Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Hospitalists often treat patients with severe acute hypertension (AH) presenting to the hospital. Little is known about the epidemiology of this syndrome. ⋯ Severe AH appears common and its prevalence varies by underlying clinical condition. Severe AH is associated with excess in-hospital mortality for patients with nervous system diseases and, for most disease categories, prolongs hospitalization.
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Review Meta Analysis Comparative Study
Continuous infusion versus intermittent bolus furosemide in ADHF: an updated meta-analysis of randomized control trials.
Administering intermittent boluses of furosemide to patients with acute decompensated heart failure (ADHF) often leads to unfavorable hemodynamic changes. Continuous infusion may induce similar or greater diuresis without adverse hemodynamic consequences. We conducted a systemic review and meta-analysis of randomized clinical trials that compared the effects of continuous infusion and intermittent bolus of furosemide in patients hospitalized with ADHF. ⋯ This meta-analysis showed statistical support for administering furosemide as a continuous infusion for greater diuresis and reduction in total body weight in patients hospitalized with ADHF. With the exception of greater diuresis, available data are homogenous for the reported outcomes but lack information on clinical endpoints. Larger studies are needed to provide robust recommendations for clinical practice.
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Infection control is the most essential component of an effective overall management strategy for prevention of nosocomial Clostridium difficile infection (CDI). The cornerstones of CDI prevention are appropriate contact precautions and strict hand hygiene. Other important tactics are effective environmental cleaning, identification and removal of environmental sources of C. difficile, and antibiotic stewardship. Hospitalists, as coordinators of care for each patient and advocates for quality care, can spearhead these efforts.
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Patients with intensive care unit (ICU) transfers from hospital wards have higher mortality than those directly admitted from the emergency department. ⋯ Early unplanned ICU transfers-even within 8 hours of hospitalization-are associated with increased mortality; outcomes vary by elapsed time to transfer and admitting diagnosis.
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The aim of this study was to assess the incidence of hypoglycemia in hospitalized patients following acute treatment of hyperkalemia with insulin. A characterization of the affected patients and the administered insulin/dextrose regimens was also performed. ⋯ Iatrogenic hypoglycemia, as a result of treatment for hyperkalemia, is a common occurrence. Hyperkalemia occurs disproportionately in patients with acute kidney injury or end-stage renal disease, and these patients are predisposed to an increased risk of hypoglycemia. The risk of severe hypoglycemia escalates inpatients with lower body weight and creatinine clearance.Hypoglycemia risk can be minimized by providing sufficient dextrose in the treatment regimen, however, patient variability in treatment response dictates careful blood glucose monitoring before and after treatment.