Cell Cycle Dysregulation in Mantle Cell Lymphoma: Genomics and Therapy.
This article reviews aberrations of cell cycle genes in MCL cells and clinical trials of CDK4/6 inhibitors for MCL. Integrative longitudinal functional genomics is discussed as a strategy to discover genomic drivers for resistance in cancer cells and cancer-immune interactions that potentially contribute to the clinical response to palbociclib combination therapy in MCL. PMID: 32861279 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - September 1, 2020 Category: General Medicine Authors: Wang K, Huang X, Di Liberto M, Chen-Kiang S Tags: Hematol Oncol Clin North Am Source Type: research

Watch and Wait in Mantle Cell Lymphoma.
Abstract Mantle cell lymphoma (MCL) is a biologically heterogeneous disease, and patients may experience a clinical course ranging from indolent to very aggressive. Observational studies suggest that a subset of patients can be safely observed for a period of months to years from initial diagnosis without adversely impacting their outcomes. However, identification of candidates for the "watch and wait" approach remains challenging because selection criteria are not well-defined. Studies that prospectively stratify patients on the basis of MCL biology and disease risk will be informative, and patients wit...
Source: The Medical Clinics of North America - September 1, 2020 Category: General Medicine Authors: Lee C, Martin P Tags: Hematol Oncol Clin North Am Source Type: research

Approach to the Initial Treatment of Older Patients with Mantle Cell Lymphoma.
Abstract With a median age of 65 years, mantle cell lymphoma affects predominantly older patients with comorbidities. Initial treatment of older patients is not standardized but traditionally includes chemoimmunotherapy regimens that are not curative. Incorporation of maintenance strategy after induction and introduction of novel agents have expanded access to effective treatment options and improved survival outcome. Ongoing randomized studies comparing induction regimens and maintenance strategies are expected to further define the role of novel agents and combinations in the initial treatment of older pati...
Source: The Medical Clinics of North America - September 1, 2020 Category: General Medicine Authors: Ruan J Tags: Hematol Oncol Clin North Am Source Type: research

Mantle Cell Lymphoma: Biologic Insights to Bedside Impact.
PMID: 32861292 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - September 1, 2020 Category: General Medicine Authors: Leonard JP Tags: Hematol Oncol Clin North Am Source Type: research

Thoughtful Prescribing and Deprescribing.
Abstract Polypharmacy, the use of five or more medications, is common in older adults. It can lead to the use of potentially inappropriate medications and severe adverse outcomes. Deprescribing is an essential step of the thoughtful prescribing process and it can decrease the use of potentially inappropriate medications. Studies have demonstrated that deprescribing is feasible in the clinical setting, especially when it incorporates patient preferences, shared decision making, and an interdisciplinary team. Medication-specific algorithms can facilitate deprescribing in the clinical setting. PMID: 32773043 [Pu...
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Pravodelov V Tags: Med Clin North Am Source Type: research

Identifying Goals of Care.
Abstract Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills. PMID: 32773044 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Comer A, Fettig L, Torke AM Tags: Med Clin North Am Source Type: research

Overview of High Yield Geriatrics Assessment for Clinic and Hospital.
Abstract Geriatric assessment is a comprehensive, multifaceted, and interdisciplinary evaluation of medical, socioeconomic, environmental, and functional concerns unique to older adults; it can be focused or broadened according to the needs of the patient and the concerns of clinical providers. Herein, the authors present a high-yield framework that can be used to assess older adult patients across a variety of settings. PMID: 32773045 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Gonzalez MR, Miller RK, Michener AR Tags: Med Clin North Am Source Type: research

The Intersection of Falls and Dementia in Primary Care: Evaluation and Management Considerations.
This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals. PMID: 32773046 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Casey CM, Caulley J, Phelan EA Tags: Med Clin North Am Source Type: research

Cognitive Impairment Evaluation and Management.
Abstract Clinicians should use a systematic approach to evaluating patients presenting with a concern for cognitive impairment. This approach includes interviewing a knowledgeable informant and performing a thorough mental status examination in order to determine the presence of functional impairments and the domains of cognition that are impaired. The results of this interview and examination determine the next steps of the diagnostic work-up. The pattern of cognitive impairment shapes the differential diagnosis. Treatment should address symptoms, and environmental, psychological, and behavioral interventions are...
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: McCollum L, Karlawish J Tags: Med Clin North Am Source Type: research

Common Urinary and Bowel Disorders in the Geriatric Population.
This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population. PMID: 32773048 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Manuelyan Z, Siomara Muñiz K, Stein E Tags: Med Clin North Am Source Type: research

Sadness and Worry in Older Adults: Differentiating Psychiatric Illness from Normative Distress.
Abstract Older adults experience greater emotional well-being in late life. However, older adults may be vulnerable to certain physiologic risk factors, including less physiologic resilience to prolonged stress. Depression and anxiety can be difficult to diagnose in late life owing to differences in self-reported symptoms from younger adults and unclear distinctions between normative and non-normative emotional experiences. We discuss age differences in the presentations of depression and anxiety, and normative and non-normative late life developmental trajectories around bereavement and grief, social isolation an...
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Lutz J, Van Orden KA Tags: Med Clin North Am Source Type: research

Musculoskeletal Pain in Older Adults: A Clinical Review.
This article reviews the current understanding of persistent pain in older adults and suggests a general approach to its assessment and management, followed by specific considerations for musculoskeletal pain conditions commonly seen in older adults. PMID: 32773050 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Welsh TP, Yang AE, Makris UE Tags: Med Clin North Am Source Type: research

Osteoporosis in Older Adults.
Abstract Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patie...
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Johnston CB, Dagar M Tags: Med Clin North Am Source Type: research

Evaluation and Management of Difficult Symptoms in Older Adults in Primary Care.
This article reviews the evaluation of 4 vexing symptoms for elderly patients in primary care: leg cramps, dizziness, insomnia, and weight loss. For each, ideal evaluations are proposed. PMID: 32773052 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Hamilton C, Christmas C Tags: Med Clin North Am Source Type: research

Perioperative Care Strategy for Older Adults.
Abstract Geriatric patients are not just older adult patients. Aging brings about unique physiologic, psychological, and sociologic changes within individuals. Recognition of these unique characteristics and measuring for their impact; instituting mitigating strategies; using age-specific anesthetic measures; and performing a systematic, algorithmic care model in the postoperative period overseen by a multidisciplinary team brings about enhanced outcomes and improved quality of care for this expanding group of patients. PMID: 32773053 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Jones TS, Moore JT, Robinson TN Tags: Med Clin North Am Source Type: research

Challenges Related to Safety and Independence.
Abstract Advancing age is associated with increasing risk of activities important for independence, such as driving and living alone. Cognitive impairment is more common with older age; financial resources and social support may dwindle. Risk, cognitive impairment, and decisional capacity each change over time. Transparent decision making and harm reduction help balance risk and safety. When a patient lacks decisional capacity, an option that considers the patient's preferences and shows respect for the person is favored. Vulnerable patients making choices that are high risk, and patients for whom others are makin...
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Ward H, Finucane TE, Schuchman M Tags: Med Clin North Am Source Type: research

Knowledge, Wisdom, and the Practice of Geriatrics.
PMID: 32773055 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Ende J Tags: Med Clin North Am Source Type: research

Caring for Older Adults.
PMID: 32773056 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Cayea D Tags: Med Clin North Am Source Type: research

Applying the Infectious Diseases Literature to People who Inject Drugs.
Abstract People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention. PMID: 32782101 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 14, 2020 Category: General Medicine Authors: Serota DP, Chueng TA, Schechter MC Tags: Infect Dis Clin North Am Source Type: research

Small Intestinal Bacterial Overgrowth: How to Diagnose and Treat (and Then Treat Again).
Abstract Small intestinal bacterial overgrowth (SIBO) is a condition with presentation that can vary from asymptomatic to steatorrhea and malnutrition. Small bowel aspiration and culture is the current gold standard of diagnosis; however, this is invasive and is not without risk to the patient. Breath testing is a noninvasive and less expensive alternative method; however, it lacks diagnostic sensitivity and specificity. Novel diagnostic methods being studied include gas-sensing capsules. The mainstay of treatment is antibiotics; alternative therapies include herbal medications, dietary modifications, and prokinet...
Source: The Medical Clinics of North America - July 30, 2020 Category: General Medicine Authors: Ginnebaugh B, Chey WD, Saad R Tags: Gastroenterol Clin North Am Source Type: research

Genetics of Equine Neurologic Disease.
Abstract Neurologic disease in horses can be particularly challenging to diagnose and treat. These diseases can result in economic losses, emotional distress to owners, and injury to the horse or handlers. To date, there are 5 neurologic diseases caused by known genetic mutations and several more are suspected to be heritable: lethal white foal syndrome, lavender foal syndrome, cerebellar abiotrophy, occipitoatlantoaxial malformation, and Friesian hydrocephalus. Genetic testing allows owners, breeders, and veterinarians to make informed decisions when selecting dams and sires for breeding or deciding the treatment...
Source: The Medical Clinics of North America - July 15, 2020 Category: General Medicine Authors: Edwards L, Finno CJ Tags: Vet Clin North Am Equine Pract Source Type: research

Emergency Department Operations: An Overview.
Abstract Emergency department (ED) operations reflect the intersection of factors external and internal to the ED itself, with unique problems posed by community and academic environments. ED crowding is primarily caused by a lack of inpatient beds for patients admitted through the ED. Changes to front-end operations, such as point-of-care testing and putting physicians in triage, can yield benefits in throughput, but require individual cost analyses. Balancing physician workloads can lead to substantial improvements in throughput. Observation pathways can reduce crowding while maintaining safety. Physician and nu...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Joseph JW, White BA Tags: Emerg Med Clin North Am Source Type: research

Queuing Theory and Modeling Emergency Department Resource Utilization.
Abstract Queueing theory is a discipline of applied mathematics that studies the behavior of lines. Queueing theory has successfully modeled throughput in a variety of industries, including within the emergency department (ED). Queueing equations model the demand for different processes within the ED, and help to factor in effects of variability on delays and service times. Utilization is a measure of the throughput of a process relative to demand, and provides a quick means of comparing the demand for certain resources. Although there have been some significant successes in applying queueing theory to EDs, the fi...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Joseph JW Tags: Emerg Med Clin North Am Source Type: research

Factors Affecting Emergency Department Crowding.
Abstract Emergency department crowding is a multifactorial issue with causes intrinsic to the emergency department and to the health care system. Understanding that the causes of emergency department crowding span this continuum allows for a more accurate analysis of its effects and a more global consideration of potential solutions. Within the emergency department, boarding of inpatients is the most appreciable effect of hospital-wide crowding, and leads to further emergency department crowding. We explore the concept of emergency department crowding, and its causes, effects, and potential strategies to overcome ...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Kenny JF, Chang BC, Hemmert KC Tags: Emerg Med Clin North Am Source Type: research

Staffing and Provider Productivity in the Emergency Department.
Abstract Staffing and productivity are key concepts to understand when managing an emergency department. Provider productivity is not static, starts out high, and decreases throughout the shift in a stepwise manner. It is commonly measured by patients per hour or relative value units per hour, and is impacted by factors from the presence of residents to shift length. Appropriate staffing requires thorough understanding of the workforce and the variable patient demand of the department. Matching capacity to this demand potentially improves overall throughput and efficiency. Once knowledgeable about these factors, w...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Stenson BA, Anderson JS, Davis SR Tags: Emerg Med Clin North Am Source Type: research

Patient Assignment Models in the Emergency Department.
Abstract Early assignment of patients to specific treatment teams improves length of stay, rate of patients leaving without being seen, patient satisfaction, and resident education. Multiple variations of patient assignment systems exist, including provider-in-triage/team triage, fast-tracks/vertical pathways, and rotational patient assignment. The authors discuss the theory behind patient assignment systems and review potential benefits of specific models of patient assignment found in the current literature. PMID: 32616282 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Hodgson NR, Traub SJ Tags: Emerg Med Clin North Am Source Type: research

Design of the Academic Emergency Department.
This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages. PMID: 32616283 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Marshall KD, Imhoff B, Zilm F Tags: Emerg Med Clin North Am Source Type: research

Lean Process Improvement in the Emergency Department.
Abstract Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize de...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Breen LM, Trepp R, Gavin N Tags: Emerg Med Clin North Am Source Type: research

Alternative Dispositions for Emergency Department Patients.
Abstract Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of pa...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Bukhman AK, Baugh CW, Yun BJ Tags: Emerg Med Clin North Am Source Type: research

Quality Assurance in the Emergency Department.
Abstract Quality assurance (QA) of care in the emergency department encompasses activities ensuring that the care provided meets applicable standards. Health care delivery is complex and many factors affect quality of care. Thus, quantification of health care quality is challenging, especially with regard to attribution of outcomes to various factors contributing to such care. A critical component of the process of QA is determination of quality health care and the concept of (unjustified) deviation from the reference applicable standard of care. PMID: 32616286 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Baker WE, Solano JJ Tags: Emerg Med Clin North Am Source Type: research

Information Management in the Emergency Department.
This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future. PMID: 32616287 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Leventhal EL, Schreyer KE Tags: Emerg Med Clin North Am Source Type: research

Best Practices in Patient Safety and Communication.
This article provides an overview of the evidence-based approaches to improve patient safety and communication. PMID: 32616288 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Im D, Aaronson E Tags: Emerg Med Clin North Am Source Type: research

Optimizing Patient Experience in the Emergency Department.
Abstract Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, doing so holds many benefits, including improved patient compliance and health outcomes, improved workplace satisfaction and reduced provider and staff burnout, decreased malpractice risk, and increased revenue. Although wait time is a major driver of patient experience, provider and staff communication are critically important and excellent communication and...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Sonis JD, White BA Tags: Emerg Med Clin North Am Source Type: research

Management of the Academic Emergency Department.
Abstract Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by aca...
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Vinton D, Sanchez LD Tags: Emerg Med Clin North Am Source Type: research

Strategies for Provider Well-Being in the Emergency Department.
Abstract A variety of operational and administrative factors have the potential to decrease wellness and negatively impact emergency physicians, in terms of both their on-the-job performance and their long-term career satisfaction. Among these are the issues of workload balance, physiologic and circadian stresses, and larger issues of malpractice risk and institutional support. This overview covers both emerging research on how these problems affect emergency physicians and strategies to help mitigate these challenges. PMID: 32616291 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Wong ML, Chung AS Tags: Emerg Med Clin North Am Source Type: research

Emergency Department Operations and Administration.
PMID: 32616292 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Mattu A Tags: Emerg Med Clin North Am Source Type: research

How the Emergency Department Works: A Work in Progress.
PMID: 32616293 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 5, 2020 Category: General Medicine Authors: Joseph JW, White BA Tags: Emerg Med Clin North Am Source Type: research

Common Data Elements in Head and Neck Radiology Reporting.
Abstract Radiologists must convert the complex information in head and neck imaging into text reports that can be understood and used by clinicians, patients, and fellow radiologists for patient care, research, and quality initiatives. Common data elements in reporting, through use of defined questions with constrained answers and terminology, allow radiologists to incorporate best practice standards and improve communication of information regardless of individual reporting style. Use of common data elements for head and neck reporting has the potential to improve outcomes, reduce errors, and transition data cons...
Source: The Medical Clinics of North America - July 2, 2020 Category: General Medicine Authors: Rajamohan AG, Patel V, Sheikh-Bahaei N, Liu CJ, Go JL, Kim PE, Gibbs W, Acharya J Tags: Neuroimaging Clin N Am Source Type: research

Sepsis and Septic Shock - Basics of diagnosis, pathophysiology and clinical decision making.
Abstract Sepsis and septic shock are major causes of mortality among hospitalized patients. The sepsis state is due to dysregulated host response to infection, leading to inflammatory damage to nearly every organ system. Early recognition of sepsis and appropriate treatment with antibiotics, fluids, and vasopressors is essential to reducing organ system injury and mortality. This review summarizes the current understanding of the epidemiology, pathophysiology, diagnosis, and treatment of sepsis and septic shock. PMID: 32505253 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Font MD, Thyagarajan B, Khanna AK Tags: Med Clin North Am Source Type: research

Management of Pneumonia Syndromes in the Hospital: Make Pneumonia Your Best Friend.
PMID: 32505254 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Kanal A, Sharpe BA, Abelson J Tags: Med Clin North Am Source Type: research

Advances in the Management of Acute Decompensated Heart Failure.
Abstract Patients hospitalized for heart failure pose a considerable clinical and financial burden on the health care system. Early recognition and deep phenotyping of heart failure for reduced and preserved ejection fraction syndromes facilitate the introduction of appropriate guideline-directed therapy and decongestion strategies to help improve heart failure morbidity and mortality. Robust and safe transitions of care programs are needed to deliver adequate care and improve overall survival. PMID: 32505255 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Mitter SS, Pinney SP Tags: Med Clin North Am Source Type: research

Recent Advances in the Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
Abstract Chronic obstructive pulmonary disease is a chronic, irreversible obstructive lung disease that results from exposure to noxious stimuli. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) usually result from viral or bacterial respiratory infections, but may also result from exposure to environmental pollution. AECOPD are associated with functional decline, increased risk of subsequent exacerbations, and death. Despite the poor prognosis of AECOPD, patients are empowered through self-management programs in their battle against this lethal disease. Morbidity and mortality of chronic obst...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Whittaker Brown SA, Braman S Tags: Med Clin North Am Source Type: research

Treatment of Acute Venous Thromboembolism.
Abstract "Acute venous thromboembolism is a common disease seen by nearly all hospitalists. The advent of low molecular weight heparin (LMWH) several decades ago ushered in the era of early hospital discharge and home treatment. More recently, the direct oral anticoagulants (DOACs) have further simplified outpatient treatment and some offer treatment without parenteral therapy. Use of DOACs for cancer-associated venous thromboembolism is emerging and is a welcome evolution of care to spare oncologic patients the burden of daily LMWH injections." PMID: 32505257 [PubMed - in process] (Source: The Medi...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Nair S, Garza N, George M, Kaatz S Tags: Med Clin North Am Source Type: research

Acute Liver Injury and Decompensated Cirrhosis.
Abstract Hospitalists often care for patients with liver disease, including those with acute liver injury and failure and patients with complications of decompensated cirrhosis. Acute liver failure is a true emergency, requiring intensive care and oftentimes transfer of the patient to a liver transplant center. Patients with decompensated cirrhosis have complications of portal hypertension, including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. These complications increase the risk of mortality among patients with decompensated cirrhosis. Comanagement by the hospital...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Crismale JF, Friedman SL Tags: Med Clin North Am Source Type: research

Catheter-Associated Urinary Tract Infection, Clostridioides difficile Colitis, Central Line-Associated Bloodstream Infection, and Methicillin-Resistant Staphylococcus aureus.
This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed. PMID: 32505259 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Luzum M, Sebolt J, Chopra V Tags: Med Clin North Am Source Type: research

Alcohol and the Hospitalized Patient.
Abstract Alcohol use is a common social and recreational activity in our society. Misuse of alcohol can lead to significant medical comorbidities that can affect essentially every organ system and lead to high health care costs and utilization. Heavy alcohol use across the spectrum from binge drinking and intoxication to chronic alcohol use disorder can lead to high morbidity and mortality both in the long and short term. Recognizing and treating common neurologic, gastrointestinal, and hematological manifestations of excess alcohol intake are essential for those who care for hospitalized patients. Withdrawal is a...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Chernyavsky S, Dharapak P, Hui J, Laskova V, Merrill E, Pillay K, Siau E, Rizk D Tags: Med Clin North Am Source Type: research

Diagnosis and Management of Opioid Use Disorder in Hospitalized Patients.
Abstract The diagnosis of opioid use disorder (OUD) is often overlooked or inadequately managed during the inpatient admission. When recognized, a common strategy is opioid detoxification, an approach that is often ineffective and can be potentially dangerous because of loss of tolerance and subsequent risk for overdose. Medication for addiction treatment (MAT), including methadone and buprenorphine, is effective and can be dispensed in the hospital for both opioid withdrawal and initiation of maintenance treatment. Hospitalists should be knowledgeable about diagnosing and managing patients with OUD, including how...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Herscher M, Fine M, Navalurkar R, Hirt L, Wang L Tags: Med Clin North Am Source Type: research

Periprocedural Management of Oral Anticoagulation.
Abstract Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. A clinical approach to perioperative DOAC management based on operative bleeding risk and renal function is safe and effective, and at present, is preferred over preprocedural DOAC levels testing. Cl...
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Shaw JR, Kaplovitch E, Douketis J Tags: Med Clin North Am Source Type: research

Teamwork Essentials for Hospitalists.
Abstract Teamwork is essential to providing high-quality patient care. Hospital settings pose important challenges to teamwork. Measurement is key to understanding baseline performance and assessing whether teamwork is improving. The authors recommend a multifaceted approach, using a combination of complementary interventions with an ultimate goal that improved teamwork translates into improved patient outcomes. PMID: 32505263 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: O'Leary KJ, Hanrahan K, Cyrus RM Tags: Med Clin North Am Source Type: research

Using Bedside Rounds to Change Culture.
Abstract Although not suitable for every patient encounter, rounding at the beside provides an opportunity to teach and augment the attitudes essential for optimal medical care. It also provides an opportunity to establish and grow the team's culture as well as the culture for each patient encounter. Finally, it provides the attending physician with an opportunity to assess learners' position on the supervision-to-autonomy spectrum, thereby ensuring appropriate supervision while enabling the autonomy necessary for optimal learner growth. PMID: 32505264 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 9, 2020 Category: General Medicine Authors: Bryne A, Wiese J Tags: Med Clin North Am Source Type: research