Volume 4, Issue 4, An Issue of Hospital Medicine Clinics, E-Book

Steven Deitelzweig

Description

This online Clinics series provides evidence-based answers to clinical questions that practicing hospitalists face daily. This issue of Hospital Medicine Clinics is Guest Editored by Dr. Steven Deitelzweig. Dr. Deitelzweig has assembled a group of expert authors to review the following topics: Bradyarrhythmias; Acute Respiratory Distress Syndrome; Tick Associated Ailments; Magnesium Disorders; Inpatient Management of Post- hepatic Transplant; Allergic Reactions and Angioedema; Optimal Glycemic Control in Hospitalized Patients; Ethics of Physician Relationships with Industry; Management of Benzodiazepine Withdrawal and Intoxication; and LEAN / Sig Sigma with Applicability to Healthcare.

Sujets

• Médecine
• Spécialités médicales
• Médecine Générale
• Hospital Administration
• Medical
• Care

Informations

• Publié par: Elsevier
• Date de parution: 24 décembre 2015
• Nombre de lectures: 1
• EAN13: 9780323391023
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Clinics Review Articles
Hospital Medicine Clinics

Steven Deitelzweig, MD
Ochsner Health System, New Orleans, LA, USA
ISSN  2211-5943 Volume 4 • Number 4 • October 2015
Elsevier
Table of Contents
Cover image
Title page
Contributors
Consulting Editor
Editor
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
Foreword
Preface
Inpatient Management of Patients After Liver Transplantation
Epidemiology
Complications, diagnosis, management
Rejection
Immunosuppression
Recurrent disease
Clinical guideline
Optimal Glycemic Control in Hospitalized Patients
Definitions
Management goals
Pharmacologic strategies
Performance improvement
Clinical guidelines
Tick-borne Infections
Definitions
Epidemiology
History and examination
Diagnosis
Management
Clinical guidelines
Performance improvement
Acute Respiratory Distress Syndrome
Recognition
Clinical course and pathophysiology of acute respiratory distress syndrome
Management principles
Low tidal volume ventilation
Prone ventilation
Refractory hypoxemia
Fluid management
Weaning from the ventilator
Prognosis
Performance improvement
Clinical guidelines
Benzodiazepine Intoxication and Withdrawal
Overview
Pharmacology
Intoxication
Withdrawal
Performance improvement
Clinical guidelines
Emergency Department Evaluation and Management of Bradyarrhythmia
Definitions
Initial approach
Types of rhythms
Induced rhythms
Management
Clinical guidelines
Performance improvement
Allergic Reactions and Angioedema
Definitions
Epidemiology
History and examination
Diagnosis
Management
Prognosis
Performance improvement
Clinical guidelines
Magnesium Disorders
Magnesium homeostasis and disorders
Magnesium deficiency and hypomagnesemia
Hypermagnesemia
Performance improvement
Clinical guidelines
Ethics of Physician Relationships with Industry
Key principles
Guidelines for practice
Lean Hospital(ist)s
Key principles
Guidelines for practice
Summary
Contributors

Consulting Editor
JOSEPH MING WAH LI, MD, SFHM, FACP
Chief, Section of Hospital Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center; Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts

Editor
STEVEN DEITELZWEIG, MD
Ochsner Health System, Medical Director of Regional Business Development, System Chairman, Hospital Medicine, Associate Professor of Medicine, Ochsner Clinical School, New Orleans, Louisiana

Authors
CHRISTOPHER M. BLAIS, MD, MPH
Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana
JOSEPH L. BREAULT, MD, ScD, MPHTM, MS
Department of Family Medicine, Bioethics Committee and Office of Human Research Protections, Ochsner Clinic Foundation, New Orleans, Louisiana
ERICH J. CONRAD, MD
Assistant Professor of Psychiatry, Louisiana State University School of Medicine, New Orleans, Louisiana
DOMINIQUE COSCO, MD, FACP
Department of Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
DEANNA DAVIS, MBA
CEO PEIT, LLC; DeAnna Davis Consulting, LLC, New Orleans, Louisiana
VISHAL DEMLA, MD
Section of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, Texas
LYDIA S. DUGDALE, MD
Assistant Professor, Department of General Internal Medicine; Associate Director, Program for Biomedical Ethics, Yale School of Medicine, New Haven, Connecticut
DAVID W. GALARNEAU, MD
Vice Chairman of Psychiatry, Ochsner Health System; Senior Lecturer, The University of Queensland, New Orleans, Louisiana
MARK GRABAN, MS, MBA
Constancy, Inc, San Antonio, Texas
STEPHEN KANTROW, MD
Department of Pulmonology, LSU Health Sciences Center; Department of Pulmonology, Ochsner Clinic Foundation, New Orleans, Louisiana
ABDUL KHAN, MD
Department of Pulmonology, LSU Health Sciences Center; Department of Pulmonology, Ochsner Clinic Foundation, New Orleans, Louisiana
DAMODAR KUMBALA, MD
Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana
RYAN MASCARENHAS, MD
Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana
RENEE Y. MEADOWS, MD
Associate Professor, Department of Hospital Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
MARTIN MOEHLEN, MD
Assistant Professor of Clinical Medicine, Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane School of Medicine, New Orleans, Louisiana
FREDRIC REGENSTEIN, MD
Professor of Clinical Medicine, Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane School of Medicine, New Orleans, Louisiana
KARLA B. RIVERA RIVERA, MD
Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana
ANITA ROHRA, MD
Section of Emergency Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, Texas
DOUGLAS SHENSON, MD, MPH, MS, MA
Associate Clinical Professor, Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, Connecticut
JOSEPH SWARTZ, MS, CSSBB
Department of Business Transformation, Franciscan St. Francis Health, Greenwood, Indiana
DAVID E. TAYLOR, MD
Department of Pulmonology, Ochsner Clinic Foundation, New Orleans, Louisiana
HIMANSHU VASHISTHA, PhD
Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana
NEIL WINAWER, MD, SFHM
Department of Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
Contents

Foreword A7
Joseph Ming Wah Li

Preface A8
Steven Deitelzweig

Inpatient Management of Patients After Liver Transplantation 457
Martin Moehlen and Fredric Regenstein
Liver transplantation is the standard-of-care treatment of patients with irreversible liver disease caused by decompensated cirrhosis or acute liver failure. Liver transplantation is the most effective treatment of selected patients with hepatocellular carcinoma and cirrhosis. Transplant recipients are at an increased risk for opportunistic infections and the risk of infection is related to the level of immunosuppression and severity of liver graft dysfunction. Live vaccines are contraindicated. Complications occurring late after liver transplantation are usually related to consequences of treatment with immunosuppressive medications, underlying medical conditions, or recurrent disease in the transplanted liver graft.

Optimal Glycemic Control in Hospitalized Patients 471
Renee Y. Meadows
Hyperglycemia and hypoglycemia are associated with poor clinical outcomes in hospitalized patients. Successful inpatient glycemic management should be provided early and continuously throughout hospitalization. Insulin is consistently implicated in causing preventable harm to inpatients, with heterogeneity of prescribing patterns and blood glucose targets adding to this risk. Guidelines and published methods for safe and effective glycemic control in the hospital are extensive; however, suboptimal glycemic control, unsafe medication regimens, and inadequate patient and provider education remain prevalent in several inpatient settings. This article aims to identify the common barriers to optimal glycemic control in hospitalized patients and offers applicable solutions.

Tick-borne Infections 489
Karla B. Rivera Rivera and Christopher M. Blais
Tick-borne illnesses (TBI) are infections acquired through a bite of a tick. Because of the nonspecific signs and symptoms experienced by patients presenting with TBIs, a high index of suspicion is crucial to include a TBI in the differential diagnosis of patients presenting with symptoms compatible with a TBI. Although the results of diagnostic testing are often not available at the time treatment decisions are made, it is important to obtain a history of possible tick exposure and consider the epidemiology of infected ticks when considering the possibility of TBI.

Acute Respiratory Distress Syndrome 500
Abdul Khan, Stephen Kantrow, and David E. Taylor
The diagnosis of acute respiratory distress syndrome (ARDS) should be considered in all patients with pneumonia, trauma, or sepsis who develop acute hypoxemic respiratory failure. There are 2 basic principles to adhere to at the time of an ARDS diagnosis: use the optimal mechanical ventilation strategy, and identify and treat underlying reversible inflammatory causes. A significantly lower mortality (31% vs 40%) was found in patients receiving lower tidal volumes. Once patients have achieved acceptable levels of oxygenation and positive end-expiratory pressure, efforts should be made to reduce ventilator support. Mobilizing patients early during critical illness may decrease subsequent neuromuscular complications.

Benzodiazepine Intoxication and Withdrawal: Assessment and Management 513
David W. Galarneau and Erich J. Conrad
Benzodiazepines are one of the most commonly prescribed classes of medication. They also are commonly abused substances. In addition to their beneficial therapeutic effects, there are inherent risks with their use including abuse, dependence, intoxication, and withdrawal. It is crucial that all clinicians be well versed on the assessment and management of benzodiazepine intoxication and withdrawal. This article reviews these topics.

Emergency Department Evaluation and Management of Bradyarrhythmia 526
Vishal Demla and Anita Rohra
Bradycardia is defined as a heart rate that is approximately two standard deviations less than the mean of the population. Classically, in adults, bradycardia is defined as a heart rate less than 60 beats per minute. Bradycardia can be seen in healthy individuals and does not require evaluation or treatment in asymptomatic individuals, provided the rhythm emanates from the sinus node. Symptomatic patien