Articles related to Hospitalist

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 […]

In a recent talk at the Internal Medicine Meeting 2023, hospitalist Heather Nye emphasized the need to update the “Ten Commandments for Effective Consultations” originally outlined by Lee Goldman and colleagues in 1983. Dr. Nye provided new insights for performing and requesting consults in the 21st century. Some key points she highlighted included the importance of going the extra mile to determine the patient’s condition, establishing urgency, providing clear and written recommendations, documenting all interactions, and following up on recommendations and actions taken. Dr. Nye stressed the significance of clear communication in consult relationships. For hospitalists requesting consults from subspecialists, she advised following the commandments outlined and overcoming reluctance in seeking clarification and follow-up. It was emphasized that hospitalists should manage consultants effectively, ensuring they follow up on recommended studies and document their recommendations in the patient’s chart. Additionally, hospitalists should be proactive in obtaining contact information and communicate with consultants even after they sign off, especially during patient discharge discussions. Overall, Dr. Nye emphasized that effective communication, documentation, and follow-up are essential in providing optimal patient care and ensuring collaboration between hospitalists and subspecialists.

In a randomized controlled trial at three US hospitals over six months in 2021, the researchers randomized 30 attendings to prioritize seeing patients who were expected to be discharged that day before seeing other patients. Marisha Burden, MD, FACP, a professor of medicine and division head of hospital medicine at the University of Colorado School of Medicine in Aurora, and Angela Keniston, MSPH, an assistant professor and director of data and analytics for the division of hospital medicine at the University of Colorado School of Medicine, discuss the study’s findings.

Based on cases reported to the CDC, this study reports an acceleration in case detection, with a dramatic increase in 2021. From 2019 to 2021, 17 states identified their first case of C auris; however, resistance to echinocandins increased threefold in 2021 compared to the previous two years. And because screening is not conducted uniformly across the United States, the true burden of C auris cases is likely higher than reported.

In this study, 800 patients admitted to ICU for severe CAP were andomized to 200mg IV hydrocortisone daily for 4 to 8 days or to placebo. By day 28, mortality rate was 6.2% versus 11.9% for the steroid and placebo groups, respectively. Rates for intubation and vasopressors were both approximately 40% lower in the test group as well.

In a review of hospitalization records in Hong Kong, Feb-July 2022, adults hospitalized for COVID and given molnupiravir or nirmatrelvir–ritonavir showed lower all-cause mortality, regardless of vaccination status. However, there was no significant reduction in ICU admission or the need for mechanical ventilation.