Hospitalists Can Join SHM’s New ‘Fight the Resistance’ Campaign

In June, Eric Howell, MD, SFHM, SHM’s senior physician advisor, attended a White House forum on antibiotic resistance. That day, SHM committed to empowering hospitalists to fight antibiotic resistance through better prescribing behaviors. In a blog post on The Hospital Leader, Dr. Howell wrote, “This isn’t limited to a single hospital. There are now more… [Read More]

Oral Steroids Not Inferior to Intravenous Steroids in Multiple Sclerosis Relapses

Clinical question: Is there any difference between oral and intravenous methylprednisolone for multiple sclerosis relapses? Background: When relapses of multiple sclerosis occur, studies have shown that intravenous steroids are the treatment of choice. Prior Cochrane meta-analyses have not found any significant difference between intravenous and oral treatments; however, the studies all have had limitations. This… [Read More]

Coronary CT Angiography, Perfusion Imaging Effective for Evaluating Patients With Chest Pain

Clinical question: When evaluating the intermediate-risk patient with chest pain, should coronary computed tomography angiography (CCTA) be used instead of myocardial perfusion imaging (MPI)? Background: CCTA has been shown in prior randomized controlled trials to save time and money compared to other protocols, including stress ECG, echocardiogram, and MPI. Less information is available as to… [Read More]

Can Low-Risk Patients with VTE Be Discharged from ED on Rivaroxabon?

Clinical question: Can a low-risk patient newly diagnosed with VTE in the ED be immediately discharged home on a direct factor Xa inhibitor? Background: Studies have shown that rivaroxaban incurs a risk of 2.1% in VTE recurrence and of 9.4% in clinically relevant major and non-major bleeding (in an average 208 days follow-up). More information… [Read More]

Clinical Care Pathway for Cellulitis Can Help Reduce Antibiotic Use, Cost

Clinical question: How would an evidence-based clinical pathway for cellulitis affect process metrics, patient outcomes, and clinical cost? Background: Cellulitis is a common hospital problem, but its evaluation and treatment vary widely. Specifically, broad-spectrum antibiotics and imaging studies are overutilized when compared to recommended guidelines. A standardized clinical pathway is proposed as a possible solution…. [Read More]

When Should Hospitalists Order Continuous Cardiac Monitoring?

Case Two patients on continuous cardiac monitoring (CCM) are admitted to the hospital. One is a 56-year-old man with hemodynamically stable sepsis secondary to pneumonia. There is no sign of arrhythmia on initial evaluation. The second patient is a 67-year-old man with a history of coronary artery disease (CAD) admitted with chest pain. Should these… [Read More]

ED Lung Ultrasound Useful for Differentiating Cardiogenic from Noncardiogenic Dyspnea

Clinical question: Is lung ultrasound a useful tool for helping to diagnose acute decompensated heart failure (ADHF)? Background: Lung ultrasound is an emerging bedside tool that has been promoted to help evaluate lung water content to help clinicians differentiate ADHF from other causes of dyspnea. Study design: Prospective, multicenter, observational cohort study. Setting: Seven EDs… [Read More]

New Studies Find RIPC Ineffective

NEW YORK – The theory that heart surgery can be made safer by periodically cutting off blood flow to an arm has been called into serious question. Two large randomized studies, published online by the New England Journal of Medicine and presented on Oct. 5 at the European Society of Intensive Care Medicine Congress in Berlin, show that the technique, known… [Read More]