Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Review
Characteristics and impact of bedside procedure services in the United States: A systematic review.
Bedside procedure services are increasingly employed within internal medicine departments to meet clinical needs and improve trainee education. Published literature on these largely comprises single-center studies; an updated systematic review is needed to synthesize available data. ⋯ There are relatively few published studies describing the characteristics of bedside procedure services and their impact on clinical and educational outcomes. Limited data point to considerable heterogeneity in service design, a positive impact on medical trainees, and a positive impact on patient-related outcomes.
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Cirrhosis accounts for a large number of deaths in the United States and worldwide, leading to an increasing burden on the healthcare system. Cirrhosis is, however, a progressive disease with different potential complications related to liver dysfunction and portal hypertension. ⋯ We will discuss the epidemiology of liver disease, cirrhosis, and its complications (hepatic encephalopathy, ascites, and varices). In this study, we will discuss the rationale and impact of missing these diagnoses on the healthcare system and patient.
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Review
Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care.
One of the most costly and frequent causes of hospital readmissions in the United States is hepatic encephalopathy in patients with underlying liver cirrhosis. In this narrative review, we cover current practices in inpatient management, transitions of care, and strategies to prevent hospital readmissions. Bundled approaches using a model such as the "Ideal Transitions of Care" appear to be more likely to prevent readmissions and assist patients as they transition to outpatient care. Numerous strategies have been evaluated to prevent readmissions in patients with hepatic encephalopathy, including technologic interventions, involvement of nonphysician team members, early follow-up strategies, and involvement of palliative care when appropriate.
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Medical Procedure Services (MPS) may represent a solution to the educational gap in procedural training among internal medicine residents and the unmet need for the clinical provision of non-urgent inpatient procedures. However, there is little guidance available to help launch an MPS. Furthermore, procedural outcomes from a newly initiated MPS, including those comparing trainees versus attending physicians, are lacking. ⋯ At a tertiary academic medical center, the implementation and maintenance of MPS is feasible, safe, and results in high rates of successful procedures performed by supervised residents. Procedures performed by supervised residents require comparable number of attempts for completion and carry similar risks as those performed alone by attendings.