Annals for Hospitalists - 21 August 2018
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2018)

Web Exclusives21 August 2018Annals for Hospitalists - 21 August 2018FREEDavid 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/AFHO201808210 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesClinical Pearls—A Young Man With Lung Cancer and Diarrhea—David H. Wesorick, MDThis month's Inpatient Notes draws attention to an emerging set of immunologic disorders that hospitalists are sure to encounter with increasing frequency.Highlights of Recent Articles From Annals of Internal MedicineIn the Clinic: Herpes ZosterAnn Intern Med. 2018;169:ITC17-ITC32. doi:10.7326/AITC201808070This recent In the Clinic article provides an update on the prevention, diagnosis, and treatment of this common disease.Key points for hospitalists include:When a diagnosis of herpes zoster is not obvious, based on the appearance of skin lesions, polymerase chain reaction is the best diagnostic test.Some patients with herpes zoster may require hospitalization, especially those with disseminated disease or neurologic or ocular involvement. Intravenous acyclovir is often recommended for these complicated patients.It is important to recognize herpes zoster ophthalmicus, which can present exclusively with eye symptoms (without skin lesions) or with blisters on the tip of the nose. An ophthalmologist should always be consulted in cases where ocular involvement is suspected.Corticosteroids may speed healing of skin lesions and reduce the acute pain of herpes zoster infections, but there is no evidence that they reduce the frequency of postherpetic neuralgia.Medications for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort StudyAnn Intern Med. 2018;169:137-145. Published 19 June 2018. doi:10.7326/M17-3107This cohort study examined data from 17 568 adults who survived an opioid overdose between 2012 and 2014, comparing subsequent mortality rates of patients treated with medications for opioid use disorder (MOUD) with those of patients not receiving these medications. In this study, MOUD could include methadone, buprenorphine, or naltrexone. Patients treated with methadone or buprenorphine after an opioid overdose had significantly reduced subsequent all-cause and opioid-related mortality rates than patients not receiving MOUD.Key points for hospitalists include:Thousands of people die each year of opioid overdose in the United States. The use of MOUD after nonfatal opioid overdose seems to significantly reduce subsequent opioid-related deaths.In this study, only 30% of patients received MOUD in the year after their nonfatal opioid overdose. An editorial suggests that the stigma of OUD has resulted in a failure of the system to make the necessary policy and infrastructural changes to allow broader use of this potentially lifesaving treatment. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort StudyAnn Intern Med. 2018;169:205-213. Published 10 July 2018. doi:10.7326/M17-2785This cohort study used electronic health records to compare rates of venous thromboembolism (VTE), ischemic stroke, and myocardial infarction between transgender and cisgender subjects. Investigators matched 2842 transfeminine patients and 2118 transmasculine patients to 48 686 cisgender men and 48 775 cisgender women. The study's main finding is that transfeminine patients demonstrated a higher incidence of VTE than either cisgender males or females, with 2- and 8-year risk differences of 4.1 (95% CI, 1.6 to 6.7) and 16.7 (CI, 5.4 to 27.5) per 1000 persons relative to cisgender males, and 3.4 (CI, 1.1 to 5.6) and 13.7 (CI, 4.1 to 22.7) per 1000 persons relative to cisgender females.Key points for hospitalists include:This study provides evidence that transfeminine patients experience a significantly increased risk for VTE, presumably related to the use of hormone therapy.Clinicians should be aware of this increased risk when providing long-term care for transfeminine patients and when assessing pretest probability for transfeminine patients presenting with symptoms of possible VTE.The Latest Highlights From ACP Journal ClubDo postdischarge home interventions reduce falls in older adults?Review: Postdischarge home interventions can increase or decrease falls in older adultsAnn Intern Med. 2018;169:JC10. doi:10.7326/ACPJC-2018-169-2-010This review examined 16 trials (n = 3290), 15 of them randomized controlled trials, to compare fall rates among patients receiving home fall interventions versus those receiving placebo or no intervention. Home exercise programs did not appear to reduce fall rates, although the interventions were noted to be heterogeneous, and the exercise was unsupervised in 1 of the trials. Trials of home hazard modification showed mixed results. The evidence does not support the use of home exercise programs to reduce falls in older adults.Should you use dual or single antiplatelet therapy (DAPT or SAPT) in combination with oral anticoagulants in patients with atrial fibrillation after percutaneous coronary intervention?Review: After PCI in AF, OAC plus single vs dual antiplatelets reduces major bleeding; no difference for MACEAnn Intern Med. 2018;169:JC8. doi:10.7326/ACPJC-2018-169-2-008This review examines studies comparing SAPT with DAPT after percutaneous coronary intervention in patients with atrial fibrillation who were treated with oral anticoagulants. Analysis of the 4 randomized controlled trials (n = 6026) reveals that SAPT is associated with significantly lower rates of bleeding and no difference in major adverse cardiac events compared with DAPT. This conclusion is also supported by several other recent reviews. When clinically appropriate, SAPT may be preferred to DAPT for patients with atrial fibrillation receiving anticoagulants after percutaneous coronary intervention.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 - Clinical Pearls—A Young Man With Lung Cancer and Diarrhea David H. Wesorick Metrics 21 August 2018Volume 169, Issue 4Page: HO4KeywordsDeath ratesElderlyExerciseFallsHemorrhageHospitalistsLesionsOpioid use disorderOpioidsPercutaneous coronary intervention ePublished: 21 August 2018 Issue Published: 21 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...