<i>Annals</i> for Hospitalists - 18 October 2016
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2016)

Web Exclusives18 October 2016Annals for Hospitalists - 18 October 2016FREEDavid H. Wesorick, MD* and Vineet Chopra, MD, MSc*David H. Wesorick, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this author and Vineet Chopra, MD, MSc*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AFHO201610180 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesAnnals for Hospitalists Inpatient Notes - Reducing Diagnostic Error—A New Horizon of Opportunities for Hospital Medicineby Hardeep Singh, MD, MPH, and Laura Zwaan, PhDDiagnostic errors are an important source of preventable harm. In this article, the authors explain why efforts to prevent diagnostic errors may represent a new horizon of opportunities for hospitalists.Highlights of Recent Articles From Annals of Internal MedicinePrediction Models of Mortality in Acute Pancreatitis in Adults: A Systematic ReviewAnn Intern Med. 2016;165:482-90. Published online 26 July 2016. doi:10.7326/M16-0650This article reviewed 91 cohort studies and 3 randomized, controlled trials to assess the test characteristics and clinical utility of tools for predicting mortality in acute pancreatitis. Eighteen scores were evaluated, including the APACHE II score and the Ranson criteria. The included studies were highly heterogeneous and of low quality. Despite decades of use of these tools, evidence to support their utility is very limited.Key points for hospitalists include:Studies that evaluate prognostic accuracy are limited by clinical heterogeneity and inadequate methodological quality.None of the included studies directly assess the influence of these models on patient management and outcomes, or their cost-effectiveness.Based on existing evidence, it is difficult to make recommendations about the practical clinical use of these scores, and the authors suggest that this area is ripe for additional research.The CMS Sepsis Mandate: Right Disease, Wrong MeasureAnn Intern Med. 2016;165:517-8. Published online 14 June 2016. doi:10.7326/M16-0588This review discussed the recent Centers for Medicare & Medicaid Services (CMS) mandate for hospitals to use the SEP-1 sepsis management bundle and report several sepsis-related process measures. The authors state that the bundle is too rigid, fails to reflect the most recent recommendations about sepsis, and imparts a huge administrative burden without significant gain.Key points for hospitalists include:The mandatory reporting on these bundles is hampered by the lack of a widely agreed-on definition of sepsis.Although the CMS bundle still uses systemic inflammatory response (SIRS) criteria, the recent Sepsis-3 Consensus Conference has conceptually reframed sepsis, and has abandoned the use of SIRS in sepsis.The bundle is based on the concept of goal-directed therapy, but at least 3 trials over the past 2 years have found no benefit with this approach.The Latest Highlights From ACP Journal ClubShould blood pressure be intensively lowered in cases of intracerebral hemorrhage?Intensive lowering of systolic BP did not reduce death or disability more than standard lowering in ICHAnn Intern Med. 2016;165:JC32. doi:10.7326/ACPJC-2016-165-6-032This trial randomly assigned 1000 adult patients with ICH to intensive blood pressure (BP) control (target systolic BP, 110–139 mm Hg) or standard BP control (target systolic BP, 140–179 mm Hg). It found no difference in the occurrence of death or severe or moderately severe disability between the 2 groups.Does the use of long-acting opioids for chronic noncancer pain increase risk for mortality?Long-acting opioids for chronic noncancer pain were linked to mortalityAnn Intern Med. 2016;165:JC34. doi:10.7326/ACPJC-2016-165-6-034This cohort trial used a propensity matching methodology to compare mortality rates for patients with chronic noncancer pain who were treated with opioids with those treated with nonopioid medications. In this evaluation of more than 45 000 Medicaid patients, opioid use was associated with a significantly increased risk for all-cause mortality.Do existing VTE risk assessment models accurately estimate risk of this outcome?4 risk assessment models had good calibration but poor discrimination for VTE in hospitalized medical patientsAnn Intern Med. 2016;165:JC35. doi:10.7326/ACPJC-2016-165-6-035Using data from a consortium of 48 Michigan hospitals, this study compared 4 venous thromboembolism (VTE) assessment models (Intermountain, Improve, Padua, and Kucher) in hospitalized, adult, medical patients. Although all models had similar accuracy, none were highly predictive of VTE risk (c-statistic about 0.6 for all).Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C.)Disclosures:Drs. Wesorick and Chopra have disclosed no conflicts of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.* The authors are co-first authors and contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Reducing Diagnostic Error—A New Horizon of Opportunities for Hospital Medicine Hardeep Singh and Laura Zwaan Metrics 18 October 2016Volume 165, Issue 8Page: HO8KeywordsDisabilitiesHospitalistsMedicareMortalityOpioidsResearch quality assessmentRisk assessmentsSepsisSystemic inflammatory response syndromeVenous thromboembolism ePublished: 18 October 2016 Issue Published: 18 October 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.Loading ...