Annals for Hospitalists - April 2022
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2022)

Web ExclusivesApril 2022Annals for Hospitalists - April 2022FREEMegan Mack, MD*, Matthew Luzum, MD* and David H. Wesorick, MDMegan Mack, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author, Matthew Luzum, MD*From Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this author and David H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (M.M., M.L., D.H.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWHO202204190 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesIntravenous Iron Supplementation for Patients With Heart Failure—What a Hospitalist Should Know—Konrad Teodor Sawicki, MD, PhD, and Hossein Ardehali, MD, PhDIn this article, expert authors discuss the evidence supporting iron supplementation in heart failure and the challenge of determining which patients may benefit.Highlights of Recent Articles From Annals of Internal MedicineIn the Clinic: Community-Acquired PneumoniaAnn Intern Med. 2022;175:ITC49-ITC64. Published 12 April 2022. doi:10.7326/AITC202204190This narrative review provides an update on the diagnosis, treatment, and prevention of community-acquired pneumonia.Key points for hospitalists include:A fluroquinolone, or the combination of a β-lactam with a macrolide or doxycycline, is the recommended empirical antibiotic treatment for non–critically ill patients without risk factors for antibiotic resistant organisms.There are only 2 consistently strong risk factors for infection with antibiotic-resistant organisms: previous isolation of a resistant organism or hospitalization with antibiotic use during the prior 90 days. Given the variable prevalence of resistant organisms across different hospitals, the American Thoracic Society/Infectious Diseases Society of America guidelines recommend that hospitals validate their own local risk factors.For patients who are empirically treated for resistant organisms, antibiotics can be deescalated at 48 hours if culture results are negative and the patient remains stable. A negative rapid nasal polymerase chain reaction for methicillin-resistant Staphylococcus aureus can limit the need for empirical methicillin-resistant Staphylococcus aureus coverage. Patients can also change to oral antibiotics once they are afebrile (2 readings 8 hours apart) and clinically improved.Patients can be safely discharged once they are clinically stable. There is no need to monitor the patient in the hospital for an additional day on oral antibiotics before discharge. Total duration of antibiotics should not exceed 5 to 7 days.How Would You Treat This Patient With Acute and Chronic Pain From Sickle Cell Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterAnn Intern Med. 2022;175:566-573. Published 12 April 2022. doi:10.7326/M22-0038In this article, 2 expert discussants offer differing views on a series of controversial questions related to the treatment of pain in patients with sickle cell disease.Key points for hospitalists include:Ketamine is a N-methyl-D-aspartate receptor antagonist, which leads to a reduction of central nervous system glutamate, resulting in analgesic, anesthetic, and amnestic effects. In 1 study of 85 patients with vaso-occlusive crisis, ketamine yielded a 20% decrease in pain scores and opioid medication use.Although both discussants agree that ketamine is useful in refractory acute pain related to vaso-occlusive crisis, the optimal timing of its use remains uncertain. One discussant prefers to use it early, within the first 24 hours, if pain is not rapidly controlled with opioids. However, the other discussant notes that the evidence for using ketamine in acute vaso-occlusive crisis is of low certainty, and that it can be associated with bothersome adverse effects. Therefore, he prioritizes aggressive titration of opioid dosing, reserving ketamine for patients who do not gain control of their pain after several days.There is little evidence supporting the long-term use of opioid therapy in patients with sickle cell disease. One of the discussants considers it her goal to minimize the use of long-term opioids in this population, and she recommends maximizing nonopioid medications (including tricyclic antidepressants, nonsteroidal anti-inflammatory drugs, serotonin–norepinephrine reuptake inhibitors, and gabapentinoids) to address chronic pain.Contribution of Individual- and Neighborhood-Level Social, Demographic, and Health Factors to COVID-19 Hospitalization OutcomesAnn Intern Med. 2022;175:505-512. Published 22 February 2022. doi:10.7326/M21-2615This cross-sectional study examined data from 2678 patients with COVID-19 admitted to 38 hospitals in Michigan to study the relationship between hospital outcomes and the patients' degree of social disadvantage. Social disadvantage was determined by the patients' ZIP codes using the social vulnerability index (a scale that estimates social vulnerability on the basis of residential location). Patients living in high-vulnerability ZIP codes were more often Black or Hispanic, younger, and more likely to have Medicaid insurance than those from less vulnerable ZIP codes. Higher vulnerability scores were associated with a higher likelihood of mechanical ventilation, acute organ dysfunction, and acute organ failure but not with increased risk for death.Key points for hospitalists include:This study demonstrates that disease severity for inpatients with COVID-19 is directly correlated with the level of social vulnerability of the neighborhood where a patient lives.The authors hypothesize that patients living in high-vulnerability ZIP codes may present to the hospital later, with more advanced illness, resulting in the need for higher intensity of care.The authors suggest that these disparities may be ameliorated by providing the residents of vulnerable neighborhoods with better social support and improved access to medical care.The Latest Highlights From Journal ClubAre higher doses of corticosteroids more effective in COVID-19?In COVID-19 with hypoxemia, 12 vs. 6 mg/d of dexamethasone did not increase days alive without life supportAnn Intern Med. 2022;175:JC33. doi:10.7326/J22-0001This multicenter randomized controlled trial randomly assigned 1000 inpatients with COVID-19 and respiratory failure to either 12 mg or 6 mg of dexamethasone per day. The higher dose was not associated with an increase in days alive without life support at up to 28 days.Does the influenza vaccine reduce mortality in patients with myocardial infarction or high-risk coronary disease?In patients with MI or high-risk coronary disease, influenza vaccination reduced CV events at 12 moAnn Intern Med. 2022;175:JC28. doi:10.7326/J22-0006In this randomized controlled trial, 2571 patients with myocardial infarction (or other high-risk coronary disease) were randomly assigned to receive either influenza vaccination or placebo. Patients receiving the vaccine had lower all-cause and cardiovascular mortality at 12 months, and vaccine administration seem to be safe in the early post–myocardial infarction period.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 (M.M., M.L., D.H.W.)Disclosures:Authors have reported no disclosures of interest. Forms can be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3315.* The authors contributed equally to the article. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Intravenous Iron Supplementation for Patients With Heart Failure—What Hospitalists Should Know Konrad Teodor Sawicki and Hossein Ardehali Metrics April 2022Volume 175, Issue 4Page: HO4 ePublished: 19 April 2022 Issue Published: April 2022 CopyrightCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...