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.
On the basis of the limited available evidence, it remains uncertain whether sitters actually reduce the risk for falls. The authors found moderate-certainty evidence that video monitoring reduces the use of sitters, without increasing falls.
All identified studies had at least 1 significant methodological limitation affecting their internal validity.
An editorialist states that this “shallow evidence base should not yet compel us to stop using sitters in clinical care…” and advocates for creating an “age-friendly health system” that focuses on maintaining function in older hospitalized patients.
Of all of the pharmacologic interventions studied, only antibiotics and systemic corticosteroids demonstrate a reduced rate of treatment failure in AECOPD. Corticosteroids are associated with an increase in adverse effects, including endocrine-related ones.
This review finds insufficient or no evidence informing the optimal choice of antibiotic or corticosteroid regimen, including dosage, route, or duration of treatment. However, it is noted that 5 days of corticosteroid treatment does not appear to be inferior to 14 days.
Aminophyllines were not associated with any improved outcomes but were associated with gastrointestinal adverse effects. Magnesium sulfate, simvastatin, zileuton, and inhaled corticosteroids (with or without short-acting β-agonists) were associated with improvements in FEV1, but not other outcomes.
The authors highlight the “lack of good-quality, reliable evidence to answer many of the important clinical questions surrounding treatment of patients with exacerbation of COPD.”
Wesorick DH, Chopra V. Annals for Hospitalists - 17 March 2020. Ann Intern Med. 2020;172:HO1. doi: https://doi.org/10.7326/AWHO202003170
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Published: Ann Intern Med. 2020;172(6):HO1.
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