Beddow D, Patel L, Smith CS, Kirven J, Schmidt C, Ruppman D, Kethireddy R, Wankum M, Dawud B, St Hill CA. Outcomes in hospitalised patients with sepsis, severe sepsis or septic shock and reported penicillin allergy: a retrospective cohort study. BMJ Open. 2022 Feb 23;12(2):e050879. doi: 10.1136/bmjopen-2021-050879. PMID: 35197334; PMCID: PMC8867335 (read more)Recently, robust antimicrobial stewardship programmes (ASPs) have been implemented to address appropriate and timely antibiotic choices. The Centers for Disease Control and Prevention recommend that all hospitals have ASPs to minimise adverse events and reduce antibiotic resistance. Some ASPs also incorporate PcnA skin testing proven to be safe and effective even for critically ill patients. Our research question was, ‘What are the health outcomes of inpatients with sepsis, severe sepsis, and shock who were labelled as having PcnA compared with inpatients who were not labelled as having PcnA?’ Subsequently, the objective of this study was to compare antibiotic use patterns and outcomes between patients with reported PcnA and non-PcnA hospitalised with sepsis, severe sepsis, and septic shock in a health system with active ASPs.
Lillyblad MP, Qadri GA, Weise BE, Smith CS, St Hill C, Tierney DM, Melamed RR. Post-thrombolytic coagulopathy and complications in patients with pulmonary embolism treated with fixed-dose systemic alteplase. J Thromb Thrombolysis. 2022 Mar 23. doi: 10.1007/s11239-022-02640-6. Epub ahead of print. PMID: 35320471. (read more)Alteplase treatment can cause a systemic coagulopathy although the incidence and contributory factors are unknown in pulmonary embolism (PE). Fixed-dosing of alteplase for PE may lead to interpatient variability in drug exposure and influence post-thrombolytic coagulopathy (PTC). While changes in fibrinogen and INR have been used to describe PTC,
no universal PTC definition is available.
Patel L, Beddow D, Kirven J, Smith CS, Hanovich S, Holaday K, Agboto V, St Hill CA. Outcomes of Minnesota Detoxification Scale (MINDS) Assessment With High-dose Front Loading Diazepam Treatment for Alcohol Withdrawal in Hospitalized Patients. Am J Med Sci. 2021 Oct 16:S0002-9629(21)00362-1. doi: 10.1016/j.amjms.2021.10.003. Epub ahead of print. PMID: 34666063. (read more)Benzodiazepines are the gold standard for alcohol withdrawal treatment but choice and dosing vary widely. In 2015, our institution implemented a Minnesota detoxification scale (MINDS) and single standardized high-dose diazepam based protocol for treatment of alcohol withdrawal to replace multiple Clinical Institute Withdrawal Assessment for Alcohol (CIWA) based protocols using lower dose benzodiazepines. We compared use of MINDS versus CIWA assessment protocols with high front loading diazepam treatment in care of patient experiencing alcohol withdrawal during hospitalization.
Quadri N. Visionary insight. Lancet Respir Med. 2021 Jan 22:S2213-2600(21)00026-6. doi: 10.1016/S2213-2600(21)00026-6. Epub ahead of print. PMID: 33493444. (Read More)These days, we walk into our patient’s room fully masked. Eye protection is the only window for my patient to see
their doctor. I have been paying attention to how I use my eyes to communicate, mostly because the height of my
opera voice through my COVID-19 shielding mask only results in muffled echoes.
Skeik N, Smith JE, Patel L, Mirza AK, Manunga JM, Beddow D, Risk and Management of Venous Thromboembolism in Patients with COVID-19, Annals of Vascular Surgery (2021), doi: https://doi.org/10.1016/j.avsg.2020.11.007. (Read More)One of the most pronounced and poorly understood pathological features of COVID-19 infection has been high risk for venous and arterial thromboembolic complications. An increasing number of thromboembolic events are being reported almost on a daily basis, and the medical community has struggled to predict and mitigate this risk. We aimed to review available literature on the risk and management of COVID-19 related venous thromboembolism (VTE), and provide evidence-based guidance to manage these events.
Gandhi D, Ahuja K, Quade A, Batts KP, Patel L. Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report. World J Hepatol. 2020 Oct 27;12(10):863-869. doi: 10.4254/wjh.v12.i10.863. PMID: 33200023; PMCID: PMC7643221 (Read More)A 37-year-old female with a history of depression and obesity (body mass index: 32) presented to emergency room with a week-long history of nausea, decreased appetite, fatigue, and two days of jaundice. On admission bilirubin was markedly elevated. Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms. Liver biopsy showed changes mimicking primary biliary cholangitis. Patient’s symptoms and jaundice improved quickly.
Gandhi D, Ahuja K, Grover H, Sharma P, Solanki S, Gupta N, Patel L. Review of Xray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic. World J Radiol 2020; 12(9): 195-203 (Read More)As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps
assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.
Darshan Gandhi, Nitin Jain, Kanika Khanna, Shuo Li, Love Patel, Nishant Gupta. “Current role of imaging in COVID-19 infection with recent recommendations of point of care ultrasound in the contagion: a narrative review.” Ann Transl Med 2020;doi:10.21037/atm-20-3043 (Read More)Radiological studies have an important role in the diagnosis and follow up of many infectious diseases. With current pandemic of Coronavirus disease 2019 (COVID-19) though the molecular analysis with reverse transcriptase polymerase chain reaction (RT-PCR) remains the cornerstone of diagnosis, the critical role of chest imaging including CT scan and baseline X-ray became apparent early in the course due to concern for less than optimal sensitivity of PCR testing.
Patel L, Gandhi D, Beddow D. Controversies on the Stethoscope During COVID-19: A Necessary Tool or an Unnecessary Evil? [published online ahead of print, 2020 Jul 6]. Am J Med Sci. 2020;doi:10.1016/j.amjms.2020.07.006 (Read More)Stethoscope” though a listening device actually means “look into thorax”. It has been over 200 years since Laennec first described his work on auscultation and the stethoscope gradually gained popularity in the practice of medicine. Nowadays it would be rare to see a physician or a physician in training without a stethoscope during patient care.
Autumn Gode, MS, APRN-CNS; Elizabeth Kozub, MS, APRN-CNS, CCNS, CNRN, CCRN; Kyla Joerger, BSN, RN-BC; Cassandra Lynch, BSN, NE-BC, OCN; Maren Roche, BSN, RN; Justin Kirven, MD. “Reducing Delirium in Hospitalized Adults Through a Structured Sleep Promotion Program.” Journal of Nursing Care Quality. 2020; Vol. 00, No. 00: 1-6 (Read More)Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. Sleep deprivation is a significant risk factor for developing delirium and is a patient dissatisfier. An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions. Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P=.0005; CI, 0.05 to 0.67) with ongoing sustainment.
Kirven J, Beddow D, Patel L, Smith C, Agboto V, Wagner, C, St. Hill C. “Outcomes in reported penicillin allergic mothers and their infants requiring Group B Streptococcal (GBS) prophylaxis”. Hospital Medicine 2020, Society of Hospital Medicine (SHM), Virtual Abstract Competition, May 2020 (Read More)
Beddow D, Patel L, Kirven J, Smith C, Agboto V, Wagner C, St.Hill C ” Outcomes in reported penicillin allergic patients with sepsis, severe sepsis and septic shock. Hospital Medicine 2020, Society of Hospital Medicine (SHM), Virtual Abstract Competition, May 2020 (Read More)
Wetergard E, Ornes M, Patel L, Schotl B, Wohlwend L” Optimizing Patient Care: Appropriate VTE Prophylaxis” . Hospital Medicine 2020, Society of Hospital Medicine (SHM), Virtual Abstract Competition, May 2020 (Read More)
Patel L, Elliott A, Storlie E, Kethireddy R, Goodman K, Dickey W. “Ethical and Legal Challenges During the COVID-19 Pandemic – Are We Thinking About Rural Hospitals?” [published online ahead of print, 2020 Apr 13]. J Rural Health. 2020;10.1111/jrh.12447. doi:10.1111/jrh.12447. (Read More)Emerging zoonotic infections are a major threat to public health. The current outbreak of coronavirus disease 2019 (COVID-19) is already overwhelming health care systems across the globe. At the time of this writing it has already spread to 181 countries involving close to 1 million patients. Health care resources including ventilators, dialysis machines, ECMO machines, and personal protective equipment (PPE) are finite. In the US, intensive care units typically run at 90% of capacity and have little surge capacity […]
Brooks CD, Melchert PJ, Stillerman A, Ott NL. “Reintroduction of foods after a negative oral food challenge: A 2-year follow-up.” Ann Allergy Asthma Immunol. 2020;124(4):398–399. doi:10.1016/j.anai.2020.01.005. (Read More)
Rajat Kalra , Vibhu Parcha , Nirav Patel , Anirudh Bhargava , Katherine S Booker, Garima Arora and Pankaj Arora “Increased awareness, inadequate treatment, and poor control of cardiovascular risk factors in American young adults: 2005–2016.” European Journal of Preventative Cardiology: March 2 2020. (Read More)We sought to evaluate prevalence trends for diabetes mellitus, hypertension, and hypercholesterolemia in the general American population of adults aged 18–44. We hypothesized that the prevalence of diabetes mellitus, hypertension, and hypercholesterolemia were rising and that there were differences in awareness, prevalence, and control across sex. We present the results of an investigation that employs the National Health and Nutrition Examination Study (NHANES) surveys to investigate these hypotheses.
Emily Westergard, DO; Michael Ornes, MD; Love Patel, MD; Brent Schotl, MD; Luke Wohlwend, MD. “Optimizing Patient Care: Appropriate Use of VTE Prophylaxis.” Poster presentation at SHM – MN Chapter – October 2019 – Second place winner (Read More)Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), constitute a major health problem in the United States health system, with a reported high mortality rate and a significant economic toll. Despite the prevalence of VTE and associated mortality, clinicians have struggled in prescribing appropriate VTE prophylaxis for the inpatient palpation, often over or under prescribing, subsequently increasing patient risk, compliance, and cost.
One sample retrospective observational study to assess the occurrence in-hospital falls and to better understand the events that trigger the use of head CT scans and to give recommendations to guide appropriate utilization of head CT scans.
Love Patel, MBBS, Kristopher Holaday, MD, Tonya Montesinos, RN, Catherine A. St. Hill, DVM, PhD, Peter Melchert, MD, David Beddow, MD. “Utilization and Factors Influencing use of Head CT after In-Hospital Falls.” Poster presentation at SHM – MN Chapter – October 2019 (Read More)
The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction.
Xiao M, St Hill CA, Vacquier M, Patel L, Mink P, Fernstrom K, Kirven J, Jeruzal J, Beddow D. Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates. South Med. 2019 Jul;112(7):357-362. (Read More)
The science of health is always shape-shifting and evolving in a way that might appear ?ckle to any outside viewer. That observation certainly applies to the science of food. How could such a simple and ageless question—‘‘What should we eat?’’—have such a complicated and elusive answer?
Craig Bowron (2019) Udder Confusion: Are Dairy Foods Good for Us?. Journal of the Minneapolis Heart Institute Foundation: May 2019, Vol. 2, No. 2, pp. 14-15 . (Read More)
The week of “real patient” POCUS training allowed participating hospitalists to complete a volume of exams not achievable outside this type of training and with real-time feedback and education. They were much more comfortable managing the machine, the process, and the discussion with patients. They demonstrated much improved image acquisition, image interpretation, and understanding of real benefits and limitations of POCUS.
Ornes, M; Tierney, D; Sausker, D; Prebil, S; Odenbach, P. GETTING HOSPITALISTS UP TO SPEED: A NOVEL HANDS-ON POCUS TRAINING PROGRAM. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 391. (Read More)
Patel L, Beddow D, Hanovich S, Kirven J, Agboto V, Smith C, Holaday K, St. Hill C “Outcomes of Standardized Minnesota Detoxification Scale (MINDS) Assessment with High Dose Diazepam Treatment for Alcohol Withdrawal in Hospitalized Patients” Hospital Medicine 2019, Society Of Hospital Medicine (SHM), National Harbor, MD, March 2019. (Read More)In 2013, at a 12-hospital system in Minnesota, a symptom based detoxification scale assessment tool (MINDS) and a single standardized high dose, diazepam-based treatment protocol (loading dose up to 80 mg diazepam) was initiated for alcohol withdrawal patient.
Holaday K, Hanovich S, Beddow D, Patel L “Minnesota Detoxification Scale (MINDS) Assessment Protocol For Treatment of Alcohol Withdrawal, Pre and Post Implementation Comparison ” 2018 American College of Physicians (ACP) Minnesota Chapter Meeting, Minnesota, November 2018. (Read More)
Kelly H, Lobo A, Patel L “When Screening Becomes Anything But Routine” 2018 American College of Physicians (ACP) Minnesota Chapter Meeting, Minneapolis, Minnesota, November 2018 (Read More)
Xiao M, Fernstrom K, Kirven J, Mink P, Patel L, Vacquier M, Jerizal J, Beddow D, St.Hill C. “A retrospective analysis of the impact of post-discharge phone calls by hospitalist on patient satisfaction and readmission rates” Hospital Medicine 2018, Society of Hospital Medicine (SHM), Orlando, FL, April 2018 (Read More)
Bowron C. Ask Your Doctor if Direct-to-Consumer Drug Ads Are Right for You. Journal of the Minneapolis Heart Institute Foundation: Spring/Summer 2018, Vol. 2, No. 1, pp. 4-6 (Read More)
Kirven J, Xiao M, Fernstrom K, Mink P, Jeruzal J, Agboto V, St.Hill C ” Characterization of patterns of social determinants of health and health outcomes using area-based socioeconomic measures” 2018 Institute Of Healthcare Improvement (IHI) National Forum, Orlando, FL, December 2018 (Read More)