Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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To determine the incidence and manifestations of hypoglycemia in hospitalized patients receiving antihyperglycemic therapy. ⋯ Hypoglycemia in hospitalized patients taking antihyperglycemic agents is common; 1 in 25 episodes is associated with an adverse event. Opportunities exist to improve care, particularly around discontinuation of feeding.
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Controlled Clinical Trial
Firm-based trial to improve central venous catheter insertion practices.
Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein. ⋯ Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.
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Comparative Study
Conflicting measures of hospital quality: ratings from "Hospital Compare" versus "Best Hospitals".
In April 2005 the Centers for Medicare and Medicaid Services launched "Hospital Compare," the first government-sponsored hospital quality scorecard. We compared the ranking of U.S. News and World Report's "Best Hospitals" with Hospital Compare performance ratings. ⋯ Hospital Compare scores are frequently discordant with Best Hospital rankings, which is likely attributable to the markedly different methods each rating approach employs. Such discordance between major quality rating systems paints a conflicting picture of institutional performance for the public to interpret.
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Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy. ⋯ A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.