Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Postdischarge follow-up visits for medical and pharmacy students on an inpatient medicine clerkship.
Teaching medical and pharmacy students to collaborate on discharge planning for chronically ill patients may facilitate their ability to provide quality care. ⋯ A clinically oriented curriculum with postdischarge visits improved students' attitudes and self-assessed skills in interdisciplinary collaboration and transitional care and fostered a patient-centered approach to care.
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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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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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Review Meta Analysis Comparative Study
Effects of rapid response systems on clinical outcomes: systematic review and meta-analysis.
A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. ⋯ Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven.
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Randomized Controlled Trial Comparative Study
A randomized clinical trial to compare the use of safety net enclosures with standard restraints in agitated hospitalized patients.
Although hospitals attempt to minimize the use of restraints, certain cases require their application. For such patients, there is a need for novel, safe and more humane restraint systems. ⋯ For hospitalized patients requiring restraint, the SOMA Safe Enclosure is effective and more acceptable to relatives, physicians, and secondary nurses than currently used restraints.