Shared Experiences Make Us Stronger Together
Dr. Kris Rehm, outgoing SHM president, and Dr. Rachel Thompson, immediate past president, continued The Prez Room series of discussions with members.
As I reflect on our time this year, I want to highlight a few experiences and moments that embody why I’m so grateful to have served as president of our society—some of which, I hope, you’ve shared with me. Since last year’s SHM Converge in Austin, Texas, the SHM staff and Board of Directors have worked to advance the mission, vision, and goals that we shared last year. This has provided us with a clear focus on areas where we should remain engaged and others where w...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Leadership Source Type: research
Coding Corner: A Critical Opportunity
A 17-year-old with a history of major depressive disorder who is new to the hospitalist service is being transferred out of the pediatric intensive care unit (PICU) after an intentional Benadryl overdose in a suicide attempt.
You review her labs from this morning showing that her electrolytes are normal. You review her pregnancy test and urine drug screen which are both negative. You review the nursing note from this morning which states she is alert, oriented, and calm and her parents are at the bedside. You interpret her electrocardiogram (EKG) tracing and calculate her QTc to be back to normal at 420.
She remains active...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine Clinical Guidelines Coding Source Type: research
Torsemide or Furosemide After Discharge in Patients Hospitalized with HF
Clinical question: Is there a mortality difference in patients discharged on torsemide versus furosemide after heart failure hospitalization?
Background: Torsemide has been thought to be superior to furosemide in patients with congestive heart failure (CHF), but no high-quality, randomized, controlled, trial data were available comparing different loop diuretics in patients with CHF and looking at all-cause mortality until the TRANSFORM-HF trial.
Study design: Open-label, pragmatic, randomized, controlled trial
Setting: 60 U.S. hospitals
Synopsis: 2,859 patients with a median age of 65 years randomized to torsemide (1,431)...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Semaglutide in Patients with HFpEF and Obesity
Clinical question: Does treatment with semaglutide lead to a reduction in symptoms and physical limitations and improve exercise function in patients with heart failure with preserved ejection fraction (HFpEF) and obesity? Does it affect hospitalizations?
Background: Patients with HFpEF and obesity have more adverse clinical features and hemodynamics, more symptoms, worse functional capacity, and more severely impaired quality of life. There is growing evidence that obesity and excess adiposity may play a role in the development and progression of HFpEF.
Study design: Randomized, double-blinded, placebo-controlled trial
Se...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research
VTEs and Their Effects on Patients with AE-COPD
Clinical question: How common are venous thromboembolisms (VTEs) in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) and what is the effect on prognosis, hospital length of stay (LOS), and one-year mortality?
Background: Worldwide, COPD is a leading cause of mortality, and many COPD patients will suffer from exacerbations. Many times, infections or environmental triggers are to blame, but the etiology remains elusive in up to one-third of patients. It is known that COPD patients are twice as likely to develop VTE compared to those without, and prior studies have shown variable ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research
Risk and Benefit of Secondary Prevention with Aspirin Versus P2Y12 Inhibitor in CAD Patients
Clinical question: In patients with coronary artery disease (CAD), what is the difference in risk and benefit between secondary prevention with aspirin (ASA) versus a P2Y12 inhibitor?
Background: Lifelong ASA is the mainstay of care for patients with CAD who require secondary prevention. This is predicated on studies from several decades ago. Subsequent studies examining P2Y12 monotherapy versus ASA have had inconsistent results.
Study design: Systematic review and meta-analysis
Setting: Seven randomized clinical trials from 1996 to 2021 were found to meet the criteria for analysis.
Synopsis: 24,325 patients were included ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Cefepime Versus Piperacillin-tazobactam in Adults Hospitalized with Acute Infection
This study analyzed 2,511 patients over the age of 18 prescribed antipseudomonal antibiotics from November 10, 2021, to October 7, 2022, in the emergency department, medical inpatient unit, or ICU at Vanderbilt University Medical Center in Nashville, Tenn. The patient population had a median age of 58 years with 42.7% being female. The primary outcome was acute kidney injury (AKI) or death within 14 days. Secondary outcomes were major adverse kidney events and number of days alive free of delirium or coma within the 14 days. After the patients were randomized to a 1:1 ratio, the patient was provided the antibiotic and the ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Pharmacology Source Type: research
Time to Benefit of SGLT-2 Inhibitors Among Patients with HF
Clinical question: What is the time to benefit for patients with heart failure (HF) and prescribed a sodium-glucose cotransporter-2 (SGLT-2) inhibitor?
Background: SGLT-2 inhibitors are an effective medication for patients with heart failure and preserved (HFpEF) or reduced ejection fraction (HRrEF).
Study design: Comparative effectiveness study
Setting: The authors conducted a systematic review of the literature up to the date of September 5, 2022. 636 articles were identified, and 449 papers were excluded due to meeting the exclusion criteria of a meta-analysis, review, nonhuman research study, correspondence, or editori...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Reliability of Admission Procalcitonin Testing for Capturing Bacteremia Across the Sepsis Spectrum
This study wanted to look at the performance of procalcitonin for detecting bloodstream infections on admission in a real-world setting.
Study design: Retrospective, observational, cohort study
Setting: Cerner HealthFacts database, electronic health record data from 65 U.S. hospitals
Synopsis: This study looked at 74,958 patients at 65 U.S. hospitals, analyzing real-world data on the utilization of procalcitonin in patients admitted with potential bloodstream infections. They included patients 18 years or older who had blood cultures and procalcitonin ordered within 24 hours of admission. The procalcitonin cutoff used was ...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research
Pitavastatin to Prevent Cardiovascular Disease in HIV Infection
This study highlights that pitavastatin use can decrease MACEs in patients with HIV who are on antiretroviral therapy.
Study design: Multicenter, randomized, placebo-controlled trial (REPRIEVE)
Setting: 7,769 people aged 40 to 75 years with low to moderate CV risk with HIV on ART were recruited from 145 sites in 12 different countries
Synopsis: This trial was a multinational, randomized, placebo-controlled, efficacy study where patients were randomized to receive pitavastatin or placebo. The participants were between the ages of 40 and 75 years and on ART therapy, with a low-to-moderate risk of ASCVD. Patients with known A...
Source: The Hospitalist - April 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Infectious Diseases Source Type: research
Getting Another Degree While Working … Or Not?
The monthly(-ish) #JHMChat on X, formerly Twitter, is a time to discuss interesting articles in the Journal of Hospital Medicine [The Hospitalist’s sister publication], meet new people, and learn from each other. Our chat this past November was based on this article by Drs. Jennifer Spicer and Samuel Lai about deciding to get a degree while working, and it did not disappoint. We had Dr. Spicer, who received another degree while working, as our guest expert. Among our participants who finished secondary degrees, those actively obtaining their secondary degree, and those who have chosen not to pursue an additional degr...
Source: The Hospitalist - March 12, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: Career Education Source Type: research
A Clinician ’ s Romance with Uncertainty
It all started as a fling; harmless, unburdened. My tryst with uncertainty found its roots in those educational conferences where every case started as a mystery and was resolved with a definitive answer.
Out on the wards, there was a thrill in the chase. I was exhilarated by those opportunities to solve the mysterious fever; ensnared by the curious constellation of symptoms. Although I did feel the twinges of vulnerability that accompany any new relationship, I always took solace in the safety nets that stripped me of ultimate accountability for the patient mysteries I couldn’t solve.
These safety nets also allowed me t...
Source: The Hospitalist - March 4, 2024 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research
Time to Rethink AF Treatment: Prolonged Benefits of Cryoballoon Ablation
Clinical question: Does initial therapy with catheter cryoballoon ablation reduce progression to persistent atrial fibrillation (AF) in patients with symptomatic, paroxysmal AF when compared to antiarrhythmic therapy?
Background: Atrial fibrillation can progress from a paroxysmal to a persistent form due to electrical and structural remodeling of the heart. The Early Aggressive Invasive Intervention for Atrial Fibrillation (Early-AF) trial concluded that initial treatment of symptomatic, paroxysmal AF with cryoballoon ablation resulted in lower recurrence of arrhythmias compared to antiarrhythmic drug therapy alone during ...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Cardiology In the Literature Source Type: research
Longer-term Outcomes in Critically Ill Patients with COVID-19 in the REMAP-CAP Trial
Clinical question: What is the longer-term (180-day) mortality effect of common therapies on critically ill patients with COVID-19?
Background: Most randomized clinical trials for patients with COVID-19 focus on short-term outcomes such as 28-day mortality or organ failure. Trials evaluating longer-term outcomes of therapeutic interventions are needed.
Study design: Randomized adaptive-platform trial
Setting: International multicenter trial (197 sites in 14 countries)
Synopsis: 4,869 critically ill patients were enrolled from March 2020 through June 2021. Patients were randomized to one of six treatment arms (immune modula...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: COVID-19 In the Literature Source Type: research
Main Causes of Costly Inappropriate Hospital Admissions are Premature Admission and the Potential for Outpatient Management
Clinical question: How prevalent and costly are inappropriate hospital admissions and are patients’ intrinsic risk factors (IRFs) or comorbidities associated with inappropriate hospital admissions?
Background: Health care resource overuse (inappropriate hospital admissions) has a significant economic impact on U.S. health care spending. While previous studies have focused on the frequency and non-clinical patient factors linked to improper hospital admissions, this article explores the economic consequences of such admissions and the connection between IRFs or comorbidities and inappropriate hospital admissions using the...
Source: The Hospitalist - March 1, 2024 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine In the Literature Source Type: research
