Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Older adults make up an increasing proportion of patients hospitalized with cardiovascular disease. Such patients often have multiple coexisting geriatric syndromes that may affect management and outcomes and are frequently underdiagnosed and untreated. ⋯ These findings suggest that geriatric syndromes are prevalent among older patients hospitalized for cardiovascular disease. Further study is needed to determine if interventions designed to increase recognition and treatment of these syndromes can improve outcomes in this patient population.
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Klebsiella pneumoniae liver abscess is known to be associated with metastatic endophthalmitis, with most cases clustered in Taiwan. We report a case of Klebsiella liver abscess with metastatic endophthalmitis in a nondiabetic Haitian man without underlying medical problems.
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Comparative Study
Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents: a retrospective cohort study.
Drug-eluting coronary stents (DESs) pose a challenge in the perioperative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk. ⋯ These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone at least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.
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The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. ⋯ We also discuss approaches to promoting more effective transitions of care, including improvements in communication between inpatient and outpatient physicians, effective reconciliation of prescribed medication regimens, adequate education of patients about medication use, closer medical follow-up, engagement with social support systems, and greater clarity in physician-patient communication. By understanding the key challenges and adopting strategies to improve patient care in the transition from hospital to home, hospitalists could significantly reduce medical errors in the postdischarge period.
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Organ donation after cessation of cardiac pump activity is referred to as non-heart-beating organ donation (NHBOD). NHBOD donors can be neurologically intact; they do not fulfill the brain death criteria prior to cessation of cardiac pump activity. For hospitals to participate in NHBOD, they must comply with a newly introduced federal requirement for ICU patients whose deaths are considered imminent after withdrawal of life support. This report describes issues related to NHBOD. ⋯ The use of comprehensive quality indicators for EOL care can determine the impact of NHBOD on care offered to donors and the effects on families and health care providers. Detailed evaluation of NHBOD will enable the public to make informed decisions about participating in this type of organ donation.