Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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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.
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The paucity of research linking thiamine treatment with improved outcomes may be driving its underutilization among patients at risk for Wernicke encephalopathy. ⋯ Thiamine is not reliably given to patients with pneumonia and alcohol use disorder receiving benzodiazepines. Improving thiamine administration may represent an opportunity to save lives in this high-risk group of inpatients.
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American Society of Hematology 2021 Guidelines for Management of Venous Thromboembolism: Prevention and Treatment in Patients with Cancer RELEASE DATE: February 23, 2021 PRIOR VERSION(S): n/a DEVELOPER: American Society of Hematology FUNDING SOURCE: American Society of Hematology TARGET POPULATION: Adult patients with cancer.
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Guidelines recommend testing hospitalized patients with community-acquired pneumonia (CAP) for Legionella pneumophila only if the infection is severe or risk factors are present. There are no validated models for predicting Legionella. ⋯ Although Legionella is an uncommon cause of pneumonia, patient characteristics can identify individuals at high risk, allowing for more efficient testing.