Articles related to Hospitalist

The article explores social interactions and institutional structures impacting the consistent practice of 24-hour rooming-in for new mothers and newborns in hospitals. Researchers employed an institutional ethnographic design, gathering data through semistructured interviews and unit observations from February 2020 to June 2021. Seven mother-baby nurses participated in interviews. Additionally, three on-unit observations lasting 2 hours each took place. From the collected data, the researchers unearthed a shared sentiment: “Baby-Friendly” practices don’t always equate to being “mother-friendly.” Three primary social interaction themes surfaced from the data analysis: viewing the mother as a patient, managing expectations, and inconsistent practices. The nurses’ perspectives revealed the complexity of managing maternal care while juggling newborn demands. Discrepancies in methods highlighted the need for standardized practices to maintain consistency across care provision. The analysis also identified three significant institutional factors that affect 24-hour rooming-in: rates of labor induction and cesarean births, nurse staffing, and nursery use monitoring. Labor induction and cesarean births often disrupt the smooth transition to rooming-in. Limited nurse staffing presents challenges in managing both mother and baby needs, while nursery use monitoring practices influence rooming-in implementation. The article’s findings provide critical insights into the daily organization and experience of 24-hour rooming-in from a […]

Dive into how the FDA-approved Farxiga is changing the heart failure treatment landscape. Colleagues, let’s dive into a remarkable milestone. Farxiga, known as dapagliflozin, now has FDA approval. This is groundbreaking for heart failure treatment. It applies to all patients, regardless of their left ventricular ejection fraction (LVEF) status. The approval didn’t happen overnight. Let’s talk about the DELIVER trial, a vital part of the process. It involved over 6,000 patients, all over 40. Each had heart failure, LVEF above 40%, and may or may not have had type 2 diabetes. They took either dapagliflozin or a placebo daily, plus their usual therapy. The trial had a clear goal: time to the first composite event. This included CV death, heart failure hospitalization, or an urgent heart failure visit. The goal applied to everyone, including patients with LVEF less than 60%. Fast forward about 2.3 years, the results were significant. Dapagliflozin cut the composite outcome by 18% versus the placebo. Both worsening heart failure and CV death rates dropped in the dapagliflozin group. The best part? These findings were consistent, even in patients with lower LVEF or diabetes. Expanding the picture, let’s consider two trials together: DELIVER and DAPA-HF. Over 22 […]

Uncover vital insights about supplemental oxygen use, demystify misconceptions, and learn best practices for managing respiratory diseases. Good day, physicians. Let’s talk about the controversial issue of supplemental oxygen use, frequently discussed by patients, clinicians, advocacy groups, and even politicians. In this summary, we’ll untangle misconceptions and illuminate best practices. To start with, the body’s oxygen utilization depends on three things: lung function, heart efficiency, and muscle oxygen use. These factors can improve with exercise, but worsen with inactivity. Remember, exercise matters. Why does oxygen matter? For patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), or pulmonary hypertension (PH), impaired oxygenation can lead to hypoxemia and hypoxia. Hence, supplemental oxygen becomes a necessity. How do we assess oxygen levels? Two tests can be employed: arterial blood gas (ABG) or pulse oximetry. Normal partial pressure of oxygen, as per ABG, is around 75-100 mmHg, and a drop below 60 necessitates supplemental oxygen. Oxygen saturation, measurable via either test, should ideally be 95% or above, and values dropping to 90 or below indicate the need for supplemental oxygen. Now, let’s dispel some myths. Shortness of breath doesn’t always equate to hypoxia. A patient can experience breathlessness even with normal oxygen […]

Dive into this CME program to grasp the latest C. difficile guidelines and implement treatment strategies effectively. This interactive CME program focuses on Clostridioides difficile, or C. difficile. As you know, this bacterium causes severe GI disturbances. Alarmingly, it impacts half a million Americans annually and burdens the healthcare system. Who is this for? Infectious disease physicians, gastroenterologists, hospitalists, intensivists, and all HCPs managing patients with C. difficile infection (CDI) will benefit greatly. Initially, the program offers a comprehensive review of CDI. It presents the epidemiology and pinpoints key risk factors. Moreover, it explains the underlying pathophysiology and outlines clinical features. Significantly, it emphasizes the disease’s burden and unveils diagnostic tools, including NAAT, GDH assay, and toxin tests. Following this, the program shifts to treatment strategies for CDI. It details procedures for various severity levels – mild, severe, fulminant, and recurrent. Concurrently, it underlines the common challenges in therapy decision-making. Importantly, it stresses the necessity of adhering to CDI guidelines and presents preventative measures. In the concluding section, participants receive practical patient cases. This allows the application of newfound knowledge directly. Afterward, it wraps up with a summary and a best practice recap. Upon completion, participants will grasp the burden […]

Delve into the changes in the updated Beers criteria and their implications for medication use in older patients. The American Geriatrics Society (AGS) has recently revised the Beers criteria. Significantly, these guidelines advise physicians to be cautious when prescribing medications like warfarin and sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients over 65. Importantly, warfarin is now a drug to avoid in initial therapy for venous thromboembolism or nonvalvular atrial fibrillation unless alternatives are contraindicated or face significant usage barriers. The Beers criteria are organized into five distinct categories. These include potentially inappropriate medications, ones that might be inappropriate for patients with certain conditions, medications requiring careful usage, potential drug-drug interactions, and medications needing renal function-based dosage adjustments. An expert panel sifted through evidence from June 1, 2017, to May 31, 2022, to create these updates. These guidelines apply to patients aged 65 years and older in most care settings in the US, excluding hospice and end-of-life care situations. Among the notable changes since 2019 is the inclusion of warfarin. For older patients using warfarin long-term, continuation might be reasonable if they show well-controlled international normalized ratios and no adverse effects. Additional drugs introduced since 2019 include ticagrelor and SGLT2 inhibitors (use […]

The case involves a 73-year-old patient, Ms. B, who had a history of rheumatoid arthritis and was taking prednisone for adrenal insufficiency caused by a pituitary tumor. She was treated by an internist, Dr. R, for various ailments over a period of four years. In November 2016, Ms. B was diagnosed with severe community-acquired pneumonia and admitted to the hospital, where she was treated with levofloxacin. After being discharged, she continued taking levofloxacin and suffered an acute rupture of the gluteus medius tendon, resulting in significant disabilities. Ms. B filed a lawsuit against Dr. R, alleging negligence and failure to inform her about the risks and contraindications of the medication. Dr. R sought a summary judgment to have the case dismissed but was denied by the court. The court ruled that a Boxed Warning on a medication, such as the one associated with levofloxacin, can create a triable issue of fact regarding a physician’s departure from accepted medical practice. Dr. R claimed he was unaware of the risks and relied on the hospitalists’ choice of medication, but the court found that he should have been knowledgeable about the specific risks and suitability of the medication for his patient. The case […]