Journal of general internal medicine
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Patients with bacteremia often have elevated white blood cell (WBC) and neutrophil counts, yet these alone are poor predictors of bacteremia. Data on the continuous relationship between WBC response and bacteremia are lacking. ⋯ ILRs offered a more discriminating approach to estimating the probability of bacteremia than a single threshold. Physicians assessing risk of bacteremia should pay attention to the magnitude of abnormality because very high and very low values have much stronger predictive power than dichotomized results.
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The Health Insurance Portability and Accountability Act (HIPAA) aims to safeguard patient information; however, complex legal language may lead to confusion and mistrust, and hinder enrollment in clinical trials. ⋯ The inclusion of a standard HIPAA authorization in mailed enrollment packets for a large pragmatic trial led to lower rates of study enrollment. This study informs how HIPAA authorization forms should be redesigned to be more accessible to patients to prevent unnecessary barriers to research enrollment.
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Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Treatment of hyponatremia is associated with improved outcomes, but more than one in three cases of new onset hyponatremia is not corrected by the time of hospital discharge. Nephrologist input may improve the diagnosis and treatment of hyponatremia, but specialist resources are limited. Targeted automatic electronic consultations (TACos) may be one approach to provide expert nephrologist guidance to the workup and management of hyponatremia using a scalable model. ⋯ Inpatient TACos for hyponatremia were feasible and acceptable to primary teams, and frequently led to changes in diagnosis and management. Further studies are needed to determine the impact of the TACo model on clinical outcomes and cost-effectiveness.