Annals for Hospitalists - 17 April 2018
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2018)

Web Exclusives17 April 2018Annals for Hospitalists - 17 April 2018FREEDavid H. Wesorick, MD*, 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, 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/AFHO201804170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesWhy Should Hospitalists Use Point-of-Care Ultrasound?—Anna M. Maw, MD, MS, and Nilam J Soni, MD, MScOver the past decade, hospitalists have begun to use point-of-care ultrasound to answer focused diagnostic questions at the bedside. In this month's Inpatient Notes, the authors explain why point-of-care ultrasound may become a routine part of a hospitalist's physical examination.Highlights of Recent Articles From Annals of Internal MedicineShould This Patient Receive Prophylactic Medication to Prevent Delirium?: Grand Rounds Discussion From Beth Israel Deaconess Medical CenterAnn Intern Med. 2018;168:498-505. doi:10.7326/M18-0388This Beyond the Guidelines article summarizes a case-based Grand Rounds discussion from Beth Israel Deaconess Medical Center. In this case, 2 experts offer opposing views on the use of antipsychotic medications for the prevention of postoperative delirium in high-risk patients.Key points for hospitalists include:Both experts agree that nonpharmacologic prevention strategies (e.g., reorientation; early mobility; optimization of nutrition, oxygenation, and gastrointestinal and urinary function) form the backbone of delirium prevention.One expert—a psychiatrist—recommends the use of prophylactic antipsychotic medications for some high-risk patients based on meta-analyses suggesting that they decrease the incidence of delirium and his experience that these medications can also help reduce the distress of perceptual disturbances, paranoia, and agitation.Another expert—a geriatrician—recommends against the use of prophylactic antipsychotic medications to prevent delirium, noting that studies have used various of delirium assessment tools and may have underdiagnosed hypoactive delirium.Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1): A Systematic ReviewAnn Intern Med. 2018;168:558-568. Published 20 February 2018. doi:10.7326/M17-2947The Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) is a Centers for Medicare & Medicaid Services (CMS) performance measure that was released in 2015. Hospitals are required to report metrics based on the components of this bundle. This systematic review analyzed 20 studies examining SEP-1 as a whole or the 5 hemodynamic interventions in the bundle, including serial lactate measurement; fluid infusion of 30 mL/kg of body weight; and assessment of volume status and tissue perfusion with a focused examination, bedside cardiovascular ultrasonography, or fluid responsiveness testing. The review was unable to identify any high- or moderate-level evidence (based on 2013 CMS criteria) demonstrating that SEP-1, or its individual hemodynamic interventions, improve survival in adults with sepsis.Key points for hospitalists include:This systematic review concludes that the SEP-1 performance measure is not supported by strong evidence.The authors submit that CMS performance measures should be based on strong evidence because the requirement for reporting these measures is resource-intensive and they often evolve into criteria for hospital accreditation or reimbursement.An editorial suggests that this evidence review should prompt reconsideration of the components of this bundle. The Latest Highlights From ACP Journal ClubCan fecal microbiota transplantation for recurrent Clostridium difficile infection (CDI) be effectively accomplished via oral capsules?Fecal transplant by oral capsule was noninferior to delivery by colonoscopy for C difficile recurrenceAnn Intern Med. 2018;168:JC31. doi:10.7326/ACPJC-2018-168-6-031This unblinded controlled trial randomly assigned 116 patients with 3 or more episodes of CDI to microbiota transplantation via either colonoscopy or capsule ingestion. The acute episode of CDI was treated, and symptoms had resolved at the time of transplantation. Patients were excluded if they had severe or complicated disease. Capsule delivery was noninferior to delivery via colonoscopy, with rates of CDI absence at 12 weeks of 96.2% in both groups.Does the addition of rifampicin improve outcomes in patients with Staphylococcus aureus bacteremia?In adults with S aureus bacteremia, adding rifampicin to standard antibiotic therapy did not improve outcomesAnn Intern Med. 2018;168:JC32. doi:10.7326/ACPJC-2018-168-6-032This blinded controlled trial randomly assigned 770 patients with Staphylococcus aureus (mostly methicillin-sensitive S aureus) bacteremia to standard antibiotics plus rifampicin or standard antibiotics plus placebo. The addition of rifampicin was not associated with a decreased rate of the composite outcome (treatment failure, disease recurrence, or all-cause mortality). The study was not powered to detect a difference in patients with methicillin-resistant S aureus bacteremia or endocarditis.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 InformationDisclosures: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 - Why Should Hospitalists Use Point-of-Care Ultrasound? Anna M. Maw and Nilam J. Soni Metrics 17 April 2018Volume 168, Issue 8Page: HO8KeywordsAntibioticsColonoscopyBacteremiaAntipsychoticsSystematic reviewsUltrasound imagingTransplantationDeliriumHospitalists ePublished: 17 April 2018 Issue Published: 17 April 2018 CopyrightCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...