Discharges Against Medical Advice
This article describes the characteristics of patients at higher risk for AMA discharges. The necessary criteria for AMA discharge, including informed consent and decision-making capacity, are discussed. Critical elements of documentation are also reviewed. Finally, ethical obligations for the medical care of patients who discharge AMA, including facilitation of aftercare, are considered. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Wheezing
Publication date: July 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 3 Author(s): Rachel H. Bardowell, Robert J. MahoneyTeaser Wheezing can be caused by a variety of conditions. In hospitalized adults, primary considerations include asthma, chronic obstructive pulmonary disease (COPD), and acute bronchospasm related to an allergic reaction. The treatment of acute exacerbations of asthma and COPD is similar; some key differences are discussed. Patients with COPD are at high risk of readmission, and hospitals see a reduction in reimbursement for excessive readmissions. Strategies for reducing readmissions in...
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Benzodiazepine Intoxication and Withdrawal
This article reviews these topics. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Allergic Reactions and Angioedema
Publication date: Available online 16 July 2015 Source:Hospital Medicine Clinics Author(s): Dominique Cosco, Neil WinawerTeaser Allergic reactions and angioedema are overreactions by the immune system, producing immunoglobulin E (IgE) antibody to an otherwise harmless antigen or allergen. Anaphylaxis is a potentially fatal hypersensitivity reaction involving multiple organ systems that occurs seconds to minutes following exposure to the inciting antigen. Anaphylactoid reactions present with clinically indistinguishable features to anaphylaxis; however, the underlying mechanisms are nonimmunologic (not IgE mediated)...
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Inpatient Management of Patients After Liver Transplantation
Publication date: Available online 16 July 2015 Source:Hospital Medicine Clinics Author(s): Martin Moehlen, Fredric RegensteinTeaser Liver transplantation is the standard-of-care treatment of patients with irreversible liver disease caused by decompensated cirrhosis or acute liver failure. Liver transplantation is the most effective treatment of selected patients with hepatocellular carcinoma and cirrhosis. Transplant recipients are at an increased risk for opportunistic infections and the risk of infection is related to the level of immunosuppression and severity of liver graft dysfunction. Live vaccines are contr...
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Optimal Glycemic Control in Hospitalized Patients
This article aims to identify the common barriers to optimal glycemic control in hospitalized patients, and offers applicable solutions. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Tick-borne Infections
Publication date: Available online 16 July 2015 Source:Hospital Medicine Clinics Author(s): Karla B. Rivera Rivera, Christopher M. BlaisTeaser Tick-borne illnesses (TBI) are infections acquired through a bite of a tick. Because of the nonspecific signs and symptoms experienced by patients presenting with TBIs, a high index of suspicion is crucial to include a TBI in the differential diagnosis of patients presenting with symptoms compatible with a TBI. Although the results of diagnostic testing are often not available at the time treatment decisions are made, it is important to obtain a history of possible tick expo...
Source: Hospital Medicine Clinics - July 17, 2015 Category: Internal Medicine Source Type: research
Acute Respiratory Distress Syndrome
Publication date: Available online 14 July 2015 Source:Hospital Medicine Clinics Author(s): Abdul Khan , Stephen Kantrow , David E. TaylorTeaser The diagnosis of acute respiratory distress syndrome (ARDS) should be considered in all patients with pneumonia, trauma, or sepsis who develop acute hypoxemic respiratory failure. There are 2 basic principles to adhere to at the time of an ARDS diagnosis: use the optimal mechanical ventilation strategy, and identify and treat underlying reversible inflammatory causes. A significantly lower mortality (31% vs 40%) was found in patients receiving lower tidal volumes. Once pati...
Source: Hospital Medicine Clinics - July 15, 2015 Category: Internal Medicine Source Type: research
Benzodiazepine Intoxication and Withdrawal Assessment and Management
This article reviews these topics. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - July 12, 2015 Category: Internal Medicine Source Type: research
Magnesium Disorders
Publication date: Available online 11 July 2015 Source:Hospital Medicine Clinics Author(s): Ryan Mascarenhas , Himanshu Vashistha , Damodar KumbalaTeaser Magnesium is the fourth most abundant cation in the human body and is the second most abundant intracellular cation, after potassium. The kidneys and intestines regulate magnesium reabsorption and maintain homeostasis. This cation plays an important physiologic role in many functions of the body, especially the neuromuscular and cardiovascular systems. Magnesium as a catalyst can modulate many various enzymatic pathways that depend on magnesium as a catalyst, inclu...
Source: Hospital Medicine Clinics - July 12, 2015 Category: Internal Medicine Source Type: research
Caring for the Actively Dying
This article reviews communication and symptom management issues and suggests ways to address them in order to improve end-of-life care. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Prescribing Methadone
This article discusses indications for initiating methadone and highlights important aspects of patient evaluation and monitoring when methadone is prescribed. In addition, government restrictions on the use of methadone are explained. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Discharges Against Medical Advice Considerations for the Hospitalist and the Patient
This article describes the characteristics of patients at higher risk for AMA discharges. The necessary criteria for AMA discharge, including informed consent and decision-making capacity, are discussed. Critical elements of documentation are also reviewed. Finally, ethical obligations for the medical care of patients who discharge AMA, including facilitation of aftercare, are considered. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Paraneoplastic Syndromes
Publication date: July 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 3 Author(s): Eileen Lee , James FreerTeaser Paraneoplastic syndromes are uncommon manifestations of cancer not directly related to mass effect or to a substance normally produced by the cancerous tissue. They are often classified by the affected organ system and may present before or after the diagnosis of cancer. Neuroendocrine tumors are most likely to cause paraneoplastic syndromes. In patients with no known malignancy, the diagnosis of a well-characterized paraneoplastic syndrome should prompt a cancer work-up, including age-appropriate...
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Acute Cholecystitis, Choledocholithiasis, and Acute Cholangitis
This article defines the clinical entities of acute cholecystitis, choledocholithiasis, and cholangitis and provides an overview of the clinical presentation, laboratory and physical examination findings, imaging standards, and treatment guidelines for each. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
