Hospital Medicine News Archive

Higher-Volume Hospitals Have Better Laryngectomy Outcomes

Reduced morbidity associated with a minimum hospital volume threshold of 6 cases/year.

Patients Hospitalized for COPD Rarely Receive Pulmonary Rehab

Elderly, those living 10 miles from facility, those with lower SES less likely to receive pulmonary rehab.

Harms Identified With Nonoperative Management of Appendicitis

Higher likelihood of readmission, developing abscess; more follow-up needed in year after admission.

Insurance Coverage for Adult Obesity Care Increasing

Findings among Medicaid, state employee health insurance programs in 2009 to 2017.

Online Patient Reviews of EDs and Urgent Care Centers Inform Care Delivery

Publicly available online ratings of emergency departments and urgent care centers provide important insights for health systems.

Poor Experience With PCP Linked to Hospitalization in CKD

Risk of hospitalization up for Hispanic patients with lower scores on Ambulatory Care Experiences Survey.

Simple Clinical Assessment in ED Best for Predicting Mortality

Agreement between formalized triage assessment and simple clinical assessment was poor.

CDC: Many Children With Heart Conditions Have Special Needs

One in 77 US children reportedly had heart conditions in 2016, with special needs in 60%.

Timing of Pushing Does Not Impact Spontaneous Vaginal Delivery

Rate of spontaneous vaginal delivery similar for immediate pushing or waiting for 60 minutes.

One-Third of Older Adults Die After Emergency Intubation

Twenty-four percent of adults aged 65 years who undergo intubation in ED are discharged home.

Hospital Privacy Curtains Become Increasingly Contaminated

Ten to 14 days after being hung, curtains show increased MRSA positivity.

Effects of Parental Decision Aids on ED CT Rates Among Children at Risk for TBI

Emergency department computed tomography rates for children with minor head trauma were not affected by parent decision aid use.

Implementing EMRs Affects Time Spent With Patients in Clinic

Even after return to pre-EMR efficiency, more time spent on documentation, less on patient interaction.

Interpreter Services Critical for Emergency Care

Authors recommend professional interpreter when practical if patient has limited English proficiency.

Actigraphy May Overestimate Sleep in ICU Setting

Wide ranges of sleep quality and quantity with use of actigraphy among critically ill patients in ICU.

Dozens of Medical Groups Join Forces to Improve Diagnoses

Diagnostic error is the most common cause of medical errors that patients report.

No Clear Benefit for Rivaroxaban After Hospital Discharge

Incidence of major bleeding low with rivaroxaban, but clot risk not lower.

Ambient Particulate Matter Linked to Emergency Asthma Care

Increase in asthma hospital visits with increasing ambient particulate matter in San Luis Valley.

Recommendations Issued for Enhancing ICU Diagnostic Safety

Include enhancing recognition of potential errors, increasing teamwork, patient-centeredness.

Reducing HF Hospitalization Risk: Antidiabetic Drug Classes Compared

The authors searched for randomized placebo-controlled trials (December 1, 2008 to November 24, 2017) involving 3 pharmacologic classes of antidiabetic medications to compare the effects of these agents on the risk of hospitalization for HF in T2DM patients.

Nurse-Led Call After Discharge Doesn't Cut Peds Urgent Care

One-time nurse-led call does not lower reutilization of urgent care services after pediatric discharge.

Discharge Directly From ICU Not Linked to Increased Health Care Use or Mortality

Patient discharge directly home from intensive care compared with discharge from a hospital ward was not associated with increased healthcare resource use or mortality.

New Bronchoscopic Option Used for Severe Emphysema

First bronchoscopic lung volume reduction using endobronchial valve performed at Temple University.

Physician Assistants Match Medical Residents in ICU Skills

Score in clinical performance in the simulated ICU setting equal for PAs, medical residents.

Medicare, Med Advantage Health Care Use Differs Regionally

Variation in skilled nursing facility, hospital care up in Medicare Advantage vs traditional Medicare.

Laryngeal Tube Insertion Beats Endotracheal Intubation in OHCA

And, 30-day functional outcomes similar with supraglottic airway device or tracheal intubation.

Opioid-Related Emergency Department Visits, Hospitalization Rates Decrease From 2009 to 2015

The number of patients prescribed opioids and visiting an emergency department or requiring hospitalization decreased from 2009 to 2015.

Lower Long-Term Survival for In-Hospital Cardiac Arrests in Blacks

Black survivors of in-hospital cardiac arrest have lower survival at 1, 3, 5 years vs whites.

Information Deficits, Moral Stances Contribute to Lack Interest in Organ Donation

A person's unwillingness to become an organ donor may be explained by a significant information deficit, mistrust for the medical establishment, or a moral opposition to killing.

Lumpectomy + Radiation May Cut Breast Cancer Mortality in DCIS

Lumpectomy, radiotherapy tied to reduction in breast cancer mortality vs lumpectomy, mastectomy.

AAP Outlines Appropriate Pediatric Nephrology Testing

Five evidence-based recommendations list tests, procedures that doctors, patients should question.

Majority of Patients With Liver Metastases From Colorectal Cancer Eligible for Laparoscopy

In high-volume centers, patients with liver metastases from colorectal cancer may often be eligible for minimally invasive liver surgery via laparoscopy, thereby reducing potential morbidity risks associated with open surgery.

DNR Orders Linked to Increased Mortality in Older Adults

Early vs late DNR tied to shorter median length of stay in hospitalized adults aged 65 years and older.

Completing Sepsis Bundle Within an Hour Cuts Pediatric Mortality

However, completing individual bundle elements in that timeframe does not reduce pediatric mortality.

CDC: EMS Administration of Naloxone Up From 2012 to 2016

Monitoring non-fatal overdose events from EMS data may aid in developing emergency response.

Resource Use Greater for More Severe Pediatric Appendicitis

Findings suggest need for reimbursement to have severity adjustment, especially in underserved areas.

Elevated Late Mortality Persists After Blood or Marrow Transplant

But in past 3 decades, decrease in late mortality seen among those who underwent BMT in childhood.

Ethical Guidelines for Living Donor Transplantation

The Belmont Report provides an appropriate framework for living donor organ transplantation.

Pediatric Ward Noise at Night Exceeds Recommended Levels

Poorer quality sleep for children, parents attributed to high levels of noise.

More Preventive Care Guidelines Linked to Less Preventive Care Utilization

An increase in guideline-recommended preventive services may be associated with a decrease in patient utilization of each suggested service, which may have a negative impact on patient life expectancy or quality of life.

Embezzlement Not Uncommon in Medical Practices

Employees should undergo detailed background checks; practices should have zero-tolerance for theft.

2001 to 2015 Saw Decline in Self-Employment in Health Care

Gap in earnings between self-employed and employed health care professionals also decreased.

Pelvic Exam in ER Doesn't Help Predict STI for Young Females

Pelvic exam doesn't add to history for diagnosis of STIs in young females with suspected cervicitis, PID.

fMRI Evidence for Social Motivation Hypothesis of Autism

These data show that ASD may arise from an early neurobiological difference in response to rewarding social stimuli, which could result in reduced social motivation.

Red Cross Calls for Blood Donors

While all blood types are needed, type O negative and positive are especially crucial.

WHO Calls for Renewed Effort to Combat Chronic Disease

Commission makes 6 recommendations to meet 2030 goals for non-communicable diseases

FDA Permits Marketing of Devices to Create Arteriovenous Fistula

Two devices designed to create arteriovenous fistula in patients with CKD in need of hemodialysis

AMA Calls for Electronic Health Record Training

Association says medical students, residents should undergo training with evaluative feedback.

Intensive Management Program Benefits High-Risk Patients

Use of an intensive management program for high-risk patients is associated with greater receipt of outpatient care with no increase in total costs.

AMA: Docs Declare Drug Shortages Public Health Emergency

AMA calls for greater manufacturer transparency in order to prepare for disasters, mitigate shortages.

Discharge Tools, Follow-Up Calls Reduce Readmission for Congestive Heart Failure

A literature review revealed that the use of care navigators in conjunction with follow-up telephone calls from nursing staff improved transition of care and readmission rates in patients with congestive heart failure.

Preoperative Testing, Management: Addressing a Potential Hospitalist NP Gap

Hospitalist NPs are key to successfully implementing Society of Hospital Medicine guidelines for preoperative testing and management.

Quantification of Prevalence, Outcomes of Incidental Imaging Abnormalities

Incidental abnormalities are most frequently observed in computed tomography colonoscopy, computed tomography of the chest, and cardiac magnetic resonance imaging.

Clotting Time in Transfemoral PCI Linked to Bleeding Risk

More major bleeding seen at maximal activated clotting time greater than 290 seconds.

Study Compares Treatment Options for T1a Renal Cancer

Percutaneous ablation compared with partial, radical nephrectomy for 4,310 patients aged 66 years

C difficile Risk Higher With Stoma Reversal vs Colectomy

Findings based on examination of 30-day postoperative period in large cohort

Double Lung Transplantation Improves Survival in Interstitial Pulmonary Fibrosis

Double lung transplantation appears to offer superior survival outcomes to single lung transplantation in patients with interstitial pulmonary fibrosis who are younger than 70 years.

Increase in Global Cancer Incidence, Drop in Death Rates

From 2006 and 2016, smallest increase seen in high Sociodemographic Index countries.

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.

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