Toxic-Metabolic Encephalopathy
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Grace F. Crotty, Shamik BhattacharyyaTeaser Toxic-metabolic encephalopathy, synonymous with delirium or altered mental status, is commonly seen in hospital settings. It is an acute confusional state that can occur in a vulnerable person from a variety of insults. The presence of delirium is associated with increased mortality, cognitive impairment, and institutionalization. Primary prevention and treatment of underlying medical disorder are imperative to reducing cases of delirium. In this article, the authors review the under...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Blood Pressure Management During Hospitalization
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Rajesh Patel, Matthew P. VitaleTeaser Hypertension (HTN) is highly prevalent in the outpatient setting, affecting approximately one-third of the US population. Prevalence in the inpatient setting may be higher, affecting up to one-half of admitted patients. Guidelines do not address goals for HTN management in the inpatient setting. Therefore, blood pressure (BP) goals in the inpatient setting vary by provider and may be more permissive that the outpatient setting. Pharmacologic treatment for HTN in the inpatient should consis...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Best Practices in Inpatient Handoffs of Care
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Stephanie Mueller, Rajesh Patel, Jennifer O'Toole, Jeffrey SchnipperTeaser Patient handoffs, particularly shift change handoffs, occur frequently during patient hospitalization and expose patients to risks of discontinuity of care. High-quality handoffs create a seamless transition in patient care and require skillful communication regarding clinical information. Best practices in management of patient handoffs include standardized structure, provider training on communication, and systems organization design to support high...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Geriatric Consultation and Expertise for the Hospitalized Patient
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Laura Perry Fernandez, Lindy Romanovsky, Houman JavedanTeaser With the “oldest old” patients becoming a larger portion of the population of hospitalized patients every year, hospitalists will have to develop a working system that incorporates geriatric medicine expertise into their daily work flow. In this article, the authors review whether geriatric expertise is needed, which patients benefit from geriatric expertise, what geriatric expertise consists of, and what system changes are needed to implement geriatric experti...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Cardiac Troponin
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): David M. Nemer, Hicham SkaliTeaser Cardiac troponin is a component of the myocyte contractile apparatus that is highly specific for the detection of myocardial necrosis. It is the preferred biomarker for use in the diagnosis and risk stratification of ischemic and nonischemic causes of myocardial damage. Importantly, cardiac troponin is not specific for the mechanism of myocardial injury, and elevations should always be interpreted in a comprehensive clinical context. This review discusses the appropriate use of cardiac tropon...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Chronic Kidney Disease and Adverse Outcomes in the Perioperative Period
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Adam C. SchafferTeaser The importance of kidney disease to perioperative outcomes is demonstrated by its inclusion in our commonly used tools for assessing perioperative cardiovascular risk. Chronic Kidney Disease (CKD) is a significant predictor of postoperative mortality, and, as the severity of CKD worsens, so do postoperative outcomes. The magnitude of the increased risk of postoperative death associated with CKD is comparable to other commonly used risk factors for adverse postoperative outcomes, such as diabetes mellitus....
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Dialysis Initiation During the Hospital Stay
Publication date: October 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 4 Author(s): Kenneth Lim, Ragnar Palsson, Andrew SiedleckiTeaser The decision to commence renal replacement therapy is a pivotal milestone in the management of patients with acute kidney injury and advanced chronic kidney disease. There is currently a paucity of evidence to help guide clinicians on the optimal timing of renal replacement therapy initiation and no consensus currently exists to help guide decision-making strategy. As a result, considerable variation exists in practice among physicians and centers. This review discusses impo...
Source: Hospital Medicine Clinics - September 3, 2016 Category: Internal Medicine Source Type: research
Antiglycemic Agents
Publication date: Available online 27 July 2016 Source:Hospital Medicine Clinics Author(s): Lee-Shing Chang, Matthew I. KimTeaser Incretins are hormones produced by cells in the gastrointestinal tract that increase secretion of insulin from pancreatic β cells after ingestion of a meal. Glucagon-like peptide-1 (GLP-1) receptor agonists increase secretion of insulin from pancreatic β cells, slow gastric emptying, and increase satiety to control hyperglycemia while promoting weight loss. Dipeptidyl peptidase inhibitor-4 (DPP-4) inhibitors block the activity of a peptidase enzyme that degrades endogenous incretin hor...
Source: Hospital Medicine Clinics - July 27, 2016 Category: Internal Medicine Source Type: research
High-Value, High-Quality Perioperative Care —A Collaborative Opportunity for Hospitalists
Publication date: April 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 2 Author(s): Rachel E. Thompson (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 20, 2016 Category: Internal Medicine Source Type: research
Metastatic Spinal Cord Compression
Publication date: July 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 3 Author(s): Nicole WhiteTeaser Metastatic spinal cord compression (MSCC) occurs in up to 6% of patients with malignancy when metastases in the epidural space compress the spinal cord. MSCC causes back pain and neurologic impairment and ultimately progresses to complete loss of motor, sensory, and sphincter function. Rapid progression of symptoms and loss of neurologic function renders MSCC an oncologic emergency typically necessitating hospital admission; a multidisciplinary approach to management involving surgery, radiation oncology, and...
Source: Hospital Medicine Clinics - July 1, 2016 Category: Internal Medicine Source Type: research
Tumor Lysis Syndrome
This article provides a comprehensive overview of the epidemiology, pathyophysiology, diagnosis, management, treatment and potential complications of tumor lysis syndrome (TLS), often seen to occur spontaneously, or as a result of tumor-targeted treatment. It underscores the importance of early identification and risk stratification of patients that could develop TLS. Management is strategized by assessed risk. Prevention is the best management and timely interventions can optimize therapeutic options for patients with cancer, potentially affecting ultimate prognosis, while reducing the morbidty and mortality associated wi...
Source: Hospital Medicine Clinics - July 1, 2016 Category: Internal Medicine Source Type: research
Chemotherapy Complications
This article guides hospitalists in the management of the adverse reactions and side effects most commonly encountered in patients undergoing chemotherapy. There are several modalities of medical therapy available. Different factors need to be taken into account in the selection of the treatment regimen. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 1, 2016 Category: Internal Medicine Source Type: research
Quality and Safety in Hospitalized Patients with Cancer
This article explores four topics in safety and quality and their impacts on hospitalized patients with cancer: falls, venous thromboembolic disease, intensive care unit transfers, and central line infections. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 1, 2016 Category: Internal Medicine Source Type: research
Acute Leukemia
Publication date: July 2016 Source:Hospital Medicine Clinics, Volume 5, Issue 3 Author(s): Rushdia Zareen YusufTeaser Acute leukemia is not a single disease. Traditionally classified into acute myeloid leukemia, acute lymphoid leukemia, and acute promyelocytic leukemia, it is now understood to be several molecularly distinct entities, each with a predictable course and its own prognosis. However, the basics of the in-hospital treatment of these 3 entities have remained largely unchanged over the last two decades. Familiarity with how patients present, key points to be followed during their stabilization, and an under...
Source: Hospital Medicine Clinics - July 1, 2016 Category: Internal Medicine Source Type: research
Malignant Bowel Obstruction in Advanced Cancer
This article examines the epidemiology, diagnosis, prognosis, and management strategies in patients with MBO applicable to practicing hospitalists. In addition, the appropriateness of surgical versus medical management is discussed, including interventional procedures, medications, and supportive measures, as well as addressing issues surrounding discharge planning, palliative care, and practice improvement. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - May 11, 2016 Category: Internal Medicine Source Type: research
