Annals for Hospitalists - 17 March 2020
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2020)

Web Exclusives17 March 2020Annals for Hospitalists - 17 March 2020FREEDavid 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/AWHO202003170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesAnnals for Hospitalists Inpatient Notes - Hospital Wards—Joel D. Howell, MD, PhDIn this month's commentary, the author explores the history of hospital wards and explains the social, political, and economic forces that have led us to the private rooms of today.Highlights of Recent Articles from Annals of Internal MedicineSitter as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic ReviewAnn Intern Med. 2020;172:317-324. Published 4 February 2020. doi:10.7326/M19-2628This literature review summarizes the effect of sitters, and alternatives to sitters, on patient falls in acute care hospitals. Twenty eligible studies (no randomized trials) were categorized as either adding sitters to standard care (2 of 20) or employing interventions to reduce the existing use of sitters (18 of 20). The 2 studies that added sitters to standard care reported conflicting results. Almost all studies of alternatives to sitters used multicomponent interventions, such as video monitoring, staff and patient education, environmental modifications, and decision support tools. These studies generally reported a reduction in sitter use that either did not affect or decrease falls. They also reported cost savings for sitter use but did not report costs of the alternatives.Key points for hospitalists include:On the basis of the limited available evidence, it remains uncertain whether sitters actually reduce the risk for falls. The authors found moderate-certainty evidence that video monitoring reduces the use of sitters, without increasing falls.All identified studies had at least 1 significant methodological limitation affecting their internal validity.An editorialist states that this “shallow evidence base should not yet compel us to stop using sitters in clinical care…” and advocates for creating an “age-friendly health system” that focuses on maintaining function in older hospitalized patients.Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysisAnn Intern Med. Published 25 February 2020. doi:10.7326/M19-3007This systematic review analyzed 68 randomized controlled trials of pharmacologic interventions for inpatients (non–intensive care unit) or outpatients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Only 2 antibiotic trials were identified in hospitalized patients.Key points for hospitalists include:Of all of the pharmacologic interventions studied, only antibiotics and systemic corticosteroids demonstrate a reduced rate of treatment failure in AECOPD. Corticosteroids are associated with an increase in adverse effects, including endocrine-related ones.This review finds insufficient or no evidence informing the optimal choice of antibiotic or corticosteroid regimen, including dosage, route, or duration of treatment. However, it is noted that 5 days of corticosteroid treatment does not appear to be inferior to 14 days.Aminophyllines were not associated with any improved outcomes but were associated with gastrointestinal adverse effects. Magnesium sulfate, simvastatin, zileuton, and inhaled corticosteroids (with or without short-acting β-agonists) were associated with improvements in FEV1, but not other outcomes.The authors highlight the “lack of good-quality, reliable evidence to answer many of the important clinical questions surrounding treatment of patients with exacerbation of COPD.”The Latest Highlights From Journal ClubIn post–percutaneous coronary intervention (PCI) patients, after 3 months of dual antiplatelet therapy (DAPT), how does ticagrelor monotherapy compare with continued DAPT for another 12 months?After PCI and 3 mo of DAPT, ticagrelor for 12 mo reduced bleeding vs continued DAPT and did not increase ischemic eventsAnn Intern Med. 2020;172:JC19. doi:10.7326/ACPJ202002180-019This study randomized 7119 patients who underwent successful PCI and completed 3 months of DAPT with ticagrelor and aspirin to either monotherapy with ticagrelor or continuation of DAPT for an additional 12 months. Patients treated with ticagrelor monotherapy experienced significantly fewer bleeding events than DAPT patients, without any increase in ischemic events.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 - Hospital Wards Joel D. Howell Metrics 17 March 2020Volume 172, Issue 6Page: HO6KeywordsAntibioticsFallsHemorrhageHospitalistsPatientsPercutaneous coronary interventionRandomized trialsResearch quality assessmentSulfatesSystematic reviews ePublished: 17 March 2020 Issue Published: 17 March 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.Loading ...