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Management: Hospitalists

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Total 37 results found since Jan 2013.

Syncope Evaluation: Evidence-Based and Economical
This study eliminated low-risk syncope patients and those with non-syncope transient loss of consciousness, such as seizure and head trauma, using a structured approach in the emergency department (ED), with only high-risk syncope patients being admitted. These high-risk syncope patients made up 28% of the patients included in the study. After admission, a simplified Wells’ pulmonary embolism criteria score was calculated, and a D-dimer was obtained. If either was high, the patient was scanned for PE and 17% were found to be positive, with two-thirds of those being found to have large-vessel pulmonary emboli. The bottom ...
Source: The Hospitalist - July 5, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Clinical Guidelines Source Type: research

Clinical guideline highlights for the hospitalist: 2022 American Heart Association/American Stroke Association Guideline for the management of patients with spontaneous intracerebral hemorrhage
GUIDELINE TITLE2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke AssociationRELEASE DATEMay 2022PRIOR VERSIONGuidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association 2015DEVELOPERAmerican Heart Association and American Stroke AssociationFUNDING SOURCENoneTARGET POPULATIONAdult Patients with Spontaneous Intracerebral Hemorrhage
Source: Journal of Hospital Medicine - February 2, 2023 Category: Hospital Management Authors: Desir ée C. Burroughs‐Ray, Ariana F. VanDillen, Christopher D. Jackson Tags: CLINICAL GUIDELINE HIGHLIGHTS FOR THE HOSPITALIST 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

Rivaroxaban Monotherapy is Preferable to Combination Therapy with Antiplatelets with Regards to Total Cardiovascular and Bleeding Events in Patients with AF and Stable CAD
In this study conducted across 294 centers, 2,215 patients were randomly assigned to rivaroxaban monotherapy, or therapy with rivaroxaban in combination with aspirin or a P2Y12 inhibitor. All patients were diagnosed with AF with a CHADS2 score greater than one, as well as confirmed CAD without percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 12 months. Primary endpoints were the total number of first and subsequent bleeding and thrombotic events over a 24-month follow-up period. Thrombotic events included ischemic stroke, systemic embolism, myocardial infarction, and unstable angina requir...
Source: The Hospitalist - January 3, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: CAD & Atherosclerosis Cardiology In the Literature Source Type: research

Mr. M
Dr. Migliore I step off the subway, up the elevator, and up several flights of stairs. There’s a homeless man there who always uses the last stair of the lower staircase as a tray for his food. And by tray, I mean he sets his half-eaten rice burrito directly onto the step and picks around at it while I imagine the guacamole is mixing with Hep B and C. diff and MRSA. He looks up at me, I promise myself for the 100th time I’m going to start carrying cash or Kind bars or something; I give him my best sheepish face, and emerge at street level. I walk toward my hospital and pass a gentleman who sits on a ledge next to the ...
Source: The Hospitalist - December 1, 2022 Category: Hospital Management Authors: Lisa Casinger Tags: Essay 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

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

Role of hospitalists in the diagnosis of atrial fibrillation for the management of cryptogenic stroke patients
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Source: Hospital Practice - November 16, 2016 Category: Hospital Management Authors: Alpesh Amin Source Type: research