Hospital Medicine Alert
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Post-ICU Stress Symptoms Associated with Increased Acute Care Service Utilization
Over the past two decades, advances in critical care have resulted in more patients surviving to hospital discharge, but these successes are attenuated by several sequelae of critical illness, including depression and post-traumatic stress disorder (PTSD).1 Risk factors for and the health care ramifications of these disorders are poorly understood. Given this, Davydow and colleagues aimed to investigate whether PTSD symptoms in the acute (< 1 month) ICU hospitalization period and PTSD and depressive symptoms at 3 months post-ICU were risk factors for future hospitalizations and emergency department (ED) visits.
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Nasal Screening for MRSA: The New Basis for De-escalation of Empiric Antibiotics?
Although nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) is a widely accepted method for infection control, the relationship between nasal carriage and development of MRSA lower respiratory tract infection (LRTI) is not well studied. Tilahun and colleagues sought to determine the association between MRSA nasal swab results and MRSA LRTI in a medical ICU. In this single-site, retrospective cohort study, 165 patients were diagnosed with pneumonia and had both nasal swabbing and culturing of respiratory specimens within 24 hours of admission.
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Inpatient and Outpatient Care Providers: Why Can’t We Just Work Together?
Many problems occur after a patient is discharged that are a direct result of poor coordination of care between hospitalists and primary care providers (PCPs). These issues include, but are not limited to, missed test results, medication errors, inadequate follow up, and harm to the patient. PCPs are frequently unaware that their patient was hospitalized and they often do not receive a copy of the discharge summary. The authors of this paper did a qualitative study to analyze the barriers and solutions to care coordination between hospitalists and PCPs in North Carolina.
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Influenza, 2014-2015 — Something Old, Something New
As of early January, influenza activity had reached epidemic proportions in large parts of the United States, with many of those being affected despite prior vaccination.1 The occurrence of infection in vaccinated individuals is not unexpected since influenza vaccine efficacy is usually only approximately 60%. There is, however, an additional problem during this influenza season because of an unanticipated mismatch between the components of the 2014-2015 vaccine, which are identical to the 2013-2014 vaccine composition, and the dominating circulating virus type. Thus, current trivalent influenza vaccines contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagata lineage) virus. Quadrivalent influenza vaccines contain these antigens as well as a B/Brisbane/60/2008-like (Victoria lineage) virus.
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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Surgical Management of Infective Endocarditis
Although guidelines outline specific indications for surgery in infective endocarditis (IE), applying these recommendations in the clinical area is challenging. In order to understand these challenges, the International Collaboration on Endocarditis (ICE) conducted a prospective study to evaluate the factors that influence the decision with regard to surgical intervention in IE.
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Intravenous Fluids in Patients With Acute Heart Failure
Volume overload is a hallmark of acute heart failure (AHF). In hospitalized patients, intravenous loop diuretics are the most commonly used treatment for decongestion and symptom relief. Intravenous (IV) fluids are routinely administered to hospitalized patients, although their use in patients with AHF seems counterintuitive. No previous study has evaluated the frequency and effects of IV fluid administration among patients hospitalized for AHF.
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Do Corticosteroids Play a Role in the Treatment of Community-acquired Pneumonia?
Despite antibiotic therapy and hospital-based care, severe community-acquired pneumonia still carries a high risk for morbidity and mortality.
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Paradoxical Low-flow, Low-gradient AS
This article originally appeared in the January 2015 issue of Clinical Cardiology Alert. It was peer reviewed by Susan Zhao, MD. Dr. Crawford is Professor of Medicine, Chief of Clinical Cardiology, University of California, San Francisco. He is the editor of Clinical Cardiology Alert. Dr. Zhao is Director, Adult Echocardiography Laboratory, Associate Chief, Division of Cardiology, Department of Medicine, Santa Clara Valley Medical Center. Dr. Crawford and Dr. Zhao report no financial relationships relevant to this field of study.
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Sudden Death Risk: ARBs or ACE Inhibitors & Co-trimoxazole
Older patients using an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker with co-trimoxazole had an increased risk of sudden death.