Annals for Hospitalists - 17 January 2017
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2017)

Web Exclusives17 January 2017Annals for Hospitalists - 17 January 2017FREEDavid 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/AFHO201701170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesAnnals for Hospitalists Inpatient Notes - Rituals in Chaos, the Sacred in the Profaneby Poonam Hosamani, MD, and Abraham Verghese, MDIn the often-chaotic inpatient environment, how can hospitalists direct their attention to what is really important? In this commentary, the authors recommend the use of rituals to focus on what is sacred.Highlights of Recent Articles From Annals of Internal MedicineDiagnosis of Acute Gout: A Clinical Practice Guideline From the American College of PhysiciansAnn Intern Med. 2017;166:52-57. Published online 1 November 2016. doi:10.7326/M16-0569This guideline is based on a systematic review of the literature involving a search of multiple electronic databases from database inception through February 2016.Key points for hospitalists include:The American College of Physicians (ACP) recommends synovial fluid analysis for diagnosis of acute gout. Although some clinical algorithms that have more than 80% sensitivity and specificity for acute gout, they are less accurate than synovial fluid analysis and evidence that they effectively rule out joint sepsis is limited.Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of PhysiciansAnn Intern Med. 2017;166:58-68. Published online 1 November 2016. doi:10.7326/M16-0570This guideline is based on a systematic review of the literature involving a search of multiple electronic databases from January 2010 through February 2016.Key points for hospitalists include:The ACP recommends that colchicine (low dose), nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids be used to treat acute gout.It recommends against use of long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks (e.g., <2/y), noting that the risks and benefits of this therapy are uncertain.The guideline notes that using urate-lowering medications to achieve a specific serum urate level is not based on strong evidence and thus does not endorse this approach (in contrast to the American College of Rheumatology guideline). One editorial defends this recommendation, noting that the ACP guideline is based solely on scientific evidence and that its recommendations are not influenced by expert opinion or consensus. Another editorial argues that “treat-to-target” is the most rational approach, based on observational data, experience, and practical factors. High-quality evidence supports the use of low-dose colchicine or NSAID prophylaxis during initiation of urate-lowering therapy to prevent disease flares.The Latest Highlights From ACP Journal ClubAre prothrombin complex concentrates better than plasma for warfarin reversal?Review: For warfarin reversal, prothrombin complex concentrates reduce mortality compared with fresh frozen plasmaAnn Intern Med. 2016;165:JC65. doi:10.7326/ACPJC-2016-165-12-065This review examines 5 randomized, controlled trials, and 8 observational studies, including a total of 2114 encounters requiring the reversal of warfarin for bleeding and/or the need for an urgent invasive procedure. It finds that prothrombin complex concentrates, compared with fresh frozen plasma, reduce the international normalized ratio (INR) faster, cause less volume overload, and are associated with lower mortality. However, the observational data in this review are of low quality, and the observed mortality benefit should be viewed with caution.Is triple therapy with inhaled corticosteroid (ICS), long-acting β2-agonist (LABA), and long-acting muscarinic antagonist (LAMA) better than dual therapy with ICS and LABA in chronic obstructive pulmonary disease?Adding glycopyrronium to beclomethasone plus formoterol improved pulmonary function in COPDAnn Intern Med. 2016;165:JC67. doi:10.7326/ACPJC-2016-165-12-067This multicenter, randomized, controlled trial of 1368 patients with chronic obstructive pulmonary disease (COPD) (postbronchodilator FEV1 <50%, FEV1–FVC ratio <0.7, COPD Assessment Test score ≥10, Baseline Dyspnea Index focal score ≤10, and ≥1 moderate or severe COPD exacerbation in the past year) found that adding glycopyrronium bromide to beclomethasone dipropionate and formoterol fumarate resulted in a small improvement in FEV1 and a small decrease in moderate to severe exacerbations at 26 weeks. Whether triple therapy is superior to dual therapy with LABA plus LAMA remains unclear.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 - Rituals in Chaos, the Sacred in the Profane Poonam Hosamani and Abraham Verghese Metrics 17 January 2017Volume 166, Issue 2Page: HO2KeywordsColchicineDatabasesForced expiratory volume in the first second of expirationGoutHospitalistsInternational normalized ratioMortalityNSAIDsSynovial fluidSystematic reviews ePublished: 17 January 2017 Issue Published: 17 January 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.Loading ...