Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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To assess complications of condom catheters compared with indwelling urethral catheters, we conducted a prospective cohort study in two Veterans Affairs hospitals. Male patients who used a condom catheter or indwelling urethral catheter during their hospital stay were followed for one month by interview and medical record review. ⋯ Condom catheter patients were significantly less likely than indwelling catheter patients to report complications during catheter placement (13.9% vs 43.2%; P < .001). Patients reported approximately three times more noninfectious complications than the number recorded in the medical record.
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The clinical deterioration of patientsin general hospital wards is an important safety issue. Aggregate-weighted early warning systems (EWSs) may not detect risk until patients present with acute decline. ⋯ Compared with aggregate-weighted tools, EWSs using statistical modeling consistently demonstrated superior prognostic performance and generated less workload to identify and treat one true positive case. A standardized approach to reporting EWS model performance is needed, including outcome definitions, pretest probability, observed and adjusted PPV, and workup-to-detection ratio.
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Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. ⋯ This initiative demonstrated a significant reduction in inappropriate use of IV antihypertensives and an associated reduction in adverse events.
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Clinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts. ⋯ Evidence that clinicians were awareof deterioration preceded pRI alerts in most CDEs that generated alerts in the preceding 24 hours.