Journal of hospital medicine : an official publication of the Society of Hospital Medicine
-
Mortality in hospitalized human immunodeficiency virus (HIV)-infected patients is not well described. We sought to characterize in-hospital deaths among HIV-infected patients in the antiretroviral (ART) era and identify factors associated with mortality. ⋯ Non-AIDS deaths increased significantly during the ART era and are now the most common cause of in-hospital deaths; non-AIDS infection, cardiovascular and liver disease, and malignancies were major contributors to mortality. Higher CD4 cell count, liver, and cardiovascular comorbidities were most strongly associated with non-AIDS deaths. Interventions targeting non-AIDS-associated conditions are needed to reduce inpatient mortality among HIV-infected patients.
-
Prior studies have found that outpatients are frequently unaware of their chronic kidney disease (CKD). Little is known about CKD awareness in hospitalized patients. We conducted a retrospective study of general medicine inpatients with CKD, ascertained through International Classification of Diseases, Ninth Revision codes for non-dialysis-dependent CKD (585.0-585.9) in their first 20 admission diagnoses (n = 590). ⋯ In multivariable analysis, factors significantly associated with patient self-report of CKD included advanced CKD stage, other race (nonwhite, non-African American), and increasing Mini-Mental State Exam score (all P < 0.05). CKD awareness increased, but remained low, in patients with advanced CKD who would benefit from referral to multidisciplinary nephrology care. Hospitalization provides an opportunity to educate patients with CKD and link them to care.
-
Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. ⋯ Administration of norepinephrine, dopamine, or phenylephrine by peripheral intravenous access was feasible and safe in this single-center medical intensive care unit. Extravasation from the peripheral intravenous line was uncommon, and phentolamine with nitroglycerin paste were effective in preventing local ischemic injury. Clinicians should not regard the use of vasoactive medication is an automatic indication for central venous access.
-
Observational Study
Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards.
Obstructive sleep apnea (OSA) has been associated with clinical deterioration in postoperative patients and patients hospitalized with pneumonia. Paradoxically, OSA has also been associated with decreased risk of inpatient mortality in these same populations. ⋯ After adjustment for important confounders, OSA was not associated with clinical deterioration on the wards and was associated with significantly decreased in-hospital mortality.
-
Standardized Clinical Assessment and Management Plans (SCAMPs) are tools to facilitate learning and discovery in a rapid iterative fashion. SCAMPs aim to reduce practice variation, improve patient outcomes, and identify unnecessary resource utilization. ⋯ These data are then analyzed to change and improve the SCAMP algorithm itself. The purpose of this article is to describe the general SCAMPs methodology and to compare SCAMPs to traditional tools like clinical practice guidelines.