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Intermittent, Continuous Proton Pump Inhibitor Therapies Are Comparable
February 2, 2015
Clinical question: Is intermittent proton pump inhibitor (PPI) therapy comparable to the current standard of continuous PPI infusion for high risk bleeding ulcers? Background: Current guidelines recommend an intravenous bolus dose of a PPI followed by continuous PPI infusion for three days after
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VTE Treatment Strategies Don’t Differ in Efficacy, Safety
February 2, 2015
Clinical question: Are there differences in efficacy and safety between the treatment strategies for acute venous thromboembolism (VTE)? Background: There are a number of treatment strategies available for acute VTE.
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Antimicrobial Prescribing Common in Inpatient Setting
February 2, 2015
Clinical question: What is the daily prevalence of antimicrobial use in acute-care hospitals? Background: Inappropriate antimicrobial use is associated with adverse events and contributes to the emergence of resistant pathogens. Strategies need to be implemented to reduce inappropriate use.
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Hemoglobin Transfusion Threshold Not Associated with Differences in Morbidity, Mortality Among Patients with Septic Shock
February 2, 2015
Clinical question: Is there a difference in 90-day mortality and other outcomes when a lower versus higher hemoglobin threshold is used for blood transfusions in ICU patients with septic shock? Background: Patients with septic shock frequently receive blood transfusions.
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Early, Goal-Directed Therapy Doesn’t Improve Mortality in Patients with Early Septic Shock
February 2, 2015
Clinical question: Does early goal-directed therapy (EGDT) improve mortality in patients presenting to the ED with early septic shock? Background: EGDT (achieving central venous pressure of 8-12 mmHg, superior vena oxygen saturation (ScvO2) of > 70%, mean arterial pressure ≥ 65mmHg, and urine
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Arterial Catheter Use in ICU Doesn’t Improve Hospital Mortality
February 2, 2015
Clinical question: Does the use of arterial catheters (AC) improve hospital mortality in ICU patients requiring mechanical ventilation? Background: AC are used in 40% of ICU patients, mostly to facilitate diagnostic phlebotomy (including arterial blood gases) and improve hemodynamic monitoring.
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Bedside Attention Tests May Be Useful in Detecting Delirium
February 2, 2015
Clinical question: Are simple bedside attention tests a reliable way to routinely screen for delirium? Background: Early diagnosis of delirium decreases adverse outcomes, but it often goes unrecognized, in part because clinicians do not routinely screen for it.
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What Should Hospitalists Know about Transarterial Liver Tumor Therapies?
February 2, 2015
Case A 51-year-old male with known hepatocellular carcinoma (HCC) recently underwent successful transarterial chemoembolization of a segment VII liver lesion. The patient was admitted to the hospitalist service for overnight observation.
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Time-Based Physician Services Require Proper Documentation
February 2, 2015
Providers typically rely on the “key components” (history, exam, medical decision-making) when documenting in the medical record, and they often misunderstand the use of time when selecting visit levels.
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Vermont Hospital Honored for Reducing Healthcare-Associated Infections
February 2, 2015
The University of Vermont Medical Center (UVMC), a 562-bed academic facility in Burlington, has been honored with a Partnership in Prevention award for sustainable improvements to eliminate healthcare-associated infections (HAIs). The award, sponsored by the U.S.