Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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To evaluate for adverse outcomes associated with gastroesophageal reflux disease (GERD) following an apparent life-threatening event (ALTE) and potential risk factors of these outcomes. ⋯ Adverse outcomes associated with GERD are rare following an ALTE. Patients who developed neurological impairment and a longer initial LOS were at higher risk for developing these outcomes. Positive testing for gastroesophageal reflux during hospitalization for ALTE did not predict adverse outcomes associated with GERD.
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The increase in hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of hospitalists and the publicly reported patient outcomes is unknown. ⋯ The presence of hospitalists is not an independent predictor of performance on publicly reported mortality and readmissions measures for AMI, HF, or pneumonia. It is likely that broader system or organizational interventions are required to improve performance on patient outcomes.
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Optimizing postdischarge medication adherence is a target for avoiding adverse events. Nevertheless, few studies have focused on predictors of postdischarge medication adherence. ⋯ In patients hospitalized for cardiovascular disease, predictors of lower medication adherence postdischarge included younger age, Medicaid insurance, and baseline nonadherence. These factors can help predict patients who may benefit from further interventions.
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Shift work is necessary for hospitalists to provide on-site 24-hour patient care. Like all shift workers, hospitalists working beyond daylight hours are subject to a misalignment between work obligations and the endogenous circadian system, which regulates sleep and alertness patterns. With chronic misalignment, sleep loss accumulates and can lead to shift work disorder or other chronic medical conditions. ⋯ If these attempts fail and chronic fatigue persists, then a diagnosis of shift work disorder should be considered, which can be treated with stronger pharmacotherapy. Night float scheduling strategies may also help to limit chronic sleep loss. More research is urgently needed regarding the sleep patterns and job performance of hospitalists working at night to improve scheduling decisions and patient safety.
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Comparative Study
Comparative effectiveness of low-molecular-weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients.
Both unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are approved for venous thromboembolism (VTE) prophylaxis. Which agent is superior remains controversial. ⋯ For VTE prophylaxis, the effectiveness and cost of LMWH and UFH are similar, but LMWH is associated with fewer complications.