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Costs of major complications in people with and without diabetes in Tasmania, Australia
ConclusionsDiabetes complications are costly, and the costs are higher in people with diabetes than without diabetes. Our results can be used to populate diabetes simulation models and will support policy analyses to reduce the burden of diabetes.PMID:36375176 | DOI:10.1071/AH22180
Source: Australian Health Review - November 14, 2022 Category: Hospital Management Authors: Ngan T T Dinh Barbara de Graaff Julie A Campbell Matthew D Jose Burgess John Timothy Saunder Alex Kitsos Nadine Wiggins Andrew J Palmer Source Type: research

Hospital Closures Pose Challenges to Care
Empty beds in a hospital room. When 10-bed Nye Regional Medical Center, in west-central Nevada, closed abruptly in 2015, it meant that the residents of the former gold-mining town of Tonopah would have to drive about two hours across a hundred miles of desert roads to get to the nearest hospital.  The hospital’s CEO, Wayne Allen, didn’t sugar-coat it. “This is a decision that will ultimately jeopardize the health and well-being of our community and surrounding areas,” he said. Hospital closures over the last decade—most notably in rural areas and in pediatrics, but urban closures as well—have left patients wi...
Source: The Hospitalist - November 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine Career Pediatrics PHM22 Source Type: research

Sodium-containing Acetaminophen Intake Increases the Risk of CVD and All-cause Mortality
Dr. Hoque Clinical question: Does the use of sodium-containing acetaminophen increase the risk of cardiovascular disease (CVD) and all-cause mortality in patients with and without a history of hypertension when compared to non-sodium-containing acetaminophen? Background: There is a common misconception that excess sodium intake comes primarily from dietary sources. The excipients of common over-the-counter medications such as some formulations of acetaminophen may contain significant amounts of sodium. For example, a 500-mg dose of soluble acetaminophen contains 390 mg of sodium, and a 500-mg dose of effervescent acetamin...
Source: The Hospitalist - October 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research

There is a Decreased Risk of Hospitalization from Heart Failure in Type II Diabetics Initiated on a SGLT2 Inhibitor When Compared to a GLP-1 Receptor Agonist
Dr. Huang Clinical question: Determine the cardiovascular risk outcome in type II diabetic patients initiated on an sodium-glucose cotransporter-2 (SGLT2)  inhibitor versus a glucagon-like peptide-1 (GLP-1) receptor agonist. Background: Various studies have suggested that several SGLT2 inhibitors and GLP-1 receptor agonists may improve cardiac outcomes—myocardial infarction, stroke, hospitalization for heart failure, and cardiovascular death. Current guidelines recommend using either an SGLT2 inhibitor or GLP-1 receptor agonist for patients with type II diabetes and cardiovascular disease. However, there has been no st...
Source: The Hospitalist - September 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Diabetes Heart Failure In the Literature Source Type: research

Tranexamic acid minimized perioperative bleeding in patients undergoing noncardiac surgery
Dr. Menon Clinical question: Does tranexamic acid reduce the incidence of life-threatening perioperative bleeding in patients undergoing noncardiac surgery without increasing the risk of major cardiovascular adverse events? Background: Large surgical trials have shown that tranexamic acid reduces the incidence and severity of perioperative bleeding in patients undergoing a cesarean section or cardiac surgery. Other, smaller trials have suggested similar findings with tranexamic acid in patients undergoing orthopedic surgery as well. But, there are limited data on the use of tranexamic acid in patients undergoing non-ortho...
Source: The Hospitalist - August 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Critical Care In the Literature Perioperative Medicine Source Type: research

DES reduce the risk of ISR in patients with ICAS compared to BMS
Dr. Snipe Clinical question: In patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS), does the use of a drug-eluting stent (DES) reduce the incidence of in-stent restenosis (ISR) and stroke recurrence compared to using a bare-metal stent (BMS)? Background: ICAS is a common cause of stroke in North America (accounting for 8-10% of strokes) and is even more common in Asia (accounting for 30-50% of strokes). In previous trials, aggressive medical management was found to be the superior first-line treatment, but intracranial stenting is growing in popularity and safety. DES is known to reduce ISR ...
Source: The Hospitalist - August 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: CAD & Atherosclerosis Critical Care In the Literature Source Type: research

Cost-effectiveness of the Victorian Stroke Telemedicine program
ConclusionThe VST program was likely to be cost saving or cost-effective. Our findings provide confidence in supporting wider implementation of telemedicine for acute stroke care in Australia.PMID:35589669 | DOI:10.1071/AH21377
Source: Australian Health Review - May 19, 2022 Category: Hospital Management Authors: Joosup Kim Elise Tan Lan Gao Marj Moodie Helen M Dewey Kathleen L Bagot Nancy Pompeani Lauren Sheppard Christopher F Bladin Dominique A Cadilhac Source Type: research

What Medications Prevent Delirium in Elderly Medical Inpatients?
This study demonstrated lower rates of delirium in the melatonin arm, with an impressive number needed to treat (NNT) below six patients; mortality and length of hospital stay were unaffected.3 A delirium-prevention effect of melatonin has not been reproduced in other studies, notably Jaiswal et al, which randomized patients to a placebo or 3 mg of melatonin and found no difference in rates of delirium prevention.7  The melatonin receptor agonist ramelteon also has small but favorable evidence for preventing non-ICU hospitalized delirium. This comes from a study of 67 patients aged 65 years or older who were randomized to...
Source: The Hospitalist - May 2, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Drug Therapy Geriatrics Key Clinical Questions Medication Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Anticoagulant choice in antiphospholipid syndrome – associated thrombosis
Background: DOACs have largely replaced VKAs as first-line therapy for venous thromboembolism in patients with adequate renal function. However, there is concern in APS that DOACs may have higher rates of recurrent thrombosis than VKAs when treating thromboembolism. Dr. David Portnoy Study design: Randomized noninferiority trial. Setting: Six teaching hospitals in Spain. Synopsis: Of adults with thrombotic APS, 190 were randomized to receive rivaroxaban or warfarin. Primary outcomes were thrombotic events and major bleeding. Follow-up after 3 years demonstrated new thromboses in 11 patients (11.6%) in the DOAC...
Source: The Hospitalist - December 10, 2021 Category: Hospital Management Authors: Daniel Hickman Tags: Hematology Thrombosis Source Type: research

Frequent general practitioner visits are protective against statin discontinuation after a Pharmaceutical Benefits Scheme copayment increase.
ConclusionsPatients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs.What is known about the topic?Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention.What does this paper add?Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase.What are the imp...
Source: Australian Health Review - May 10, 2020 Category: Hospital Management Authors: Seaman KL, Sanfilippo FM, Bulsara MK, Brett T, Kemp-Casey A, Roughead EE, Bulsara C, Preen DB Tags: Aust Health Rev Source Type: research

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