Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Multicenter Study
The association of patient complexities with antibiotic ordering.
Antibiotic treatment decisions for medically complex patients are complicated, as the risk of undertreatment may be severe, whereas overtreatment may be associated with adverse effects and the emergence of antibiotic resistant pathogens. ⋯ In 3 vignettes depicting common clinical scenarios among hospitalized adults, inappropriate antibiotic use was prevalent and occurred more often for patients with medical complexities. Treatment guidelines should consider addressing medically complex patients in the context of infection management.
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Multicenter Study
Hospital course and discharge criteria for children hospitalized with bronchiolitis.
For children hospitalized with bronchiolitis, there is uncertainty about the expected inpatient clinical course and when children are safe for discharge. ⋯ Although children hospitalized with bronchiolitis had wide-ranging recovery times, only 4% worsened after initial improvement. Children who worsened were more likely to be younger, premature infants presenting in more severe distress. For children hospitalized with bronchiolitis, these data may help establish more evidence-based discharge criteria, reduce practice variability, and safely shorten hospital length-of-stay.
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Multicenter Study
Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes.
Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes. ⋯ Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration. Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.
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Multicenter Study
Development, implementation, and impact of an automated early warning and response system for sepsis.
Early recognition and timely intervention significantly reduce sepsis-related mortality. ⋯ An automated prediction tool identified at-risk patients and prompted a bedside evaluation resulting in more timely sepsis care, improved documentation, and a suggestion of reduced mortality.
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Multicenter Study
Blood culture use in the emergency department in patients hospitalized with respiratory symptoms due to a nonpneumonia illness.
Guidelines and performance measures recommend obtaining blood cultures in selected patients hospitalized with community-acquired pneumonia (CAP). Due to inherent diagnostic uncertainty, there may be spillover effects of these recommendations on other conditions that resemble pneumonia. ⋯ The increase in collecting cultures in the ED in patients hospitalized with respiratory symptoms due to a nonpneumonia illness suggests an important potential unintended consequence of blood culture recommendations for CAP. More attention to the judicious use of blood cultures to reduce harm and costs is needed.