Acetaminophen Rises Systolic Blood Pressure in Those with Hypertension
This study’s limitations include: being a single-center study, exclusively done on the white population, and including only patients with underlying hypertension so its impact on the normotensive population is unknown. Moreover, because the trial only lasted two weeks, it is challenging to predict whether the results would persist over time.
Bottom line: Acetaminophen elevates blood pressure by roughly 5/2 mmHg in patients with underlying hypertension (treated or untreated) within a two-week period when compared to placebo.
Dr. Sheikh
Citation: MacIntyre IM, et al. PATH-BP (paracetamol in hypertension–blood pressure)...
Source: The Hospitalist - March 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Drug Therapy Hypertension In the Literature Source Type: research
Early Initiation of Dialysis Improves Survival: To Start or Not to Start
Clinical question: What is the ideal estimated glomerular filtration rate (eGFR) at which to start dialysis in patients with advanced chronic kidney disease?
Background: Uncertainty exists over the optimum time to start dialysis in order to lower mortality and cardiovascular events. The Initiating Dialysis Early and Late (IDEAL) trial, published in 2010, demonstrated that initiating dialysis at an eGFR of 10 to 14 mL/min/1.73 m2 was not associated with an improvement in survival or clinical outcomes as compared to patients with the eGFR 5 to 7 mL/min/1.73 m2.
Study design: A nationwide observational cohort study
Setting: ...
Source: The Hospitalist - March 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Nephrology Source Type: research
Bolus IV 0.9% Saline Leads to Interstitial Permeability Pulmonary Edema in Healthy Volunteers
Clinical question: Can intravenous fluid (IVF) administration cause direct lung injury independent of cardiogenic overload?
Background: Bolus IVF therapy is a central component to managing critically ill patients with hypotension. In the clinical setting, pulmonary edema after IVF is thought to primarily occur by cardiogenic mechanisms, though studies in healthy subjects have suggested that IVF administration itself can lead to indirect lung injury and permeability pulmonary edema.
Study design: Randomized, crossover trial
Setting: Intensive care unit at a tertiary hospital in Australia
Synopsis: Fourteen healthy adult pat...
Source: The Hospitalist - March 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research
Effectiveness of Oxycodone Hydrochloride vs. Combination Acetaminophen and Codeine for Subacute Pain After Fractures Managed Surgically: A Randomized Controlled Trial
Clinical question: Do less potent opioids suffice for adequate pain control for patients with surgically managed fractures?
Background: For post-surgical pain management at time of discharge, hospitalists try to balance the analgesic effects of opioid therapy with the risks of dependency and overdose. Data on optimal discharge opioid dosing for adult patients who have undergone surgical management of fracture are currently limited.
Study design: Double-blind, randomized controlled trial
Setting: Trauma hospital in Sydney, Australia
Synopsis: Adult patients who had sustained non-pathological fractures of a long bone (e.g., ...
Source: The Hospitalist - March 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Drug Therapy In the Literature Pain Source Type: research
Nutritional Support Improves Mortality in Frail, Elderly Patients
Clinical question: Is there a mortality benefit to optimizing nutritional status for malnourished patients with age-related frailty?
Background: Age-related frailty syndrome has been associated with increased morbidity and mortality in critically ill patients. It has not been well studied whether optimizing nutrition in elderly hospitalized patients with frailty syndrome improves outcomes.
Study design: Randomized controlled trial
Setting: Secondary and tertiary hospitals in Switzerland
Synopsis: A subgroup analysis of data from the EFFORT Trial included 881 patients identified as having age-related vulnerability with over...
Source: The Hospitalist - March 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Geriatrics In the Literature Source Type: research
Healthcare Circus
Handoff, rounding, charting, click on sepsis alert.
Consecutive 12-hour shifts, have to “Rinse & Repeat.”
Luxury to pause, reflect, connect with patients & peers.
Has, unfortunately, taken a tremendous beat.
Pandemic, high volumes, short staffing & burnt-out team.
Clinicians walking around like zombies, with low self-esteem.
Dwindling workforce & morale is nothing new.
Now the “Pandemic health care heroes” need a miracle or two.
Our tank is empty
Our battery low
No one is coming to save us
That’s yet another blow
Can’t rely too much on powers that be
The ones who will “fix” this, are you a...
Source: The Hospitalist - February 22, 2023 Category: Hospital Management Authors: Lisa Casinger Tags: Poetry Source Type: research
Alternative Hospitalist “ Uniform ” When Hospitalists Were New (2003)
I read with interest the contrasting articles “Have We Gotten too Casual “ and “Heels, White Coats, Formal Wear, and Scrubs” all about hospitalists’ attire in the January 2023 issue.
It brought back memories of being part of a team forming one of the first non-academic, private-practice, hospitalist groups in Wisconsin. I worked for Infinity Healthcare and this occurred at Community Memorial, in Menomonee Falls, Wisc., in 2003. Infinity was interested in protecting its emergency department (ED) contract and thus we bid on the RFP and won it.
In the course of our formative discussions, we talked about what clothi...
Source: The Hospitalist - February 22, 2023 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research
The Rabbit Hole or The Thin Red Line
The last two years have nearly drained my soul to the last drop. There have been so many moments that have been tear-stained, hopeless, dark, full of loss, and covered in blood. We have faced a nearly insurmountable amount of death and debility from COVID-19 in addition to the very unexpected undeserved scorn from some of our patients and their families about COVID-19 being a real diagnosis in addition to their associated treatments.
On top of this, the health care industry, which pretends not to care about money but only patient well-being, has been intermittently furloughing providers. I have imagined them biting their n...
Source: The Hospitalist - February 14, 2023 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research
How Does Thiamine Deficiency Result in an Elevated Lactate?
Case
A 50-year-old male with a medical history of severe alcohol use disorder and type 2 diabetes mellitus presented to the emergency department with shortness of breath and dry cough. Initial venous blood gases showed a pH of 7.06, anion gap of 41, and lactate of 5.19 mmol/L. After fluid resuscitation, glycemic control, and standard thiamine replacement, the patient’s lactate remained elevated.
Overview
Elevated lactate is a common finding in hospitalized patients.1
Hyperlactatemia is defined as a serum lactate level greater than 2 mmol/L. Lactic acidosis is elevated lactate in the setting of pH under 7.35.2 The dif...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Key Clinical Questions Source Type: research
Chapter Spotlight: Central Texas
They say everything is bigger in Texas—and it appears SHM chapters are no exception.
Take the Central Texas group, which stretches from Waco to San Antonio (anchored by Austin roughly halfway between). That’s nearly 200 miles apart, or, put another way, roughly the length of New Jersey end to end.
“It’s both challenging and fun,” said chapter president Hameed Ali, DO, SFHM. “It’s a real combination of urban, suburban, and even rural medicine.”
Dr. Ali
At its most recent count, this collection of hospitalists treating everything from cowboys to CEOs had 367 members. Dr. Ali, a veteran hospitalist with Ba...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Chapters Source Type: research
SIG Spotlight: Interdisciplinary Rounding
Sarah Horman, MD, helped lead the launch of interdisciplinary rounding at the University of California San Diego in 2017. But it wasn’t until two years later that she found herself at the annual SHM national meeting, in a session with others who seemed as interested in the systematic approach to workflow as she was.
Dr. Horman
Toss in support from SHM and the Special Interest Group (SIG) on Interdisciplinary Rounding (IR) was born.
“Interdisciplinary rounding enforces a standard workflow around synchronized communication from multidisciplinary team members involved in the patient’s care—in a reliable way,” sa...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: SIGs Source Type: research
Things to Do in Austin
Austin, Texas is not only the Live Music Capital of the World but also home to SHM Converge 2023, March 26-29 at the Austin Convention Center. Plan your conference experience and take advantage of everything Austin has to offer! From Lady Bird Lake to delicious dine-in opportunities, Austin is an incredible city to explore after a day of Converge or to extend your trip post-conference.
Outdoor activities
There’s a lot to do around Lady Bird Lake (also known as Town Lake), a river-like reservoir on the Colorado River in Austin. The Ann and Roy Butler Hike-and-Bike Trail surrounds the lake, offering a 10-mile trek with a g...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: SHM Converge Source Type: research
The Power of Emotional Intelligence for Hospitalists
Emotions drive people, people drive performance. This oft-quoted expression provides a simplified explanation of emotional intelligence, but let’s dive a little deeper and consider its importance to hospitalists.
It’s a typical workday as a hospitalist. As you’re talking with a sick patient and frustrated family members, your pager goes off, your employer-provided phone just gifted you a new admission in the emergency department, and secure chat messages are piling up in the electronic medical record as you struggle to keep up with the real world.
How do you control your emotions and stay composed during your super...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Career Source Type: research
Doctors Should Play a Role in Preventing Climate-change-related Health Matters
A 5-year-old with second-degree burns on their hands and thighs after playing on a playground with a metal structure in direct sunlight. A 7-year-old child presenting with altered mental status and a body temperature of 104 degrees, whose family tried to get to an air-conditioned library but couldn’t because the power cables for the bus had melted. A 17-year-old receiving follow-up, gender-affirming care who is struggling to keep their estrogen patch on because it’s been sweating off in a heat wave.
Presenters from Seattle Children’s Hospital at Pediatric Hospital Medicine 2022 offered these examples of how climate-c...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: PHM22 Quality Improvement Source Type: research
FAST Program Implementation Guide Success
Jefferson Antithrombotic Therapy Team. Front row L to R: Photi Galanis, MD, Julia Westfield, Heather Yenser, CRNP. Back row L to R: Lynda Thomson, PharmD, Dina Orapallo, CRNP, Geno Merli, MD, Tony Macchiavelli, MD, Walter Kraft, MD, Luis Eraso, MD
Hospital clinicians know well that managing anticoagulation therapy for their patients with venous thromboembolism (VTE) and other thrombotic conditions can be a balancing act between preventing further life-threatening blood clots and avoiding dangerous bleeds—both high-risk adverse events leading to diminished quality of life and worse, for patients.
These challenges are int...
Source: The Hospitalist - February 1, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Education Patient Safety Practice Management Quality Improvement Transitions of Care Venous Thromboembolism Source Type: research
