Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Randomized Controlled Trial
Changes in hospitals' credentialing requirements for board certification from 2005 to 2010.
In 2005, we conducted a study of the prevalence of board certification requirements for hospital privileging and found that one-third of hospitals did not require pediatricians to be board certified. In 2010, the American Board of Pediatrics implemented the Maintenance of Certification (MOC) program. To examine changes in the policies of hospitals regarding requirements for board certification, we surveyed privileging personnel at hospitals across the country. ⋯ In the 5 years since our previous study, a larger proportion of hospitals now require pediatricians to be board certified, although the proportion of hospitals that make exceptions to this policy has increased twofold. Hospitals appear to be incorporating the MOC program into their privileging policies.
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Multicenter Study
Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: a Michigan survey.
Peripherally inserted central catheters (PICCs) are commonly inserted during hospitalization for a variety of clinical indications. ⋯ Hospitalist experiences, practice, opinions, and knowledge related to PICCs appear to be variable. Because PICC use is growing and is often associated with complications, examining the impact of such variation is necessary. Hospitals and health systems should consider developing and implementing mechanisms to monitor PICC use and adverse events.
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End-of-life discussions are associated with decreased use of life-sustaining treatments in patients dying of cancer in the outpatient setting, but little is known about discussions that take place during terminal hospitalizations. ⋯ The majority of patients with advanced cancer are considered to have decisional capacity at the time of their terminal hospitalization. Many lose decisional capacity before having an end-of-life discussion and have surrogate decision-makers participate in these discussions. These patients received more aggressive life-sustaining treatments prior to death and represent a missed opportunity to improve end-of-life care.
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Observational Study
Answering questions on call: pediatric resident physicians' use of handoffs and other resources.
Little is known in the literature about the types of questions being asked of on-call housestaff and the resources used to provide answers. ⋯ Pediatric housestaff face frequent questions during overnight shifts and frequently use information received during handoffs to provide answers. A better understanding of how handoffs and other resources are utilized by housestaff could inform future targeted initiatives to improve trainees' access to key information at night.
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Patients with delirium, especially when superimposed on dementia, are at high risk of functional decline. ⋯ Elderly patients with dementia recovering from delirium have comparable potential for functional recovery as their cognitively intact counterparts in a delirium management unit focused on geriatric nursing care and rehabilitation.