Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Review Meta Analysis Comparative Study
Continuous infusion versus intermittent bolus furosemide in ADHF: an updated meta-analysis of randomized control trials.
Administering intermittent boluses of furosemide to patients with acute decompensated heart failure (ADHF) often leads to unfavorable hemodynamic changes. Continuous infusion may induce similar or greater diuresis without adverse hemodynamic consequences. We conducted a systemic review and meta-analysis of randomized clinical trials that compared the effects of continuous infusion and intermittent bolus of furosemide in patients hospitalized with ADHF. ⋯ This meta-analysis showed statistical support for administering furosemide as a continuous infusion for greater diuresis and reduction in total body weight in patients hospitalized with ADHF. With the exception of greater diuresis, available data are homogenous for the reported outcomes but lack information on clinical endpoints. Larger studies are needed to provide robust recommendations for clinical practice.
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Infection control is the most essential component of an effective overall management strategy for prevention of nosocomial Clostridium difficile infection (CDI). The cornerstones of CDI prevention are appropriate contact precautions and strict hand hygiene. Other important tactics are effective environmental cleaning, identification and removal of environmental sources of C. difficile, and antibiotic stewardship. Hospitalists, as coordinators of care for each patient and advocates for quality care, can spearhead these efforts.
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Comparative Study
Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.
A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing. ⋯ The adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team.
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To develop and validate a model to predict resistance to community-acquired pneumonia antibiotics (CAP-resistance) among patients with healthcare-associated pneumonia (HCAP), and to compare the model's predictive performance to a model including only guideline-defined criteria for HCAP. ⋯ Select guideline-defined criteria predicted CAP-resistance. A cohort-developed model based primarily on prior MRSA history, nursing home residence, and specific antibiotic exposures provided improved prediction of CAP-resistant organisms in HCAP.
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Patients with intensive care unit (ICU) transfers from hospital wards have higher mortality than those directly admitted from the emergency department. ⋯ Early unplanned ICU transfers-even within 8 hours of hospitalization-are associated with increased mortality; outcomes vary by elapsed time to transfer and admitting diagnosis.