Hospital Medicine News Archive

Regional Anesthesia Tied to Lower Opioid Use in TKA, Hip Arthroplasty

Findings based on comparison to general anesthesia for knee and hip arthroplasty

Early Hospital Readmissions More Preventable Than Late Readmissions

Can the length of time after hospital discharge influence readmission preventability among general medicine patients?

US Nursing Home Costs Due to Diabetes Vary Greatly by State

Per-person diabetes-attributable costs ranged from 374 in New Mexico to 1,610 in Washington, D.C.

eConsult in Primary Care: Clinicians Surveyed About the Pros and Cons

Implementing an electronic consult system for specialty requests in safety-net health systems is associated with improved specialty care access but creates new challenges for primary care practitioners.

Parkinson Drug May Be Linked to Deaths

The FDA advisory committee voted 12-2 in favor of recommending the approval of Nuplazid.

Switching from Branded to Authorized Generic Drugs Linked to Lower Switchback Rate

Switching back to branded drugs is more likely in generic drug than authorized generic drugs.

Code Stroke System Reduces Post-Stroke Epilepsy Risk in Older Adults

The adjusted analysis also demonstrated that the code stroke system was associated with a decreased risk for post-stroke epilepsy within 5 years of stroke.

Aortic valve replacement linked to increased mortality in elderly

Aside from age, other high mortality factors included left ventricular dysfunction, atrial fibrillation, COPD, and diabetes.

High-Flow Oxygen Treatment Better for Infants with Bronchiolitis Than Standard Therapy

Compared with standard oxygen therapy, high-flow treatments were better for infants with bronchiolotis.

Hospitalization, PICU admissions increasing for pediatric opioid ingestions

The US opioid crisis is negatively affecting children, and the rate of hospitalization and pediatric intensive care unit admission for pediatric opioid ingestions is increasing.

Predicting mortality and outcomes after a subarachnoid hemorrhage

A clinical prediction tool successfully forecasts subarachnoid hemorrhage management from ruptured intracranial aneurysms.

Postoperational opioid misuse linked to prescription longevity

Duration, more than dosage, may increase the risk of misuse in opioid naïve patients.

Patients treated by PCP in hospital have longer stay, lower mortality

Patients treated by PCPs vs hospitalists can have lengthier hospital stays and lower 30-day mortality rates.

Pharmacomechanical thrombolysis does not reduce post-thrombotic syndrome in DVT

The addition of pharmacomechanical thrombolysis does not reduce the risk of post-thrombotic syndrome among patients with acute proximal deep vein thrombosis.

Healthcare system fires 50 employees for refusing influenza vaccination

A Minnesota-based hospital chain fires about 50 employees for refusal to receive the influenza vaccine.

Direct oral anticoagulants vs warfarin for bleeding risk in VTE

Compared with warfarin, treatment with DOACs was not associated with an increased risk of major bleeding or all-cause mortality within the first 90 days.

Postoperative mortality lower among patients treated by female surgeons

Fewer patients treated by female surgeons died, were readmitted to the hospital, or had complications within 30 days of surgery.

Longer hospital stay linked to low health literacy

Low health literacy is associated with a longer hospital length of stay in general medicine patients.

Longer anesthesia duration linked to increased surgical complications

Among patients undergoing microvascular reconstruction of the head and neck, increased anesthesia duration is associated with higher rates of complications.

Non-vitamin K oral anticoagulants with other medications increase bleeding risk in A-Fib

The researchers found that concurrent use of amiodarone, fluconazole, rifampin, and phenytoin was associated with increased risk of major bleeding compared with the use of NOACs alone.

Increased cancer risk found in rheumatoid arthritis patients with VTE

VTE and cancer are the result of inflammation and immunological dysfunctions associated with RA.

Venous thromboembolism risk strongly linked to height in men and women

Researchers found a strong association between VTE and height using sibling pair analysis.

Weekend hospital admissions linked to higher mortality rate

Patients admitted to the ER during weekends as opposed to weekdays have a higher mortality rate.

AAP: Physicians provide little information on firearm injury prevention

The biggest predictors of clinicians providing firearm safety counseling were feeling that the information could help reduce pediatric injuries.

Many avoidable emergency department visits include mental health and dental conditions

A significant number of avoidable visits to the emergency department are related to mental health and dental conditions.

About 5% of patients with unprovoked VTE develop occult cancer

Researchers observed a linear increase in cancer prevalence with age, with a 7-fold higher prevalence in patients older than 50 years of age.

Comparing anticoagulants to prevent venous thromboembolism after hip and knee arthroplasty

Fondaparinux and rivaroxaban were associated with increased risk of major bleeding in patients who underwent total hip or knee arthroplasty.

Forty percent of hospitalized patients report breakdowns in care

Hospital patients reported breakdowns in care, which included information exchange, medications, delays in admission, team communication, providers' manner, and discharge.

Increased mortality for percutaneous coronary intervention at safety-net hospitals

Risk-adjusted in-hospital mortality is significantly increased at safety-net hospitals for patients undergoing percutaneous coronary intervention.

Less than 10% of women present to the ER after hysterectomy for benign disease

Risk factors for emergency department visits include younger age, higher parity, Medicare or self-pay insurance, and postoperative pain.

New data show aspirin safe for heart failure patients

Data from a clinical trial show that patients taking daily aspirin were not at heightened risk of being hospitalized for heart failure.

WHO updates Essential Medicines List, recommendations for antibiotics

The update includes 30 new medicines for adults and 25 for children and groups antibiotics into 3 distinct categories.

Effects of the obesity paradox: VTE risk in atrial fibrillation

Researchers found a paradoxical increase in thromboembolism risk in low-weight patients with atrial fibrillation and VTE who were treated with direct oral anticoagulants.

Adverse events common in hospitalized patients taking antibiotics

Many adverse events could be avoidable with more judicious use of antibiotics.

Idarucizumab reverses anticoagulant effect of dabigatran in emergency situations

Researchers found that idarucizumab is effective for dabigatran reversal among patients with uncontrolled bleeding and who are undergoing urgent surgery.

Heart failure hospitalization rate declining in the United States

There were 526.86 hospital admissions for every 100,000 people in 2002, compared with 364.66 per 100,000 in 2013.

Hospital revisits after discharge from observation increase among elderly

Increases were observed in repeat observation stays and any hospital revisit for seniors between 2006 and 2011.

NPs improve care coordination for high-risk complex care patients post-discharge

Post-discharge care from hospital to community coordinated by an NP in high-risk complex care patients reduced hospital readmission rates.

NPs have favorable view of retail health clinics

A survey found that 77.4% of NPs reported that the care provided in retail health clinics was in accordance with evidence-based guidelines.

Rivaroxaban decreased VTE rate in high-risk orthopedic joint surgery patients

Researchers developed a protocol to demonstrate the efficacy of rivaroxaban in lowering the risk of venous thromboembolism among orthopedic joint surgery patients.

Patients routinely overcharged in US emergency departments

Researchers say that minorities and uninsured patients are the most affected.

Restarting anticoagulation may be cost-effective in some VTE cases

The therapy may be cost-effective for patients with a predicted 1-year VTE risk of 17.5% or more.

Patients treated by older physicians have higher mortality than those cared for by younger physicians

Researchers found that patients treated by older physicians had higher 30-day mortality than those cared for by younger physicians, despite similar patient characteristics.

Warfarin dosing in HIV patients with deep venous thrombosis

Results showed that mean induction times, analyzed in 170 patients, were 12.87 days in the HIV-infected patients and 11.19 days in the HIV-uninfected patients.

Surgical pulmonary embolectomy for thrombus distribution is feasible, effective

Surgical pulmonary embolectomy for peripheral distribution of thrombus demonstrated positive outcomes in patients with either CPE or PPE.

Case study: Recurrent deep vein thrombosis in thoracic outlet syndrome

A 53-year-old woman presents to the emergency room for right upper extremity deep vein thrombosis after rib resection and subclavian vein stent placement.

Short-term oral corticosteroid use associated with increased risk for sepsis, venous thromboembolism

Approximately 1 in 5 American adults use corticosteroids in the short term, which is associated with an increased risk for sepsis, venous thromboembolism, and fracture.

Wrong-patient orders are more likely in NICU vs non-NICU pediatric units

Implementation of a combined ID re-entry intervention and distinct naming convention greatly reduced the risk.

First-year residents will be able to work 24-hour shifts

The ACGME announces that residency programs can increase shift hours for first-year residents from 16 to 24 hours.

Peroxide ingestion as a "natural cure" can be fatal

Symptomatic high-concentration peroxide exposures had a high incidence of associated embolic events.

Death rate high in elderly within 7 days of discharge from emergency department

More than 10,000 Medicare beneficiaries die each year within 7 days of being discharged from emergency departments.

Mortality rate lower in US patients treated by foreign-educated internists

Researchers observed a somewhat lower mortality among patients treated by international graduates.

Testosterone treatment may increase risk of venous thromboembolism

Researchers sought to determine the risk of venous thromboembolism associated with use of testosterone treatment.

Warfarin may be linked to reduced thromboembolism in nonvalvular atrial fibrillation

The reduction in thromboembolism was attenuated after accounting for competing death events.

Use of stronger antibiotics increases in US hospitals

Although the overall use of antibiotics in US hospitals is unchanged, use of broad spectrum agents has increased significantly.

Vital sign instability at hospital discharge linked to increased mortality risk

Nearly 17% of patients exhibiting one unstable vital sign at hospital discharge were readmitted or died within 30 days.

ICU care is frequently overused and may not improve hospital mortality

Hospital mortality rates do not improve in institutions that frequently use ICU care for patients.

Inpatient mortality, length of stay decreasing for COPD patients, but financial burden increasing

For patients hospitalized with COPD, mortality and length of stay have decreased while financial burden has increased.

Managing aspergillosis: updated guidelines from IDSA

New guidelines for the treatment and management of aspergillosis have been published by the Infectious Diseases Society of America.

New opioid use common post-hospital discharge among Medicare beneficiaries

After an acute hospitalization, many Medicare beneficiaries submit pharmacy claims for opioid prescriptions.

Short-term STICU patients often admitted for brief ventilator management

Almost one-quarter of patients admitted to the STICU short term are there for <4 hours of ventilator management.

Effective strategies to prescribe opioids, provide pain relief in hospital settings urgently needed

Clinicians in hospital settings need strategies in place to safely provide opioid pain relief to hospitalized patients.

Hospitalizations due to opioid abuse, dependence increasing significantly

Since 2002, the number of hospitalizations due to opioid abuse and dependence has increased by 72%.

Nonurgent patients routinely receive urgent care in emergency departments

Triage practices in EDs are essential to providing patient care.

Supportive-care visits while hospitalized linked to fewer adverse outcomes

Visited patients were also more likely to access community health services.

Prenatal steroids reduce respiratory complications in late preterm infants

Administering steroids to pregnant women likely to give birth before 37 weeks can reduce infants' risk of respiratory complications.

House calls from PAs reduce hospital readmissions after cardiac surgery

After adult cardiac surgery, patients are less likely to be readmitted to the hospital if they receive house calls from PAs.

Medication errors, adverse drug reactions occur in half of surgeries

About 5% of medication administrations during the perioperative period include errors or adverse drug events.

New vaccines help reduce respiratory, diarrhea-related hospitalizations

The introduction of pneumococcal conjugate and rotavirus vaccines has helped to reduce hospitalizations from respiratory infections and diarrhea.

Assessing dyspnea severity can improve cardiopulmonary care

The majority of hospitalists agree that routine dyspnea severity assessment would improve patient care.

Health insurance should cover primary care inpatient consultations, says AAFP

Health insurance companies should considering paying PCP for inpatient consulting services.

Hospital patients with HIV often die from non-AIDS causes

HIV patients undergoing ART often die from non-AIDS infections and cardiovascular disease.

Top five unnecessary medical procedures for newborns

Experts reached a consensus on the top five unnecessary medical treatments and tests for newborns.

Primary care physicians can help bridge hospital transition gaps

Care coordination can help hospital patients transition from inpatient to outpatient-only care.

Preventing acute kidney injury

Monitoring kidney function in hospitalized patients can help prevent acute kidney injury.

Primary care bundle aims to reduce ED, hospital readmissions

Health 360 is designed to be applied by an interprofessional collaborative care team and facilitated by nurse practitioners.

Quitting smoking improved pressure sore healing in patients with spinal cord injuries

Quitting smoking improved spinal cord injury quality of life.

Adjunctive corticosteroids may improve outcomes in community-acquired pneumonia

Adults hospitalized with pneumonia benefit from the addition of corticosteroids to antibiotic treatment.

Phone intervention reduced pediatric hospital readmission rates

Post-discharge phone calls have the potential to improve compliance with and understanding of hospital discharge instructions.

Clostridium difficile infections most prevalent in Northeast

C. difficile costs as much as $4.8 billion in estimated extra health care costs per year.

Antibiotic shortages may catch providers off guard

Many of the drug shortages were of broad-spectrum antibiotics.

Nurse-physician collaboration cuts ICU infection rates

Units with more nursing hours per patient-day had a 0.42 decrease in the rate of bloodstream infections.

Use metric dosing for kids' medications

New recommendations are designed to prevent caregivers from accidentally measuring out 10 times the prescribed dose.

Elderly at risk one year post-hospitalization

Within one year of being discharged from the hospital for heart failure, 67.4% of patients enrolled in the study were readmitted to the hospital and 35.8% died.

Hospital-acquired infections rates are falling

Decreases were seen in central-line associated bloodstream infections and surgical-site infections.

Statin use poses low risk of hepatic injury in liver disease

There was no difference overall in the incidence with different statins, but high-dose atorvastatin was associated with increased hospitalization.

Nearly 50% of hospitalized kids exposed to potentially dangerous drug combos

Opioids such as morphine and oxycodone were drugs most often involved in potentially dangerous drug interactions.

Formalized programs help lower antibiotic prescribing rates

Hospitals that implemented a formalized antibiotic stewardship program saw an overall reduction in antibiotic use.

Educate parents on child safety after falls at home

Fall-prevention advice may help reduce the risk of injuries at home amongst toddlers.

Avoid these five emergency department tests

The American College of Emergency Physicians has issued another list of five tests and procedures that should be questioned before use.

Hand dryers may be unsuitable in health-care settings

Compared with paper towels, jet air and warm air dryers in public restrooms had higher bacteria levels.

Medication errors occur every 8 minutes in kids

Though 94% of those mistakes didn't require medical treatment, 25 led to deaths and about 1,900 critical care admissions.

Meds main cause of U.S. allergy-related deaths

Fatal anaphylaxis caused by medications, food, and unspecified allergens was significantly associated with race and older age.

Half of hospitalized Americans are prescribed antibiotics

Of the patients, 79.5% received antibiotics to treat infections, and 19.0% received them to reduce the risk of infection during surgeries.

HIV-positive patients at higher risk of spinal fusion-related complications

Compared with HIV-negative patients, study participants with HIV infection had significantly higher rates of complications.

Ultrasound accurate in confirming carpal tunnel syndrome

Compared with electrodiagnostic testing, ultrasound was more accurate in diagnosing carpal tunnel syndrome.

Nine facts about medical malpractice every health-care provider should know

New York Law School publishes an update on the state of medical malpractice information in the United States.

Drug-resistant CRE increasing in southeastern U.S. hospitals

Greater use of broad-spectrum antibiotics, increased transmission from long-term acute care facilities associated with increases in carbapenem-resistant Enterobacteriaceae.

NP-led acute care teams improve inpatient care

Better care coordination may help reduce patient complications and length of stay.

Ortho-trained PAs shorten hospital stays

Introducing a single full-time orthopedic trained PA in the hospital setting benefited patients undergoing total knee arthroplasty.

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