Clinical

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Most Important Elements of End-of-Life Care

An Australian team conducted a literature review of expected deaths in the hospital—where the majority of deaths in the developed world occur—and identified elements of end-of-life care that are important to patients and families.1 Published in the British journal Palliative Medicine, the review of nine electronic data bases and 1859 articles released between 1990 and… [Read More]

Clinical Variables Predict Debridement Failure in Septic Arthritis

Clinical question: What risk factors predict septic arthritis surgical debridement failure? Background: Standard treatment of septic arthritis is debridement and antibiotics. Unfortunately, 23%-48% of patients fail single debridement. Data is limited on what factors correlate with treatment failure. Study design: Retrospective, logistic regression analysis. Setting: Billing database query of one academic medical center from 2000-2011…. [Read More]

Prednisolone or Pentoxifylline Show No Mortality Benefit in Alcoholic Hepatitis

Clinical question: Does administration of prednisolone or pentoxifylline reduce mortality in patients hospitalized with severe alcoholic hepatitis? Background: Alcoholic hepatitis is associated with high mortality. Studies have shown unclear mortality benefit with prednisolone and pentoxifylline. Despite multiple studies and meta-analyses, controversy about the use of these medications persists. Study Design: Multicenter, double-blind, randomized trial with… [Read More]

Corticosteroids Show Benefit in Community-Acquired Pneumonia

Joshua LaBrin, MD, SFHM, Kencee Graves, MD, Karli Edholm, MD, Devin Horton, MD, and
Katie Lappe, MD; Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City

Weijen Chang, MD, SFHM, FAAP

Standard Discharge Communication Process Improves Verbal Handoffs between Hospitalists, PCPs

Clinical question: Can a standardized discharge communication process, coupled with an electronic health record (EHR) system, improve the proportion of completed verbal handoffs from in-hospital physicians to PCPs within 24 hours of patient discharge? Background: Discharge from the hospital setting is known to be a transition of care fraught with patient safety risks, with more… [Read More]

Nomogram Predicts Post-Operative Readmission

Clinical question: Can a nomogram accurately predict a patient’s risk of post-operative 30-day readmission? Background: Medicare and Medicaid have implemented penalties for hospitals with high readmission rates. While this does not yet apply to post-operative readmissions, there is concern that it soon will. Algorithms for predicting readmission have been developed for medical patients; however, to… [Read More]

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Antibiotic Stewardship and Hospitalists: How to Educate Patients on Antibiotics

Editor’s note: This article originally appeared on SHM’s official blog, “The Hospital Leader,” in June 2015. “Tell me what you know about antibiotics.” That’s the discussion I start with hospitalized patients all the time, right after they ask me to prescribe antibiotics for their simple cough or other viral-like illness. And, from their perspective, asking for… [Read More]

Antiepileptic Drugs Reduce Risk of Recurrent Unprovoked Seizures

Clinical question: What are the updated recommendations for treating first unprovoked seizure in adults? Background: Approximately 150,000 adults present with an unprovoked first seizure in the U.S. annually, and these events are associated with physical and psychological trauma. Prior guidelines discussed evaluation of unprovoked first seizures in adults but did not address management. This publication… [Read More]

PPI Usage with SBP Prophylaxis Predicts Recurrent Infections in Cirrhosis

Clinical question: What are the risk factors for development of a recurrent infection in cirrhotic patients hospitalized with an initial infection? Background: Infections are a major cause of morbidity and mortality in patients with cirrhosis. Prior retrospective data suggest that proton pump inhibitors (PPIs) increase the risk of infections in cirrhotic patients, while beta blockers… [Read More]

Nontoxigenic C. diff Spores May Decrease Rates of Recurrent CDI

Clinical question: Is treatment with nontoxigenic C. diff strain M-3 (NTCD-M3) safe and effective in preventing recurrent Clostridium difficile infection (CDI)? Background: C. diff is the most commonly identified healthcare pathogen, and CDI has a 25%-30% recurrence rate. Not all C. diff strains produce toxins, and gastrointestinal (GI) tract colonization with NTCD has been shown… [Read More]