Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Editorial Comment
Who Will Guard the Guardians? Preventing Drug Diversion in Hospitals.
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Malignant bowel obstruction (MBO) complicates 3%-15% of cancers and often necessitates inpatient admission. Hospitalists are increasingly involved in treating patients with MBO and coordinating their care across multiple subspecialties. ⋯ Medications such as somatostatin analogs, steroids, H2-blockers, and other modalities can be effective in palliation and possible resolution of obstruction. Awareness of these pharmacologic therapies can aid hospitalists in treating patients who are confronted with this devastating condition.
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Past studies have not evaluated inhaler use in hospitalized children with asthma. The objectives of this study were to evaluate inhaler technique in hospitalized pediatric patients with asthma and identify risk factors for improper use. We conducted a prospective cross-sectional study in a tertiary children's hospital for children 2-16 years of age admitted for an asthma exacerbation, and inhaler technique demonstrations were analyzed. ⋯ More patients missed a critical step when they used a spacer with mouthpiece instead of a spacer with mask (75% [51%-90%] vs 36% [27%-46%]) and were older (7.8 [6.7-8.9] vs 5.8 [5.1-6.5] years). Patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates (odds ratio 6.95 [1.71-28.23], P = .007). Hospital-based education may provide teachable moments to address poor proficiency, especially for older children using a mouthpiece.
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Approximately 83% of hospitalist groups around the country utilize advanced practice providers; however, the demand for hospitalists continues to exceed the supply, and this has led to increased utilization of advanced practice providers in hospital medicine. Advanced practice providers receive very limited inpatient training, and there is wide variation in their clinical abilities after graduation. ⋯ The advanced practice provider fellowship has proven beneficial for the hospitalist division by (1) reducing costs associated with having unfilled vacancies, (2) improving capacity on the hospitalist service, and (3) providing a pipeline for filling nurse practitioners (NP) and physician assistant (PA) vacancies on the hospitalist service.
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Incidental pulmonary nodules (IPNs) are common and often require follow-up. The Fleischner Society guidelines were created to support IPN management. We developed a 14-item survey to examine hospitalists' exposure to and management of IPNs. ⋯ Notwithstanding, 42% were unfamiliar with the Fleischner Society guidelines. When determining the IPN follow-up, 83% used radiology report recommendations, 64% consulted national or international guidelines, and 34% contacted radiologists; 34% agreed that determining the follow-up was challenging; only 15% reported availability of automated tracking systems. In conclusion, despite frequent IPN exposure, hospitalists are frequently unaware of the Fleischner Society guidelines and rely on radiologists' recommendations.