American journal of hospital medicine, volume 3, issue 3 (2019 July-September)
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Item Impact of an Inpatient Diabetes Consulting Service on Post Discharge Glycemic Control(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-07) Sharma, Anu; Smith, Emily; Herndon, Justine; Hill, Jennifer; Partlow, Brenda; Probach, Julie; Thurber, Kristina; Smith, Steven"Diabetes mellitus has been estimated to affect 30 million Americans in 2015 with an increasing prevalence every year 1. In addition, patients with diabetes have up to a 3-fold increased risk of hospitalization 2. The health care cost for a person with diabetes has been calculated to be 2.3 times higher than that of a person without diabetes 3. The need for better systems of care has been increasingly recognized 4. Inpatient diabetes consultation results in improved glycemic control 5, shorter hospital stay 6 and decreased hospital readmission 7. Despite this, Wei et al 8 have previously shown that glycemic control does not improve post hospitalization and suggested it was a missed opportunity to implement better strategies for long term glycemic control. The Diabetes Consulting Service (DCS) in the inpatient setting at the Mayo Clinic frequently assists in the management of diabetic patients. The consultation addresses preadmission glycemic control, frequency of hypoglycemia at home, inpatient glycemic control, and discharge planning. Discharge planning involves incorporating glycemic control requirements during the hospital stay, prescribing discharge diabetes medications, and scheduling follow-up visits focused on post-discharge glycemic control. We hypothesized that the DCS would lead to improvement in glycemic control as measured by a reduction in HbA1c and a lower frequency of hypoglycemic events post discharge within a one-year period. Our primary aim was to determine if HbA1c was lower in patients receiving a DCS evaluation on post discharge. The secondary aim was to determine if there was a lower rate of self-reported hypoglycemia after discharge in patients receiving a DCS evaluation."--Introduction.Item A rash that cannot be missed : disseminated herpes zoster as a result of immunomodulation by Adalimumab(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-07) Patel, Tarang; Karle, Ethan; Nelson, Taylor; Dandachi, Dima"The patient is a 75-year-old Caucasian male who was admitted in May for management of a penile ulceration and a generalized rash. He has a medical history of Type II Diabetes Mellitus, tobacco abuse, and Rheumatoid Arthritis (RA) on adalimumab. One week prior to his presentation, the patient noted an ulcer proximal to the glans penis (Figure 1). Upon further questioning, he reported noticing a small tick attached to his thigh one week prior. He has no history of sexually transmitted illnesses, incarceration, animal exposures, or meningeal signs. Two days prior to admission, the patient developed a large, dark, vesicular lesion on the anterior scalp, followed by smaller lesions over the rest of his body including the hard palate (Figures 2-6). Laboratory studies demonstrated a mildly elevated Erythrocyte Sedimentary Rate, C-Reactive Protein, and transaminitis. The patient was started on empiric doxycycline and intravenous acyclovir. Infectious work-up was negative for gonorrhea, chlamydia, syphilis, HIV, Ehrlichia, and Rocky Mountain Spotted Fever. Shave biopsies were obtained of the penile lesion and a lesion from the patient's upper back. Dermatopathology evaluation demonstrated herpetic dermatitis in both sites, and a penile swab polymerase chain reaction for Varicella Zoster Virus was positive. Treatment for disseminated Herpes Zoster was initiated with marked improvement of the lesions noted at follow-up."Item Bone cultures(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-07) Rojas-Moreno, Christian"Bone cultures are extremely important in the diagnosis and management of bone infections. The value of bone biopsies lies in obtaining accurate microbiological data and susceptibility profiles. Ideally, these cultures should be obtained before initiation of antimicrobials. In clinically stable patients without concerns for sepsis or other urgent indications for antimicrobial therapy, antimicrobials can be withheld until a good bone sample for culture is obtained."Item ECG Dilemma(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-07) Oman, Zachary; Abraham, Leni; Horball, Piotr J.; Raffoul, Jad; Helmy, Tarek"Case: A 31-year-old man with an unremarkable past medical history presented with substernal chest pressure without radiation of two-hours duration. The patient's vitals remained stable and an ECG was obtained. What is the diagnosis? ... Answer: D) Destrocardia."Item Conference calendar (AJHM, volume 3, issue 3, 2019)(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-07)