Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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In intensive care unit (ICU) patients, signs of infection and inflammation are similar, making diagnosis of bacterial infections difficult. Antimicrobials may therefore be overused, contributing to development of antimicrobial-resistant bacteria. ⋯ Antimicrobial therapy is probably overused in the ICU, possibly resulting from difficulties in diagnosis and the perceived greater risk of untreated infection when compared to the risks of potentially unnecessary antimicrobial therapy. Efforts to improve antimicrobial-related decision-making should be mandatory.
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Patterns of clinical symptoms and outcomes of perioperative myocardial infarction (PMI) in elderly patients after hip fracture repair surgery are not well defined. ⋯ Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI-associated mortality.
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Patients undergoing noncardiac surgery frequently experience major adverse cardiac events. As a significant proportion of these patients develop cardiac complications despite optimal use of preoperative clinical risk-prediction algorithms, physicians have long searched for better methods of forecasting and ameliorating cardiac risk in this population. Recently, postoperative troponin levels have been found to be powerful and independent predictors of cardiovascular mortality in patients undergoing noncardiac surgery. ⋯ As cardiac troponin isolates an unusually high-risk subgroup, we outline a strategy that utilizes this marker to improve cardiac outcomes. Where pertinent, strengths and limitations of this approach are discussed and areas of uncertainty identified. As with all hypotheses, this proposition fuels many questions and calls for a research agenda dedicated to quantifying risk or benefit, and defining best practices.
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Hospital-level, 30-day risk-standardized mortality and readmission rates are publicly reported for Medicare patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia, but the correlations among mortality rates and among readmission rates within US hospitals for these conditions are unknown. Correlation among measures within the same hospital would suggest that there are common hospital-wide quality factors. ⋯ Risk-standardized readmission rates are moderately correlated with each other within hospitals, as are risk-standardized mortality rates. This suggests that there may be common hospital-wide factors affecting hospital outcomes.
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Therapeutic hypothermia (TH) improves outcomes following cardiac arrest in small clinical trials. ⋯ TH utilization appears low, but implementation is increasing. Case selection and referral biases limit the analysis of the relationship between center TH volume and in-hospital mortality.