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Hospital Medicine Alert – October 1, 2011

October 1, 2011

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  • Risk of Hemorrhage on Warfarin

    In this study, the authors attempt to develop a risk stratification score to predict bleeding in patients treated with warfarin oral anticoagulation.
  • Respite Staffing Decreases Intensivist Burnout

    Intensivists experienced significantly less burnout, work-home life imbalance, and job distress under an interrupted schedule vs a continuous (half-month) schedule. ICU length of stay and mortality were non-significantly higher under continuous scheduling.
  • ICU Telemedicine Can Improve Patient Outcomes

    In the ICUs of a well-staffed academic medical center committed to quality improvement, in which closed staffing, multidisciplinary rounds, and the daily use of checklists were already in place, implementation of a 24-hour ICU telemedicine system that was well accepted by the medical staff was associated with impressive improvements in adherence to best practice standards as well as with reductions in hospital mortality and lengths of stay.
  • Tdap for Health Care Workers

    Add Tdap to the growing list of recommended (and often required) vaccinations for health care workers (HCWs) in hospital, including MMR, hepatitis B, influenza, and possibly varicella. In April, the American College of Immunization Practices (ACIP) issued provisional recommendations for pertussis vaccination (Tdap) of all hospital HCWs, regardless of age and prior vaccine history (i.e., regardless of the time since last Td dose).
  • Leishmaniasis and Human Trafficking

    Physicians at the University of California-San Diego (UCSD) report a cluster of 5 cases of cutaneous Leishmaniasis in illegal immigrants from East Africa, which surprisingly turned out to be consistent with New World Leishmaniasis, although all 5 had come from an area endemic for Old World Leishmaniasis. How did this occur?
  • The Broken Heart: It CAN Be Mended

    The authors advocate that cardiovascular magnetic resonance imaging using specific criteria may be useful as a diagnostic tool for patients with stress cardiomyopathy at the time of acute clinical presentation.