Annals for Hospitalists - 18 September 2018
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2018)

Web Exclusives18 September 2018Annals for Hospitalists - 18 September 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/AFHO201809180 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesManaging Acute Pain in the Hospital in the Face of the Opioid Crisis—Shoshana J. Herzig, MD, MPHThis month's Inpatient Notes describes how widespread underestimation of the risks of opioids has contributed to the current opioid crisis and how our growing appreciation of these risks should lead to changes in our prescribing practices.Highlights of Recent Articles From Annals of Internal MedicineOpioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid GuidelineAnn Intern Med. 2018;169:367-375. Published 28 August 2018. doi:10.7326/M18-1243This study analyzed the U.S. opioid prescribing database to identify prescribing trends over the period from 2012 to 2017. The study examined trends that surfaced after the 2016 publication of the Centers for Disease Control and Prevention's (CDC's) Guideline for Prescribing Opioids for Chronic Pain. The analysis revealed that several prescribing practices were improving, even before publication; however, the rate of improvement in these practices increased further after publication.Key points for hospitalists include:Several prescribing practices improved after the publication of the CDC guideline, including the overall rate of opioid prescribing, the rate of prescription of high-dose opioids, and the rate of coprescription of opioids and benzodiazepines.These results suggest that the publication of the CDC's opioid guideline (and the associated educational campaign) did have a positive effect on opioid prescribing practices in the United States.Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings: A Call for Action After a National Academies of Sciences, Engineering, and Medicine WorkshopAnn Intern Med. 2018;169:335-336. Published 13 July 2018. doi:10.7326/M18-1203This Ideas and Opinions article highlights the fact that patients with opioid use disorder (OUD) often present to hospitals with specific infectious complications of their disorder (e.g., endocarditis, bacteremia, skin infections, hepatitis C, and HIV). While hospitalized, the infections are usually treated, but OUD is often left entirely unaddressed (or addressed only with an outpatient referral for treatment that is not started in the hospital). The authors proposed action steps to provide more reliable and timely OUD treatment for these patients.Key points for hospitalists include:This workshop concluded that all patients with infections that might be associated with OUD should be screened for OUD using such tools as the Rapid Opioid Dependence Screen.The authors also suggested that hospitals should restructure their practices to initiate effective medical treatment for OUD (e.g., buprenorphine, methadone, or naloxone) before hospital discharge and to create adequate systems for postdischarge follow-up, echoing the suggestions from a previous Inpatient Notes. This workshop provides yet another call for hospitals to take a proactive role in addressing the current opioid crisis.Risks and Benefits of Marijuana Use: A National Survey of U.S. AdultsAnn Intern Med. 2018;169:282-290. Published 24 July 2018. doi:10.7326/M18-0810This article discussed the results of a survey of over 16 000 noninstitutionalized U.S. civilians on their views about the risks and benefits of marijuana use. Almost 30% of respondents agreed that smoking marijuana prevents health problems, and 18% believe that exposure to secondhand marijuana smoke is somewhat or completely safe for adults.Key points for hospitalists include:There is a relatively limited body of scientific evidence defining the risks and benefits of marijuana smoking, but recent changes in state laws have made marijuana more readily available to the public.These survey results suggest that many Americans' views on marijuana are more favorable than existing evidence supports.The Latest Highlights From ACP Journal ClubIs a single dose of fosfomycin as effective as a 5-day course of nitrofurantoin for uncomplicated urinary tract infection (UTI)?5 day nitrofurantoin increased clinical resolution of uncomplicated UTIs in women vs 1-dose fosfomycinAnn Intern Med. 2018;169:JC19. doi:10.7326/ACPJC-2018-169-4-019This randomized controlled trial of 513 ambulatory or hospitalized women with uncomplicated UTI compared the efficacy of 1 dose of fosfomycin with a 5-day course of nitrofurantoin. It found that nitrofurantoin was associated with a higher rate of clinical resolution and bacteriologic cure than fosfomycin. This suggests that fosfomycin might be better reserved for times when susceptibility profiles limit other options.Does N-terminal pro-B-type natriuretic peptide (NT-proBNP)–guided therapy lead to better outcomes than conventional therapy for patients with acute heart failure?NT-proBNP-guided and conventional therapies did not differ for readmission or mortality in acute decompensated HFAnn Intern Med. 2018;169:JC21. doi:10.7326/ACPJC-2018-169-4-021This randomized controlled trial examined 405 patients with acute heart failure who had stabilized in the hospital. These patients were then randomly assigned to 1 of 2 groups. In the NT-proBNP group, patient levels of NT-proBNP were measured at randomization and compared with the levels at admission. Patients with >30% reduction from admission were discharged, and patients with ≤30% decrease had their care intensified. In the non–NT-proBNP group, NT-proBNP was not used to guide therapy. The 2 groups demonstrated no difference in the outcomes of mortality or readmission rates over 180 days.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 - Managing Acute Pain in the Hospital in the Face of the Opioid Crisis Shoshana J. Herzig Metrics 18 September 2018Volume 169, Issue 6Page: HO6KeywordsEndocarditisHospitalistsInpatientsMarijuanaMortalityN terminal pro brain natriuretic peptidesOpioid use disorderOpioidsOutpatient clinicsSkin infections ePublished: 18 September 2018 Issue Published: 18 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.Loading ...