Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Review Comparative Study
Frequently asked questions by hospitalists managing pain in adults with sickle cell disease.
Pain is the predominant medical presentation to hospitalists for patients with sickle cell disease (SCD). Dramatic treatment gains of SCD in childhood have resulted in more adults now requiring hospitalization than children. ⋯ We therefore offer some evidence and our informed opinion to answer frequently asked questions (FAQs) about pain management by hospitalists caring for adults with SCD. The most common questions center around defining a crisis; selecting and managing opioids; distinguishing between opioid tolerance, physical dependence, and addiction or misuse; determining appropriateness of discharge; and avoiding lengthy or recurrent hospitalizations.
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Comparative Study
Feasibility of audit and feedback to reduce postoperative urinary catheter duration.
Indwelling urinary catheter duration is an important risk factor for catheter-associated urinary tract infections (CAUTIs). ⋯ Audit and feedback of aggregated patient-level urinary catheter duration determined from electronic documentation may prove effective in improving urinary catheter management for surgical patients.
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Comparative Study
Retrospective review of emergency response activations during a 13-year period at a tertiary care children's hospital.
Pediatric in-hospital arrests are uncommon but are associated with poor outcomes. In preparation for implenting a Rapid Response Team (RRT) at The Children's Hospital, we reviewed our data collection of 13 years of emergency response team (ERT) activations. We describe demographic and clinical variables, including outcomes of ERT activations at a free-standing tertiary care children's hospital. ⋯ Our data support the general belief that younger children with chronic disease are at highest risk for ERT activations. These risk factors should be taken into consideration when planning patient placement, medical staffing, and the threshold for ICU consultations or admissions. More extensive multisite studies using clinical data are necessary to further identify hospitalized children at risk for sudden decompensation.
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Comparative Study
The use of sodium polystyrene sulfonate in the inpatient management of hyperkalemia.
Limited data exist on the precise dose of sodium polystyrene sulfonate (SPS) needed for specific potassium concentrations in the management of mild to moderate hyperkalemia in an inpatient hospital setting. ⋯ A possible direct dose response relationship between SPS and the reduction in serum potassium concentration was found and should be evaluated prospectively.