Annals for Hospitalists - 15 December 2020
Authors: David H. Wesorick, Vineet Chopra
Journal: Annals of Internal Medicine (2020)

Web Exclusives15 December 2020Annals for Hospitalists - 15 December 2020FREEDavid H. Wesorick, MD, Vineet Chopra, MD, MScDavid H. Wesorick, MDFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C)Search for more papers by this author, Vineet Chopra, MD, MScFrom Michigan Medicine and VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.H.W, V.C)Search for more papers by this authorhttps://doi.org/10.7326/AWHO202012150 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Inpatient NotesRemdesivir: Making Sense of Emerging Evidence—Megan Rose Curtis, MD, MS, and Paul Sax, MDIs remdesivir really effective against coronavirus disease 2019 (COVID-19)? Which patients stand to benefit from the medication? In this commentary, the authors use the current evidence to create a construct to guide the clinical use of remdesivir in hospitalized patients.Highlights of Recent Articles From Annals of Internal MedicineRisk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis: A Cohort StudyAnn Intern Med. 2020;173:870-878. Published 22 September 2020. doi:10.7326/M20-1594This retrospective cohort study examined the risk for hospitalized infection in patients with rheumatoid arthritis (RA) who were prescribed low-dose glucocorticoids. Using Medicare (n = 172 041) and Optum (n = 44 118) databases, the authors identified patients who were receiving a stable disease-modifying antirheumatic drug (DMARD) regimen and analyzed the rates of hospitalized infections, depending on the steroid dose. About 47.1% of Medicare patients and 39.5% of Optum patients were receiving glucocorticoids. The 1-year cumulative incidence of hospitalized infection in Medicare patients not receiving glucocorticoids was 8.6% versus 11.0% for those receiving a glucocorticoid dose of ≤5 mg/d, 14.4% for >5 to 10 mg/d, and 17.7% for >10 mg/d (all P < 0.001 vs. no glucocorticoids). The 1-year cumulative incidence of hospitalized infection in Optum patients not receiving glucocorticoids was 4.0% versus 5.2% for those receiving a glucocorticoid dose of ≤5 mg/d, 8.1% for >5 to 10 mg/d, and 10.6% for >10 mg/d (all P < 0.001 vs. no glucocorticoids).Key points for hospitalists include:The use of long-term steroids in patients receiving a stable DMARD regimen was associated with a significant dose-dependent increase in the risk for hospitalized infections, even at small doses of ≤5 mg/d.The most common infections were urinary tract infections, pneumonia, bacteremia, and skin or soft tissue infections.An editorialist cautions against extrapolating the findings to other conditions where patients are given low-dose glucocorticoids, as patients with RA have an increased baseline risk of infection related to underlying immune dysregulation.Addressing Postpandemic Clinician Mental Health: A Narrative Review and Conceptual FrameworkAnn Intern Med. 2020;173:981-988. Published 21 August 2020. doi:10.7326/M20-4199This article identifies the risks that the COVID-19 pandemic poses to the well-being of health care workers (HCWs) and develops a conceptual framework that addresses HCW's mental health needs. The authors did a narrative review of the available evidence about HCW wellness and mental health during pandemics and reviewed several well-being resources, including materials from several health care organizations and societies.Key points for hospitalists include:The risk for mental health problems is highest for frontline HCWs. Organizations should proactively address wellness in this population because these workers have a culture of not seeking support.Interventions aimed at HCW well-being include stress reduction and resilience training; meeting basic needs (i.e., nutrition, hydration, rest, transportation, personal protective equipment, and child care); specialized training for job role changes; clear communication from leadership; strategies to address moral injury; and peer, social, and mental health support.The article recommends high-yield resources for HCWs, including peer support hotlines, mindfulness multimedia, and several clearinghouses of well-being and stress management materials.The Latest Highlights From Journal ClubWhat are the test characteristics of antibody tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?Antibody tests have higher sensitivity at ≥15 days after symptom onset and 99% specificity for detecting SARS-CoV-2Ann Intern Med. 2020;173:JC57. doi:10.7326/ACPJ202011170-057 This systematic review analyzed 54 studies to determine the sensitivity and specificity of antibody testing for SARS-CoV-2 infection. Sensitivity appears to be poor in the early days after symptom onset, not reaching above 90% until after 15 days (sensitivity of 91% for IgG plus IgM testing at 15 to 21 days after symptom onset), but specificity was 99% across time points.Sign up here to have Annals for Hospitalists delivered to your inbox each month. Comments0 CommentsSign In to Submit A Comment PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Remdesivir—Making Sense of Emerging Evidence Megan Rose Curtis and Paul Sax Metrics 15 December 2020Volume 173, Issue 12Page: ED12 ePublished: 15 December 2020 Issue Published: 15 December 2020 CopyrightCopyright © 2020 by American College of Physicians. All Rights Reserved.Loading ...