Clinical Approaches to Hospital Medicine : Advances, Updates and Controversies

Preface Acknowledgments Contents Contributors Chapter 1: Clinical Approaches to the COVID-19 Pandemic Introduction Epidemiology Virology Presentation Children Adults Admission Criteria COVID-19 Management General Therapy Guidelines Dexamethasone and Other Corticosteroids Remdesivir Antibody Therapy Other Therapies Treatment of Coinfections Management of Complications Discharge from the Hospital Vaccination Special Considerations Psychiatric Complications of COVID-19 Antenatal Care and Pregnancy Issues Changes to Regular Prenatal Care Implications for Pregnant and COVID-19-Positive Patients Labor and Delivery Postpartum Care Conclusion References Chapter 2: Management of Inflammatory Bowel Disease Introduction Factors Causing IBD Flares Crohn’s Disease Presentation of Crohn’s Disease Flares Severity of Crohn’s Disease Disease Impact on the Patient Disease Burden Disease Course Evaluation of Crohn’s Disease Management for Crohn’s Disease Management of Intra-abdominal Abscesses (IAA) Due to Crohn’s Disease Percutaneous vs. Surgical Drainage Management of Structural Issues Secondary to Crohn’s Disease (CD) Ulcerative Colitis Ulcerative Colitis Flares Severity of Ulcerative Colitis Evaluation of Ulcerative Colitis Management of Ulcerative Colitis Systemic Glucocorticoids Cyclosporine Infliximab Infliximab vs. Cyclosporine Novel Treatments for ASUC References Chapter 3: Updates in Nephrology for the Hospitalist Introduction Hospital-Acquired Acute Kidney Injury Acute Kidney Injury and COVID-19 Electrolyte Abnormalities: Hyperkalemia and Hyponatremia Hyponatremia Tools to Assess Volume Status Novel Therapeutics in CKD: SGLT2 Inhibitors Conclusion References Chapter 4: Heart Failure Management for the Inpatient Provider Epidemiology Pathophysiology Clinical Assessment of Heart Failure Presentation History Physical Exam Investigations Chest X-Ray Echocardiography Biomarkers and Blood Tests Management Guideline-Directed Medical Therapy (GDMT) for Heart Failure Advancements in the Management for Heart Failure Addressing Barriers to Health Care References Chapter 5: Advances in the Evaluation and Treatment of Sepsis and Shock Introduction Defining Sepsis and Septic Shock Screening Diagnosis Antimicrobial Therapy Source Control Fluid Therapies Vasoactive Medications Blood Products Anticoagulants Mechanical Ventilation Sedation and Analgesia Glucose Control Venous Thromboembolism Prophylaxis Stress Ulcer Prophylaxis Nutritional Support Goals of Care The 1-Hour Bundle Sepsis and Antimicrobial Stewardship Sepsis and COVID-19 Conclusion References Chapter 6: Current Trends in Stroke Management Epidemiology of Stroke Types of Stroke Ischemic Stroke Management IV Thrombolysis Guidelines Mechanical Thrombectomy Guidelines The Role of Collateral Blood Flow Neuroprotection Stroke and Women COVID and Stroke Epidemiology Effects of COVID-19 on Stroke Admissions Proposed Mechanisms of COVID-19-Induced Stroke Hypercoagulability Cerebral Endotheliopathy Additional Risk Factors Post-stroke Depression Prevalence Risk Factors and Assessment of Post-stroke Depression Treatment Post-stroke Care References Chapter 7: Co-management of Orthopedic Patients What Is Co-management? Co-management Roles Orthopedic Patients Benefits of Orthopedic Co-management Hospital Length of Stay Mortality Rate Discharge Disposition Readmission Rate Total Cost of Care Satisfaction QALYs Pain Management ICU Admissions Hospital Medications Consults Complications Blending Co-management and Orthopedics References Chapter 8: Pediatric Hospital Medicine Management of Bronchiolitis in the Emergency Department and Hospital Strong Recommendations Moderate Recommendations Prevention of Neonatal Sepsis Management of Neonatal Hyperbilirubinemia Management of Multisystem Inflammatory Syndrome in Children Presentation Treatment Modalities Discharge Criteria Summary References Chapter 9: Management of Psychiatric Disorders in the Hospital Introduction Delirium Etiology Epidemiology Risk Factors Diagnostic Criteria Subtypes Assessment Management Prevention Conclusion Psychosis Epidemiology Clinical Manifestations Differential Diagnosis Workup Management Conclusion References Chapter 10: Opioids: History, Pathophysiology, and Stewardship for Hospitalists History and Evolution of the Opioid Epidemic in America Opioid Epidemic: An American Cultural Phenomenon Cardinal Features of the Opioid Epidemic The Brain Disease Model of Addiction The Pain Matrix Shared Neural Networks Chronic Pain, Central Pain Syndromes, Hyperalgesia, and Withdrawal Pain Opioid Stewardship for Hospitalists Understanding Opioid Risk Respiratory Depression Risk Factors Management Behavioral Disturbances Risk Factors Management Stewardship and Acute Pain Acute vs Chronic Pain American College of Emergency Physicians Opioid Recommendations [19] Special Complications of Opioids Multimodal Therapy Classes of Multimodal Therapy Compassionate Withdrawal of Opiates Overview Empathic Strategies Suggested Stepwise Withdrawal Timeline of Withdrawal Opioid Use Disorder: Diagnosis and Treatment Strategies Medication-Assisted Therapy (MAT) Overview Medications of MAT Barriers to MAT Initiation of Buprenorphine References Chapter 11: Overview, Updates, and New Topics in Perioperative Care Introduction What Is Perioperative Care? The Role of the Medical Team in Perioperative Care The Preoperative Clinic Medical Evaluation, Assessment, and Plan Perioperative Cardiac Disease and Risk Assessment Pulmonary Disease, Risk Assessment, and Complications Renal Disease, Risk Assessment, and Complications Liver Disease and Risk Assessment Neurological and Musculoskeletal Disease: Delirium, Frailty, and Functional Status Hematological Conditions and Anticoagulation Endocrine: Steroid Use and Diabetes Mellitus Connective Tissue Disorders Surgical Site Infections Medication Review Laboratory Investigations ERAS Protocols and Perioperative Surgical Home COVID-19 Advanced Care Planning and Informed Consent Conclusion References Chapter 12: Virtual Hospital Medicine Background Virtual Hospital Medicine at Ochsner Health Other Programs Conclusion References Chapter 13: Palliative Care for Hospitalists What Is Palliative Care? Pain and Symptom Management Since the COVID-19 Pandemic Communication Telemedicine in Palliative Care Virtual Reality in Palliative Care Music Therapy in Palliative Care References Chapter 14: Barriers to Advance Care Planning (ACP) in the Hospital: A Review and Case Study What Is Advance Care Planning? Benefits and Purpose of ACP A Snapshot of ACP in America Hospital Medicine and ACP Barriers to Conducting ACP in Practice Overcoming the Barriers to ACP Ochsner Health Case Study: Understanding Barriers Across the Practice Spectrum The Institution Project Setup and Methods Identified Barriers Identified Solutions Lessons Learned Appendix 1 Barriers to Advance Care Planning Interview Introduction References Chapter 15: Value-Based Care in the Hospital What Is Value? What Is Value-Based Care? How Do We Measure Value? Current Value of Healthcare in the United States How Did We Get Here? Early Models of Health Insurance Employer-Based Commercial Health Insurance Medicare and Medicaid The Rise and Fall of Managed Care The Affordable Care Act Transition to Value-Based Care Agency for Healthcare Research and Quality Patient-Centered Medical Homes Accountable Care Organizations Medicaid Bundled Payments Hospital Value-Based Purchasing Programs Education Conclusion References Chapter 16: Wellness in Physicians in the Era of the COVID-19 Pandemic Introduction Wellness Among Healthcare Workers During the First Year of the Pandemic Factors Contributing to Burnout in Providers Caring for COVID-19 Patients in Early Outbreaks Historical Perspective of Burnout Among Healthcare Workers Coping Mechanisms at the Individual Level System-Level Promotion of Physician Wellness During the COVID-19 Pandemic The Agency for Healthcare Research and Quality (AHRQ) Guidelines for Emergency Providers of Healthcare System Solutions: Establishing a Chief Wellness Officer Conclusion References Chapter 17: LGBTQ Healthcare Issues Epidemiology of LGBTQ+ and Healthcare Creating a Safe Space for LGBTQ+ Patients Environment Forms and Documentation Introductions, History Taking, and Vocabulary Use Special Considerations for the LGBTQ+ Patient Hormone and Other Gender-Affirming Therapies Estrogen Anti-Androgens Testosterone Lesbian, Gay, and Bisexual Care Incorporating LGBTQ+ Education into Medical School, Residency, and Other Allied Health Professional Training References Chapter 18: Racial Disparities in Healthcare Introduction Reported Disparities Cardiovascular Disease Diabetes Breast Cancer HIV/AIDS Analgesia Provider Bias Access to Health Insurance Poverty Life Expectancy Notable Examples of Racial Disparities in Recent Years Black Maternal and Infant Health Racial Disparities in COVID-19 What Can Be Done to Reduce Racial Disparities in Hospital Care? References Chapter 19: Gender and Racial Disparities in Career Advancement in the United States Introduction A Brief History of Black Physicians in the United States A Brief Timeline of Women Physicians in the United States Important Terminology Unique Challenges for Underrepresented Racial and Ethnic Minorities Today Gender in Medicine Differences in Promotion Rates The Gender Pay Gap in Medicine What About Burnout? The Intersectionality of Minority Identities: Sexuality, Gender Identity, Disability, and Religion Recommendations for Increasing Diversity in the Workforce References Chapter 20: Research in Medicine Hospital Medicine from the Research-Scientist Perspective Introduction To Scan or Not to Scan? Research Probability Guiding Practice Investigations in Suspected PE Black-Box Warning: What Is the Evidence? Research Guiding Risk-Benefit Analysis What Is in the Clot? Research on Clot Retrieval and Components Guiding Practice Protocols History of Clot Retrieval Protocols Effect of Clot Composition on Management Secondary Embolism Prediction of Clot Composition Robots: Can Research and Practice Keep Up with Medical Technology? Evolution of Robotic Surgery Changes to Perioperative Care Future Applications References Chapter 21: Sustainability and Healthcare: Expanding the Scope of “Do No Harm” Models of Success Kaiser Permanente: An Innovator of Sustainability Efforts in the Healthcare Industry Boston Green Ribbon Healthcare Working Group: Cooperation and Competition Among Healthcare Systems Cleveland Clinic Practice Greenhealth Conclusion References Chapter 22: The Evolution of International Health: Lessons to Be Learned The Ultimate Question Evolution Understanding Global Systems of Health Mortality and Life Expectancy So What Changed? Economies and Healthcare Access and Reverse Innovation Cultural Competence Alternative Medicine and Religion COVID-19 Conclusion References Chapter 23: Update in Hospital Medicine: Trends in Compensation, COVID-19, Workplace Environment and Malpractice Compensation Performance Metrics COVID-19 Experience: Insight into Career Satisfaction Hospital Medicine and Occupational Risk Related to COVID-19 Infection COVID-19 and Telemedicine Malpractice Workplace Environment and Safety References Index This book provides an update on recent clinical practice and an in-depth view of selected topics relevant to hospital medicine. It is divided into four sections that explore clinical, administrative, systems and ethical issues. Each section places an emphasis on the opportunities, challenges and potential directions of this bourgeoning subspecialty. This new edition expands on topics covered in the previous edition, including the COVID-19 pandemic, racial disparities in healthcare delivery and providers, and pediatric hospital medicine. Other chapters explore worldwide practice patterns and practical application of philosophical tools in daily practice. This up-to-date resource provides hospitalists, advanced nurse practitioners, medical students and administrators with the latest research, trends and issues in hospital medicine.