Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There is currently no consensus regarding the training required by non-anesthesiologists to provide safe sedation. We will outline the training method developed at St. Louis Children's Hospital. ⋯ A pediatric hospitalist sedation service with proper training and oversight can successfully augment sedation provided by anesthesiologists.
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Hospitalists often treat patients with severe acute hypertension (AH) presenting to the hospital. Little is known about the epidemiology of this syndrome. ⋯ Severe AH appears common and its prevalence varies by underlying clinical condition. Severe AH is associated with excess in-hospital mortality for patients with nervous system diseases and, for most disease categories, prolongs hospitalization.
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Review Meta Analysis Comparative Study
Continuous infusion versus intermittent bolus furosemide in ADHF: an updated meta-analysis of randomized control trials.
Administering intermittent boluses of furosemide to patients with acute decompensated heart failure (ADHF) often leads to unfavorable hemodynamic changes. Continuous infusion may induce similar or greater diuresis without adverse hemodynamic consequences. We conducted a systemic review and meta-analysis of randomized clinical trials that compared the effects of continuous infusion and intermittent bolus of furosemide in patients hospitalized with ADHF. ⋯ This meta-analysis showed statistical support for administering furosemide as a continuous infusion for greater diuresis and reduction in total body weight in patients hospitalized with ADHF. With the exception of greater diuresis, available data are homogenous for the reported outcomes but lack information on clinical endpoints. Larger studies are needed to provide robust recommendations for clinical practice.
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Infection control is the most essential component of an effective overall management strategy for prevention of nosocomial Clostridium difficile infection (CDI). The cornerstones of CDI prevention are appropriate contact precautions and strict hand hygiene. Other important tactics are effective environmental cleaning, identification and removal of environmental sources of C. difficile, and antibiotic stewardship. Hospitalists, as coordinators of care for each patient and advocates for quality care, can spearhead these efforts.
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Patients with intensive care unit (ICU) transfers from hospital wards have higher mortality than those directly admitted from the emergency department. ⋯ Early unplanned ICU transfers-even within 8 hours of hospitalization-are associated with increased mortality; outcomes vary by elapsed time to transfer and admitting diagnosis.