Dr. Galloway

Urinalysis Is Reliable Infection Predictor in Infants

Clinical question: In infants younger than three months of age with bacteremic urinary tract infection (UTI), how sensitive and specific are urinalysis (UA) findings? Background: Infants are commonly hospitalized with UTIs. The gold standard for diagnosis is considered to be urine culture. When compared to this gold standard, the sensitivity of UA findings for the… [Read More]

30-Day Readmission May Be Due to Income or Education

When patients are hospitalized more than once in the same month, it may have more to do with their income or education levels than the quality of care they received, a U.S. study suggests. Perhaps unsurprisingly, patients 85 and older are more likely to return to the hospital within 30 days of being sent home than people a decade or… [Read More]

Hospitalists in Richmond, Virginia Take Lead in Admitting Patients with Left Ventricular Assist Devices

Left ventricular assist devices (LVADs) are rapidly becoming commonplace treatment for end-stage heart failure, either as a bridge to transplant or as destination therapy alone.1,2 More and more patients are surviving with LVAD therapy and going on to live full lives that include, unfortunately, other illnesses and readmission to the hospital for noncardiac complaints. For… [Read More]

High-Flow Nasal Oxygen Therapy Noninferior to BiPAP in Post-Operative Respiratory Failure

Clinical question: In post-operative cardiothoracic surgery patients, is high-flow nasal oxygen therapy inferior to BiPAP for resolution of acute respiratory failure? Background: Acute respiratory failure is common following cardiothoracic surgery, and noninvasive ventilation often is used to avoid intubation. Noninvasive ventilation is resource-intensive and might be uncomfortable to patients. High-flow nasal oxygen therapy is an… [Read More]

Supplemental Oxygen During STEMI Might Increase Myocardial Injury

Clinical question: Does routine oxygen supplementation in patients with STEMI increase myocardial injury? Background: Because of physiologic and clinical studies conducted before the era of acute coronary intervention, supplemental oxygen routinely is administered to patients with STEMI, regardless of oxygen saturation; however, recent studies have shown possible adverse effects of oxygen, including increased reperfusion injury… [Read More]

Thrombectomy Within Eight Hours of Stroke Onset Reduces Post-Stroke Disability

Clinical question: Does thrombectomy, in conjunction with medical therapy, improve functional independence in patients with an acute proximal anterior stroke? Background: Revascularization of proximal anterior strokes with alteplase alone occurs less than 50% of the time. First-generation thrombectomy devices (i.e., Merci and Penumbra) have not shown improvement in revascularization or functional outcomes; however, the development… [Read More]

Interdisciplinary Team Care on General Medical Units Does Not Improve Patient Outcomes

Clinical question: Does interdisciplinary care on general medical wards improve patient outcomes? Background: Patients on general medical wards might experience errors and/or preventable deaths. One mechanism that could reduce the risk of errors or preventable death is the utilization of interdisciplinary team care. Study design: Systematic review. Setting: Studies published in English from 1998 through… [Read More]

Patient Satisfaction Scores, Objective Measures of Surgical Quality Have Positive Association

Clinical question: Is there an association between objective measures of surgical quality and patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey? Background: The Centers for Medicare and Medicaid Services (CMS) has tied financial reimbursement to patient satisfaction scores. It is unknown whether high-quality surgery correlates with higher… [Read More]

Extended Anticoagulation Therapy and Recurrent Rates of Venous Thromboembolism

Clinical question: Among patients with a first episode of unprovoked pulmonary embolism (PE), what are the benefits and harms of extending the duration of anticoagulation for secondary prophylaxis against recurrent VTE? Background: Optimal duration of anticoagulation after initial unprovoked PE is not known. Prior studies demonstrated risk reduction of recurrent VTE while on therapy but… [Read More]

Wells Score Can’t Rule Out Deep Vein Thrombosis in Inpatient Setting

Clinical question: Should the Wells score be used for DVT risk stratification in the hospital? Background: The Wells score was derived to reduce lower extremity ultrasounds (LEUS) in the outpatient evaluation of DVTs. There has never been a large prospective trial to validate its use in hospitalized patients. Study design: Single-center, prospective cohort study. Setting:… [Read More]