Annals for Hospitalists - August 2021
Authors: Megan Mack, Matthew Luzum, David H. Wesorick
Journal: Annals of Internal Medicine (2021)

Web ExclusivesAugust 2021Annals for Hospitalists - August 2021FREEMegan Mack, MD*, Matthew Luzum, MD*, 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, 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/AWHO202108170 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesHow We Treat Hyperglycemia in the Hospital—Francisco J. Pasquel, MD, MPH, and Guillermo E. Umpierrez, MD, CDEIn this commentary, expert authors describe their approach to managing diabetes and hyperglycemia in hospitalized patients.Highlights of Recent Articles From Annals of Internal MedicinePatient Characteristics and Costs Associated With COVID-19–Related Medical Care Among Medicare Fee-for-Service BeneficiariesAnn Intern Med. 2021;174:1101–1109. Published 1 June 2021. doi:10.7326/M21-1102This retrospective, observational study examined the costs of COVID-19 care for Medicare patients. From April through December of 2020, a total of 1 181 127 Medicare fee-for-service beneficiaries sought medical care for COVID-19, with a cost of $6.3 billion (not including postacute care costs). More than 90% of costs were for hospitalizations. Mean hospitalization cost was $21 752, and mean length of stay was 9.2 days. Male sex and non-White race/ethnicity were associated with higher costs because these populations were more likely to require hospital admission or ventilatory support.Key points for hospitalists include:Medicare patients (aged ≥65 years) were more than 60 times more likely to be hospitalized for COVID-19 than the general population, and most of the Medicare costs of the pandemic were related to hospitalization.Non-White patients incurred the highest costs, related to high rates of hospitalization and ventilatory support.The authors make a concerning observation: The populations that have been most severely affected by COVID-19 are also the ones most likely to express vaccine hesitancy.The Latest Highlights From Journal ClubDo patients with acute myocardial infarction (AMI) benefit from a more liberal transfusion threshold?In patients with AMI and anemia, a restrictive vs. liberal blood transfusion strategy was noninferior for 30-d MACEAnn Intern Med. 2021;174:JC77. doi:10.7326/ACPJ202107200-077In this multicenter randomized controlled trial of 668 adults with AMI and anemia, patients were randomly assigned to either a liberal transfusion strategy (that is, transfuse for hemoglobin level ≤10 g/dL) or a restrictive strategy (that is, transfuse for hemoglobin level ≤8 g/dL). Major adverse cardiovascular events did not differ between the groups.Does rifaximin prevent hepatic encephalopathy in patients having transjugular intrahepatic portosystemic shunt procedure?In patients having transjugular intrahepatic portosystemic shunt, rifaximin prevented overt hepatic encephalopathyAnn Intern Med. 2021;174:JC78. doi:10.7326/ACPJ202107200-078In this trial, 197 patients having transjugular intrahepatic portosystemic shunt were randomly assigned to receive either rifaximin (starting 14 days before the procedure and continuing for 168 days after) or placebo. The incidence of overt hepatic encephalopathy was significantly reduced in the rifaximin group (34% vs. 53%; number needed to treat, 6 [95% CI, 4 to 29]).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 - How We Treat Hyperglycemia in the Hospital Francisco J. Pasquel and Guillermo E. Umpierrez Metrics August 2021Volume 174, Issue 8Page: HO8 ePublished: 17 August 2021 Issue Published: August 2021 CopyrightCopyright © 2021 by American College of Physicians. All Rights Reserved.Loading ...