David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Patients who are hospitalized with suspected or confirmed influenza should be placed in isolation with droplet precautions, and providers should wear N95 masks (or an equivalent) when aerosol-generating procedures are performed.
Patients who are hospitalized with suspected influenza should be tested with a molecular influenza assay, such as the reverse transcriptase polymerase chain reaction (RT-PCR) assay. Molecular assays are more sensitive than antigen detection assays.
Despite the lack of evidence in hospitalized patients, the Centers for Disease Control and Prevention recommends the use of neuraminidase inhibitors (e.g., oseltamivir and peramivir) in all hospitalized patients suspected of influenza infection. Although these medications are most effective when started early, late initiation (after 48 hours) may still provide some benefit.
Bacterial co-infection (e.g., pneumonia with Pneumococcus, Staphylococcus aureus, or group A Streptococcus) should be considered in patients who present with severe disease, do not improve, worsen, or have acute onset of high fever and malaise after a period of initial improvement.
Nucleic acid amplification tests are the most sensitive of the rapid tests for influenza, followed by digital immunoassays. Rapid influenza diagnostic tests will likely be phased out soon, given their poor sensitivities.
63.4% of patients who misused opioids reported that their motivation was to relieve physical pain, prompting the authors to call for the development of better nonopioid strategies for the management of chronic pain.
Among patients who misuse prescription opioids, 40.8% obtained medications from friends or relatives, suggesting the need for more restrictive prescribing practices. Excessive prescribing may lead to sharing or diversion of these medications.
An editorial discusses how unemployment and a lack of health insurance might exacerbate opioid misuse by limiting access to evidence-based chronic pain management.
Wesorick DH, Chopra V. Annals for Hospitalists - 19 September 2017. Ann Intern Med. 2017;167:HO1. doi: https://doi.org/10.7326/AFHO201709190
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Published: Ann Intern Med. 2017;167(6):HO1.
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