when compared to subsequent specialist reviews as ...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research

PE Presents in 1/3 of Patients with Recent Onset of Exertional Dyspnea
Clinical question: What is the prevalence of pulmonary embolism (PE) among emergency department (ED) patients with recent onset (less than one month) of exertional dyspnea? Dr. Chockalingam Background: PE is often associated with the diagnostic triad of pleuritic chest pain, dyspnea, and occasional hemoptysis. Non-specific symptoms, such as subacute dyspnea on exertion, may delay the diagnosis of PE. Despite the plausibility of PE presenting with dyspnea on exertion with or without other symptoms, no prior studies have established the rate of PE among patients with recent-onset exertional dyspnea. Guidelines and pretes...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Pulmonary Infections Source Type: research

Anticoagulation for AFib Increases Bleeding Risk and Death in Patients Over 65 with Cognitive Impairment
Clinical question: In older patients with atrial fibrillation (AFib), does frailty or cognitive function affect the risk of anticoagulation use? Dr. Enix Background: In older patients with AFib, both the risk of stroke and the use of preventative anticoagulation are common. However, the impact of cognitive impairment and frailty on the risks of anticoagulation use in older patients with AFib is unknown. Study design: Observational prospective cohort study Setting: Seven ambulatory cardiology and internal medicine centers in Massachusetts and Georgia, between 2016 and 2018 Synopsis: 1,244 patients 65 years and older (aver...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research

Administering Glucocorticoids Lowers Risk of Death in ICU Patients with Severe CAP
Clinical question: Does early administration of glucocorticoids to intensive care unit (ICU) patients with severe community-acquired pneumonia (CAP) reduce mortality? Ms. Harakal Background: Previous, randomized, controlled trials have shown efficacy in using glucocorticoids in CAP treatment as far as clinical stabilization and reduction in length of stay. However, there is no substantial evidence regarding a reduction in mortality due to the use of glucocorticoids. Study design: Double-blind, randomized, placebo-controlled trial Setting: 31 French ICUs Synopsis: The study randomized 795 ICU patients with severe CAP to c...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research

Gaps Remain in Hospital Discharge Education
Clinical question: What are medicine floor patients told about their hospital discharge instructions and by whom? Dr. Mutter Background studies: Prior studies have demonstrated suboptimal communication with patients about discharge plans of care, leading to preventable harm. In addition, a lack of clarity exists among team members about the responsibility of discharge communication. Study design: Observational quality improvement study Setting: Internal medicine services at two urban, tertiary-care teaching hospitals Synopsis: A trained observer observed the communication of 33 medicine patients and their providers on th...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Patient Care Quality Improvement Source Type: research

Systemic Corticosteroids for Patients with Severe CAP
Clinical question: Among patients hospitalized with community-acquired pneumonia (CAP), does the addition of corticosteroids reduce mortality? Dr. Salline Background: Corticosteroids are used as an adjunctive treatment in infections like bacterial meningitis and COVID-19-related pneumonia. Previous trials and meta-analyses have been mixed in their findings of whether mortality and clinical outcomes are improved with the addition of steroids to standard antibiotic therapy for the treatment of CAP. Study design: Systematic review and meta-analysis of randomized controlled trials Setting: The included studies were conducted...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research

Transcatheter Arterialization Provides Safe and Effective Treatment for No-option CLI
Clinical question: Is transcatheter arterialization of lower extremity deep veins safe and effective in preventing above-ankle amputation in patients with advanced chronic limb ischemia (CLI) who are otherwise not candidates for arterial revascularization? Ms.Sanford Background: About 20% of patients with CLI are not candidates for arterial revascularization (“no-option”) due to insufficient distal arterial target vessels, and have low amputation-free survival (42%). Transcatheter arterialization of deep veins involves percutaneous creation of an arteriovenous fistula using a stent to connect the tibial artery to an ...
Source: The Hospitalist - December 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Vascular Source Type: research

Annals for Hospitalists - November 2023
Ann Intern Med. 2023 Nov;176(11):eAWHO202311210. doi: 10.7326/AWHO202311210.NO ABSTRACTPMID:37983787 | DOI:10.7326/AWHO202311210 (Source: Annals of Internal Medicine)
Source: Annals of Internal Medicine - November 20, 2023 Category: Internal Medicine Authors: David A Fried Source Type: research

Movers and Shakers November 2023
Dr. Davidyock John Davidyock, MD, FACP, SFHM, has been named senior vice president and chief physician executive at UF Health Central Florida, Leesburg, Fla. Most recently he served as vice president and chief medical officer for the Polk region at Baycare Health System, Winter Haven, Fla. He was also on the faculty at Temple University Medical School in Philadelphia and the Penn State Milton S. Hershey Medical Center, in Hershey, Pa. Dr. Davidyock earned his medical degree from MCP Hahnemann University, Philadelphia, and completed his residency in internal medicine at Lehigh Valley Hospital, Allentown, Pa. Gurpreet Dha...
Source: The Hospitalist - November 16, 2023 Category: Hospital Management Authors: Lisa Casinger Tags: Career People in HM Source Type: research