American journal of hospital medicine, volume 3, issue 4 (2019 October-December)
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Item Updates in Hospital Palliative Care(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-10) Havyer, Rachel D.; Abedini, Nauzley; Jayes, Robert L.; Matti-Orozco, Brenda; Pomerantz, Daniel H.; Ansari, Aziz A.Background: This review critiques recent palliative care (PC) literature with likelihood of impacting general hospital practice in order to help address the PC needs of patients. Methods: Articles published between January and December 2018 were identified through hand-search of leading PC journals and MEDLINE search. The final ten selected articles were determined by consensus based on scientific rigor, relevance to general hospital medicine, and impact to practice. Results: Key findings include: Early PC interventions reduced healthcare costs; Prognostic awareness of surrogates of patients with advanced dementia was associated with reduced burdensome interventions; Care transitions, especially in the last 3 days of life, can be detrimental to caregivers' well-being and perceptions of care; Haloperidol was effective for treatment of nausea and vomiting without untoward effects; Antipsychotics did not improve delirium symptoms in hospitalized patients; A fan directed to the face improved dyspnea; Disparities in advance directive completion disappeared when equal opportunities were given; Improving communication with families of critically ill patients improved perceptions of patient-centered care; Communication-priming tools improved the quality and documentation of goals of care conversations; Discussing prognosis did not harm the patient-provider relationship. Conclusion: Recent PC research affirmed the importance of PC delivery to patients with life-limiting illness and provided important guidance to hospitalists on symptom management, advance care planning, and communication.Item From Admission to Discharge, How Artificial Intelligence Could Optimize Patient Care : A Brief Review(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-10) Gilvaz, Vinit Joseph; Abraham, George M.; Radhakrishnan, Shree; Hasmath, ZebaThe applications of artificial intelligence (AI) in healthcare have been steadily growing over the past few years. This is largely due to the availability of large amounts of healthcare data, coupled with a dramatic increase in computational power. Today AI-based algorithms have been developed for numerous applications, from predicting patient outcomes to optimizing the clinical workflow. Given the current pace of innovation, AI is bound to play a significant role in healthcare in the years to come.Item Inpatient Management of Bronchial Asthma for the Hospitalist -A Concise Review(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-10) Hunter, Michael P.; Vaddi, Suman; Krvavac, Armin; Regunath, Hariharan; Guntur, Vamsi P.Asthma is a common inflammatory disease of the airways that leads to significant hospital utilization and health care cost around the world. Despite published guidelines, the diagnosis and treatment of acute asthma exacerbation varies widely due to inconsistent compliance with guidelines. We will review the evidence, guideline recommendations, clinical presentation, risk factors, and management of acute asthma exacerbations, including standard and advanced treatment options for refractory cases.Item Approach to diffuse parenchymal lung disease (interstitial lung disease) for the Hospitalist(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-10) Chairman, DennisDiffuse parenchymal lung diseases (DPLD, historically known as interstitial lung diseases) are a heterogeneous group of diseases that are uncommon and grouped together for their similarity in one or more clinical, radiological, and pathological findings. There is no universally acceptable classification system yet for such a varied group of diseases and hence impossible to have one unified diagnostic pathway. Diagnostic work up requires that the clinician have an initial list of differential diagnoses based on a thorough history and clinical evaluation. For acutely progressive diseases such as diffuse alveolar hemorrhage, urgent evaluation is necessary so that appropriate therapy can be quickly instituted; whereas, for the chronic progressive diseases like idiopathic interstitial pneumonia most of the evaluation can be done in the ambulatory setting. The decision for bronchoscopy and surgical lung biopsy should be individualized by incorporating informed decision making due to large variations in practice patterns among clinicians. Below is a brief summary of the most likely diseases to be encountered in hospital medicine practice.Item Role of ID Consultation in Candidemia(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-10) Nolan, Nathanial S."Candida bloodstream infections affect many patients across the U.S. Their mortality rate is approximately 25% to 35% according to surveillance data1,2. Candidemia is associated with immune suppression, hematologic malignancy, the presence of a central line, the use of parenteral nutrition, and exposure to broad spectrum antibiotics. The timing and appropriateness of antifungal therapy can improve outcomes. Further, patients should undergo investigations to identify the source of their infection and possible metastatic complications, such as endocarditis, endophthalmitis and invasive organ disease. The Infectious Disease Society of America has created evidence-based guidelines for the management of invasive candidiasis 3."