The American journal of medicine
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Review Comparative Study
Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs have eliminated the need for such practice. However, PICCs may not be as innocuous as once thought; a growing body of evidence suggests that these devices also have important risks. ⋯ In this context, we introduce a conceptual model to understand the risk of PICC-related complications and guide the use of these devices. Through this model, we outline recommendations that clinicians may use to prevent PICC-related adverse events. We conclude by highlighting important knowledge gaps and identifying avenues for future research in this area.
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The National Academies reported in Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering (2006) that "women are very likely to face discrimination." In academic medicine, gender distribution is becoming more balanced. In the federal government, women also have made progress, doubling their representation in professional positions to 44%. The Department of Veterans Affairs (VA) has a research program and a mission to train health care professionals; however, its gender distribution has not been described. ⋯ Marked gender disparities were seen in the VA, except in Health Services Research. Organizations must investigate their practices to reveal disparities, investigate underlying factors, and intervene as needed.
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In the United States, emergency physicians and hospitalists are increasingly responsible for managing hospitalized patients. These specialists share a common practice space and similar shift work schedules. Together they govern decisions about use of the most expensive care setting in medicine-the hospital. ⋯ Hospital care is increasingly driven by emergency physicians and hospitalists. We envision a vital role for ongoing collaboration between them in achieving the goals of patient care, education, and quality and safety outcomes.