Annals for Hospitalists - 20 December 2016
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2016)

Web Exclusives20 December 2016Annals for Hospitalists - 20 December 2016FREEDavid 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/AFHO201612200 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesAnnals for Hospitalists Inpatient Notes - Mistakes in the Hospital—Communicating, Apologizing, and Beyondby Allen Kachalia, MD, JDHow should hospitalists communicate with patients when medical errors occur? This commentary suggests that transparency should serve as a guiding principle.Highlights of Recent Articles From Annals of Internal MedicineIn the Clinic - Preoperative Evaluation for Noncardiac SurgeryAnn Intern Med. 2016;165:ITC81-ITC96. doi:10.7326/AITC201612060This In the Clinic provides a broad overview of the preoperative evaluation and management of patients having noncardiac surgery.Key points for hospitalists include:Preoperative cardiac evaluation can be facilitated by use of one of the existing tools for estimating perioperative cardiac risk, such as the Revised Cardiac Risk Index.The role of perioperative β-blockers in reducing surgical risk is uncertain, in light of mixed results of studies using variable dosing schedules. Perioperative β-blockers may decrease the risk of nonfatal MI, but may increase the risk for stroke and death.Patients with coronary stents should continue aspirin through the perioperative period, unless bleeding risk precludes it. Patients with coronary stents should remain on dual antiplatelet therapy and have elective surgeries delayed for at least 4 weeks after placement of a bare-metal stent and for at least 3 to 6 months after placement of a drug-eluting stent.Bridging anticoagulation is not recommended for patients with atrial fibrillation without a mechanical heart valve or with a CHADS2 score of 4 or less.Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ DonationAnn Intern Med. 2016;165:770-778. Published online 13 September 2016. doi:10.7326/M16-0402This retrospective study of 6963 patients with out-of-hospital cardiac arrest (OHCA) in France and the United States demonstrated that patients meeting 3 specific criteria (arrest not witnessed by emergency medical personnel, initial nonshockable cardiac rhythm, and absence of return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine) had a 0% (95% CI, 0% to 0.5%) survival rate. The authors suggest that this information might facilitate organ donation in such cases.Key points for hospitalists include:The inability to rapidly prognosticate in cases of OHCA makes it difficult to move from an aggressive resuscitation strategy to either termination of resuscitation efforts or aggressive organ procurement. The use of these clinical criteria could help with this conundrum by rapidly identifying patients who are unlikely to survive and might be appropriate candidates for organ donation.An editorial notes the complexity of the decisions surrounding OHCA situations and suggests that there is much more to learn about how best to balance the imperatives of saving lives when possible, terminating efforts when futile, and ethically maximizing procurement of transplantable organs.The Latest Highlights From ACP Journal ClubWhat is the optimal treatment duration for community-acquired pneumonia?Stopping antibiotics after 5 days in clinically stable community-acquired pneumonia was noninferior to usual careAnn Intern Med. 2016;165:JC50. doi: 10.7326/ACPJC-2016-165-10-050In this randomized, controlled trial, 312 patients with community-acquired pneumonia were randomly assigned to a 5-day course of antibiotics (if they met the criteria for stability) or usual care (an average 10-day course of antibiotics). The 5-day course was found to be noninferior to the longer course with respect to the outcomes of clinical success (defined as improvement or resolution of signs and symptoms of pneumonia) and symptom resolution (as assessed by an 18-item symptom questionnaire).For patients with atrial fibrillation, is edoxaban better than warfarin?Edoxaban had similar efficacy to and better safety than warfarin in AF, regardless of previous stroke or TIAAnn Intern Med. 2016;165:JC54. doi10.7326/ACPJC-2016-165-10-054This prespecified subgroup analysis of a large randomized trial compared patients with atrial fibrillation treated with warfarin vs. edoxaban. The analysis found no difference in rates of stroke or systemic embolization between the groups, but patients treated with edoxaban had fewer bleeding complications.When added to inhaled corticosteroids for patients with asthma, do inhaled long-acting β-agonists lead to a higher rate of serious asthma events?Adding formoterol to budesonide did not increase serious asthma events and reduced exacerbationsAnn Intern Med. 2016;165:JC56. doi10.7326/ACPJC-2016-165-10-056Adding salmeterol to fluticasone did not increase serious asthma events and reduced exacerbationsAnn Intern Med. 2016;165:JC57. doi:10.7326/ACPJC-2016-165-10-057These 2 large clinical trials randomly assigned patients with asthma to either an inhaled corticosteroid alone or an inhaled corticosteroid combined with an inhaled long-acting β-agonist (formoterol or salmeterol). Both studies found that adding the β-agonists reduced exacerbations, without increasing the risk for serious asthma-related events, such as death, hospitalization, or intubation.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 - Mistakes in the Hospital—Communicating, Apologizing, and Beyond Allen Kachalia Metrics 20 December 2016Volume 165, Issue 12Page: HO12KeywordsAntibioticsAsthmaHeartHemorrhageHospitalistsPneumoniaResuscitationStent implantationStrokeSurgery ePublished: 20 December 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.Loading ...