American journal of hospital medicine, volume 2, issue 3 (2018 July-September)
Permanent URI for this collection
Browse
Recent Submissions
Item Leadless cardiac pacemaker therapy : an overview for the Hospitalist(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2018-07) Weachter, Richard"Each year, approximately 200,000 permanent pacemakers are implanted in the United States and 1,000,000 worldwide.1,2 Since the initial transvenous pacemaker implantation 6 decades ago, improvements in battery longevity, lead performance and device programming have occurred.3 However, the basic components of and implantation technique for permanent transvenous pacemakers have remained essentially unchanged. Of the 2 pacemaker system components - pulse generator and lead – the lead has been considered the "weakest link".3 While the concept of leadless pacing was first proposed in 1970, not until 2012, with implantation of the St. Jude leadless pacemaker, did practical application of this concept come to fruition.4,5"--IntroductionItem Evaluating duration of antimicrobial therapy for community-acquired pneumonia in clinically stable patients(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2018-07) Hahn, Lucy; Hedge, Anita; Mang, Norman; Ortwine, Jessica K.; Wei, Wenjing; Prokesch, Bonnie Chase"In the United States, community-acquired pneumonia (CAP) results in an estimated 2 to 3 million diagnoses each year, 10 million physician visits, and 600,000 hospitalizations resulting in a total cost of over 20 billion dollars annually. Common causative organisms of CAP include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. Identifying the etiologic organism helps guide therapeutic decisions, however, the pathogen remains unknown in about 50 percent of cases. Therefore, optimal empiric therapy relies on a physician's experience and clinical judgment. The Infectious Diseases Society of America (IDSA) guidelines for treatment of community-acquired pneumonia (CAP) recommend a minimum 5-day course of antibiotics for patients who achieve clinical stability within 48 to 72 hours from initiation of appropriate therapy. A multicenter, cohort study of 686 patients hospitalized with CAP found that most were treated for 7 to 10 days despite median time to clinical stability of 3 days, indicating that a shorter duration of therapy is often not favored by clinicians despite guideline recommendations. Moreover, although many patients receive active antimicrobial therapy while hospitalized, additional courses of antimicrobials are often prescribed upon discharge resulting in excessive antibiotic use. While many patients are given prolonged courses of therapy for CAP, shorter durations of antibiotics in patients eligible for such courses of treatment offer a number of advantages such as minimizing the emergence and selection of resistant organisms, increasing patient compliance, and reducing the risk of medication adverse effects. The objective of this study was to assess the percentage of hospitalized patients diagnosed with uncomplicated CAP receiving antimicrobial therapy in excess of the guideline-recommended duration, evaluate subsequent thirty-day all-cause readmission rates, and determine if select co-morbidities influenced the length of antimicrobial therapy prescribed."--Introduction.Item A hill hidden by the clouds(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2018-07) Munira, Most; Randhawa, Furchetan; Dworkin, Aviva; Moh, Wendy; Ong, Kenneth"A 33-year-old woman, with a past medical history of polysubstance abuse and recently treated infective endocarditis, is admitted with septic shock due to pneumonia. The chest x-ray reveals right middle and lower lobe infiltrates plus a right pleural effusion (Figure 1). Because of persistent tachycardia and hypoxia, computed tomography (CT) of the chest with contrast was performed. It revealed a large pulmonary embolus (PE) involving the right main pulmonary artery (PA) and an absence of distal arterial filling (Figures 2, 3). Transverse images demonstrated a wedge-shaped density consistent with a pulmonary infarct (Figure 4)."Item Conference calendar (AJHM, volume 2, issue 3, 2018)(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2018-07)Calendar of hospital medicine conferences (2018).Item Non-ketonic hyperglycemia presenting with acute hemichorea and ballism(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2018-07) Bollu, Pradeep C.Non-ketotic hyperglycemia is a complication of poorly controlled diabetes mellitus. Rarely, it can present like an acute neurological syndrome with unilateral choreiform and ballistic movements. Such a presentation usually raises the suspicion of a cerebrovascular event and prompts more workup. Moreover, the neuroimaging in this condition also suggests a variety of potential possibilities. Identification of this rare presentation of non-ketotic hyperglycemia helps with the appropriate management and avoid unnecessary investigations. In this case report, we report the case of an elderly woman who presented with hemichorea-ballism due to non-ketotic hyperglycemia and discuss the literature on this presentation. We also highlighted the differential diagnosis based on neuroimaging.