Clinical

Intermittent PPI = Continuous-Infusion PPI for High-Risk Bleeding Ulcers

Clinical question Is intermittent proton pump inhibitor (PPI) therapy comparable with continuous-infusion PPI for the treatment of patients with high-risk bleeding ulcers who have undergone endoscopic therapy? Bottom line For patients with high-risk bleeding ulcers who have been treated endoscopically, treatment with intermittent proton pump inhibitor (PPI) therapy is as effective as continuous infusion of… [Read More]

PEG Better and Faster than Lactulose for Initial Treatment of Hepatic Encephalopathy

Clinical question Is polyethylene glycol 3350-electrolyte solution an effective treatment for hospitalized patients with acute hepatic encephalopathy? Bottom line Polyethylene glycol 3350-electrolyte solution (PEG) is a safe and effective therapy for the initial treatment of acute hepatic encephalopathy (HE) in hospitalized patients. As compared with lactulose alone, the use of PEG alone during the first… [Read More]

Who Should Be Screened for HIV Infection?

Who Should Be Screened for HIV Infection?

Case A 31-year-old male with a history of asthma is admitted with an asthma exacerbation. He has no regular outpatient provider. He denies tobacco use and reports that he is in a monogamous relationship with his girlfriend. On rounds, a medical student mentions that new HIV screening guidelines have been released recently and asks whether… [Read More]

Sleep Apnea Should Be Addressed in Heart Failure Population

Before you fall asleep at the thought, consider the fact that sleep apnea has been identified as a major contributing factor in new onset atrial fibrillation (Afib), acute ischemic stroke, and heart failure. How well are inpatients, in particular those with heart failure, being screened and treated for sleep apnea? To answer this question, the… [Read More]

Ebola Treatment Centers Needed in North America

As the hysteria about Ebola spreads, hospitalists who have been running most of the country’s ICUs will find themselves at the forefront of treating these patients when more of them present at our different hospitals. It is now time for America to come into the age of Ebola and treat Ebola patients in Ebola centers,… [Read More]

Dr. Smith

Academic Hospitalist Groups Use Observation Status More Frequently

Insurers’ use of certain criteria to separate hospital stays into inpatient or observation status remains widespread. Observation status ensures provider reimbursement for hospitalizations deemed necessary by clinical judgment but not qualifying as inpatient care. Admission under observation status impacts the patient’s financial burden, as well, with observation admissions typically associated with increased out-of-pocket costs. Although… [Read More]

Medical Consultants Provide Benefits for Hospitalized Surgical Patients

Clinical question: How are medical consultants used for hospitalized surgical patients, and how does this vary among regions and hospitals in the U.S.? Background: Reimbursement for surgical procedures is moving toward bundled payments, making it increasingly important to understand the use of resources in order to improve efficiency and quality of care. Study design: Observational,… [Read More]

Fluid Resuscitation in Sepsis: Systematic Review and Network Meta-Analysis

Clinical question: Is there any difference between different resuscitative fluids (crystalloids or colloids) on mortality in critically ill sepsis patients? Background: Fluid resuscitation, in addition to antibiotics and source control, is a cornerstone of initial management of sepsis. Resuscitation with crystalloids compared with colloids for critically ill patients has been evaluated in large randomized, controlled… [Read More]

Hip Fracture Adverse Outcomes Among Nursing Home Residents

Clinical question: What are the risk factors for mortality and functional decline following hip fracture among nursing home residents? Background: Little is known about the survival and functional outcomes of nursing home residents who sustain hip fracture. Previous studies on hip fracture have either excluded nursing home residents or have been limited by small sample… [Read More]

Post-Operative Pneumonia Reduced by Standardization in Noncritical Surgical Patients

Clinical question: What is the long-term effectiveness of a standardized pneumonia prevention program among surgical noncritical inpatients? Background: Few studies have focused on the prevention of post-operative pneumonia in non-mechanically ventilated patients. The current study describes the effectiveness of an intervention designed to reduce post-operative pneumonia among noncritical patients who did not require mechanical ventilation…. [Read More]