Annals for Hospitalists - 19 September 2017
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2017)

Web Exclusives19 September 2017Annals for Hospitalists - 19 September 2017FREEDavid 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/AFHO201709190 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesGender Equality in Hospital Medicine—Are We There Yet?—Jeanne M. Farnan, MD, MHPE, and Vineet M. Arora, MD, MAPPIn this issue's Inpatient Notes, the authors reflect on the current state of gender equality in hospital medicine and discuss their hope for the future.Highlights of Recent Articles From Annals of Internal MedicineIn the Clinic: InfluenzaAnn Intern Med. 2017;167:ITC33-ITC48. doi:AITC201709050This narrative review provides an update on influenza infection in the United States.Key points for hospitalists include:Patients who are hospitalized with suspected or confirmed influenza should be placed in isolation with droplet precautions, and providers should wear N95 masks (or an equivalent) when aerosol-generating procedures are performed.Patients who are hospitalized with suspected influenza should be tested with a molecular influenza assay, such as the reverse transcriptase polymerase chain reaction (RT-PCR) assay. Molecular assays are more sensitive than antigen detection assays.Despite the lack of evidence in hospitalized patients, the Centers for Disease Control and Prevention recommends the use of neuraminidase inhibitors (e.g., oseltamivir and peramivir) in all hospitalized patients suspected of influenza infection. Although these medications are most effective when started early, late initiation (after 48 hours) may still provide some benefit.Bacterial co-infection (e.g., pneumonia with Pneumococcus, Staphylococcus aureus, or group A Streptococcus) should be considered in patients who present with severe disease, do not improve, worsen, or have acute onset of high fever and malaise after a period of initial improvement.Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysisAnn Intern Med. 2017;167:394-409. Published 5 September 2017. doi:10.7326/M17-0848This systematic review and meta-analysis examined 162 studies that compared several rapid influenza tests with the more time-intensive reference standard (RT-PCR). Although all of the tests demonstrated excellent specificity (>98%), there were significant differences in sensitivity among them. Sensitivities for influenza A detection were as follows: traditional rapid influenza diagnostic tests, 54.4%; digital immunoassays, 80%; and rapid nucleic acid amplification tests, 92.6%. The numbers were similar for influenza B.Key points for hospitalists include:Nucleic acid amplification tests are the most sensitive of the rapid tests for influenza, followed by digital immunoassays. Rapid influenza diagnostic tests will likely be phased out soon, given their poor sensitivities.Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and HealthAnn Intern Med. 2017;167:293-301. Published 1 August 2017. doi:10.7326/M17-0865This article reports the results of a national survey on opioid use based on 51 200 completed surveys. In 2015, an estimated 91.8 million (37.8%) U.S. civilian, noninstitutionalized adults used prescription opioids, 11.5 million (4.7%) misused them, and 1.9 million (0.8%) met criteria for opioid use disorder. These problems are more common among the uninsured, the unemployed, and those with behavioral health problems.Key points for hospitalists include:63.4% of patients who misused opioids reported that their motivation was to relieve physical pain, prompting the authors to call for the development of better nonopioid strategies for the management of chronic pain.Among patients who misuse prescription opioids, 40.8% obtained medications from friends or relatives, suggesting the need for more restrictive prescribing practices. Excessive prescribing may lead to sharing or diversion of these medications.An editorial discusses how unemployment and a lack of health insurance might exacerbate opioid misuse by limiting access to evidence-based chronic pain management. The Latest Highlights From ACP Journal ClubIs short-term use of corticosteroids associated with an increased risk for adverse events?Short-term use of oral corticosteroids was linked to increased risk for sepsis, VTE, and fracturesAnn Intern Med. 2017;167:JC20. doi:10.7326/ACPJC-2017-167-4-020This retrospective cohort study examined rates of sepsis, venous thromboembolism, and bone fracture among 372 452 patients after treatment with short-term courses of systemic steroids. The study compared the rates of these adverse events in the period after steroid treatment to the rates during a 180-day period before steroid treatment in the same patients. The rates of all of 3 complications were significantly elevated during the posttreatment period, including a 5-fold higher rate of sepsis.When used for stroke prophylaxis in atrial fibrillation, do all of the direct oral anticoagulants (DOACs) confer similar gastrointestinal (GI) bleeding risks?In nonvalvular AF, DOAC-related risk for GI bleeding was lower with apixaban than dabigatran or rivaroxabanAnn Intern Med. 2017;167:JC21. doi:10.7326/ACPJC-2017-167-4-021In this retrospective cohort study, the authors used pharmacy administrative claims data to identify 43 303 patients treated with dabigatran, rivaroxaban, or apixiban for stroke prophylaxis. Following matching by propensity scores, the authors reported that apixaban was associated with lower rates of GI bleeding than the other 2 DOACs. However, because this was not a head-to-head study of these medications, definitive conclusions about their relative safety remain limited.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 - Gender Equality in Hospital Medicine—Are We There Yet? Jeanne M. Farnan and Vineet M. Arora Metrics 19 September 2017Volume 167, Issue 6Page: HO6KeywordsCohort studiesHemorrhageHospitalistsImmunoassaysNucleic acidsOpioidsPain managementReverse transcriptase polymerase chain reactionSepsisSteroids ePublished: 19 September 2017 Issue Published: 19 September 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.Loading ...