Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Guidelines recommend pharmacologic prophylaxis for hospitalized medical patients at increased risk of thromboembolism. Despite recommendations, multiple studies demonstrate underutilization. Factors contributing to underutilization include uncertainty that prophylaxis reduces clinically relevant events, as well as questions about the best form of prophylaxis. We sought to determine whether prophylaxis decreases clinically significant events and to answer whether unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is either more effective or safer. ⋯ Among medical patients, pharmacologic prophylaxis reduced the risk of thromboembolism without increasing risk of major bleeding. The current literature does not demonstrate superior efficacy of UFH or LMWH.
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Medical educators have raised serious concerns about the decline in bedside teaching and the effect of this decline on trainee skills. We investigated the fraction of time hospitalist attending physicians spend at the bedside during teaching rounds and how often physical examination skills are demonstrated. ⋯ Bedside teaching makes up approximately 17% of the time that hospitalists at this medical center spend on teaching rounds. Physical examination teaching has become infrequent. Research to clarify optimal strategies to improve bedside teaching and its value in patient care is needed.
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Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older. ⋯ This population-based historical cohort of patients with hip operation had a 3.9% cumulative probability of ischemic stroke over the first postoperative year. Hip fracture repair and history of stroke were the strongest predictors of this complication.
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Randomized Controlled Trial Multicenter Study
Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle.
Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. ⋯ A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger populations across a variety of inpatient settings.
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Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous. ⋯ The use of an electronic discharge summary significantly improved the quality and timeliness of discharge summaries.