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.
This study shows that most hospitalized, general care patients with CAP or HCAP received excess antibiotic treatment durations. Excess treatment was not associated with improved outcomes and was clearly associated with an increased rate of adverse events.
Almost all of the excess antibiotic duration was attributed to antibiotics prescribed after hospital discharge.
An accompanying editorial points out that the evidence for shorter antibiotic durations, for pneumonia and several other conditions, is now too strong to ignore and that clinicians, professional societies, regulatory agencies, and payers should all adopt the “shorter-is-better” mantra.
In early stage CKD (creatinine clearance < 60 mL/min and > 20 mL/min), NOACs seem to have some advantages over VKAs for preventing hemorrhagic stroke and systemic embolism in patients with AF. However, no differences were observed between VKAs and NOACs used for the treatment of VTE.
There are no studies of VKAs or DOACs in patients receiving dialysis who have VTE or AF (these patients have generally been excluded from these studies). Therefore, the efficacy and safety of these anticoagulants in such patients remains undefined.
An editorial highlights the almost complete lack of evidence for the therapeutic use of anticoagulants in dialysis patients, despite their high incidence of AF and VTE, and points to 2 ongoing clinical trials that will provide much needed evidence in this area.
This study adds to the growing body of literature demonstrating the benefits of enhancing the standard physical examination with focused use of ultrasonography.
An editorial notes that, like many other studies of point-of-care ultrasonography, this study does not provide data on important clinical end points or the cost–benefit ratio of using the technology.
The editorial also states that any added value of FoCUS depends on the skill and expertise of the user—especially awareness with regard to which questions FoCUS can definitively answer and which questions might require formal echocardiography.
The authors recommend that providers engage patients by using the computer to show them radiographic images, trends in laboratory data, consultant recommendations, or other important information.
Providers might also move from using the computer while away from the patient to directly collaborating with the patient while performing some computer tasks, such as medication reconciliation or writing orders. Engaging the patient in these activities creates transparency and encourages patients to ask questions and express preferences.
Incorporating computers into patient encounters has the potential to allow clinicians to spend more time with their patients, while providing more effective care.
Wesorick DH, Chopra V. Annals for Hospitalists - 20 August 2019. Ann Intern Med. 2019;171:HO1. doi: https://doi.org/10.7326/AWHO201908200
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Published: Ann Intern Med. 2019;171(4):HO1.
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