James Anstey MD, Ajay Bhasin MD, Ricardo Franco-Sadud MD, Anna Maw MD, MS, Benji K. Mathews MD, MBA, Ria Dancel MD, David M. Tierney MD, Elizabeth K. Haro MPH, Joel Cho MD, RDMS, RDCS, Christopher Schott MD, MS, Brandon Boesch DO, Gigi Y. Liu MD, Kreegan Reierson MD, Trevor P. Jensen MD, Robert Nathanson MD, Carolina Candotti MD, Gordon Johnson MD, Tanping Wong MD, Gerard Salame MD, Benjamin Galen MD, Gregory Mints MD, Renee Dversdal MD, Jason Williams MD, Linda Kurian MD, Charles M. LoPresti MD, Jeremy S. Boyd MD, Ernest Fischer MD, Summer L. Kaplan MD, Amer M. Johri MD, Luyao Shen MD, Rob Arntfield MD, Mangala Narasimhan DO, Paul Mayo MD, Nilam J. Soni MD, MS
Background
Point-of-care ultrasound (POCUS) use continues to expand across multiple clinical subspecialties, and the need for standardization of training and quality assurance has become increasingly important. Despite the need for training, there are currently no widely accepted multispecialty criteria to define an acceptable quality POCUS image for common POCUS applications used by clinicians. Without such criteria, discrepancies in rating POCUS image quality occur, leading to inconsistencies in training and quality assurance, which can ultimately compromise patient care and safety.
Methods
To address this gap, the Society of Hospital Medicine (SHM) Point-of-care Ultrasound Task Force convened an expert panel of 32 national POCUS experts trained in hospital medicine (n = 24), critical care (n = 4), emergency medicine (n = 3), radiology (n = 2), and cardiology (n = 1) and employed a modified-Delphi approach to develop minimum image quality criteria for five common POCUS applications: heart, lungs, abdomen, lower extremity veins, and skin/soft tissues.
Results
After three rounds of voting and group discussion, the panel achieved consensus on a comprehensive list of 215 items to define standard image quality criteria in five different body systems.
Conclusions
These POCUS image quality criteria offer a structured, consensus-based framework for evaluating POCUS images and establish a minimum standard for defining an acceptable quality image. Use of these criteria can improve inter-rater reliability and advance standardization of POCUS imaging, which affects training, quality assurance, and credentialing/privileging practices.
{"title":"Defining minimum image quality criteria for common diagnostic point-of-care ultrasound images: A position statement of the Society of Hospital Medicine","authors":"James Anstey MD, Ajay Bhasin MD, Ricardo Franco-Sadud MD, Anna Maw MD, MS, Benji K. Mathews MD, MBA, Ria Dancel MD, David M. Tierney MD, Elizabeth K. Haro MPH, Joel Cho MD, RDMS, RDCS, Christopher Schott MD, MS, Brandon Boesch DO, Gigi Y. Liu MD, Kreegan Reierson MD, Trevor P. Jensen MD, Robert Nathanson MD, Carolina Candotti MD, Gordon Johnson MD, Tanping Wong MD, Gerard Salame MD, Benjamin Galen MD, Gregory Mints MD, Renee Dversdal MD, Jason Williams MD, Linda Kurian MD, Charles M. LoPresti MD, Jeremy S. Boyd MD, Ernest Fischer MD, Summer L. Kaplan MD, Amer M. Johri MD, Luyao Shen MD, Rob Arntfield MD, Mangala Narasimhan DO, Paul Mayo MD, Nilam J. Soni MD, MS","doi":"10.1002/jhm.70156","DOIUrl":"10.1002/jhm.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Point-of-care ultrasound (POCUS) use continues to expand across multiple clinical subspecialties, and the need for standardization of training and quality assurance has become increasingly important. Despite the need for training, there are currently no widely accepted multispecialty criteria to define an acceptable quality POCUS image for common POCUS applications used by clinicians. Without such criteria, discrepancies in rating POCUS image quality occur, leading to inconsistencies in training and quality assurance, which can ultimately compromise patient care and safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To address this gap, the Society of Hospital Medicine (SHM) Point-of-care Ultrasound Task Force convened an expert panel of 32 national POCUS experts trained in hospital medicine (<i>n</i> = 24), critical care (<i>n</i> = 4), emergency medicine (<i>n</i> = 3), radiology (<i>n</i> = 2), and cardiology (<i>n</i> = 1) and employed a modified-Delphi approach to develop minimum image quality criteria for five common POCUS applications: heart, lungs, abdomen, lower extremity veins, and skin/soft tissues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After three rounds of voting and group discussion, the panel achieved consensus on a comprehensive list of 215 items to define standard image quality criteria in five different body systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These POCUS image quality criteria offer a structured, consensus-based framework for evaluating POCUS images and establish a minimum standard for defining an acceptable quality image. Use of these criteria can improve inter-rater reliability and advance standardization of POCUS imaging, which affects training, quality assurance, and credentialing/privileging practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"183-196"},"PeriodicalIF":2.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina T. Vo MSN, CRNP, Karen Brooks DNP, RN, Emmanuel King MD, SFHM, FACP
Workplace violence (WPV) in healthcare is a growing crisis, and hospital-based approaches are urgently needed. We review two recently published efforts and describe our own pathway to address WPV. Sahota et al. implemented a specialized team and leveraged individualized care plans for high-risk patients, while Littlefield et al. took a policy-driven approach, enabling administrative discharge of disruptive patients. Our pathway utilized patient-centered anticipatory guidance, staff de-escalation training, and a behavioral emergency response. All three approaches illustrate that WPV prevention must move beyond reactive protocols and pivot to proactive, patient-informed solutions.
{"title":"Breaking the cycle: Preventing workplace violence against healthcare workers","authors":"Christina T. Vo MSN, CRNP, Karen Brooks DNP, RN, Emmanuel King MD, SFHM, FACP","doi":"10.1002/jhm.70167","DOIUrl":"10.1002/jhm.70167","url":null,"abstract":"<p>Workplace violence (WPV) in healthcare is a growing crisis, and hospital-based approaches are urgently needed. We review two recently published efforts and describe our own pathway to address WPV. Sahota et al. implemented a specialized team and leveraged individualized care plans for high-risk patients, while Littlefield et al. took a policy-driven approach, enabling administrative discharge of disruptive patients. Our pathway utilized patient-centered anticipatory guidance, staff de-escalation training, and a behavioral emergency response. All three approaches illustrate that WPV prevention must move beyond reactive protocols and pivot to proactive, patient-informed solutions.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"93-95"},"PeriodicalIF":2.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam E. Gailani MD, Walter Dehority MD, MSc, Sophie E. Katz MD, MPH
Rates of rubella infection and congenital rubella syndrome decreased significantly since the introduction of the rubella vaccine in 1969. Endemic rubella was declared eliminated in the United States in 2004, and since 2012, all rubella cases in the United States have been associated with infections acquired abroad. With vaccine rates falling worldwide and outbreaks of vaccine preventable diseases increasing, it is important for clinicians to be prepared to recognize and manage diseases they may have never seen before, including rubella. This article reviews the clinical manifestations, complications, diagnosis, management, and prevention of acute rubella infection and congenital rubella syndrome.
{"title":"Clinical progress note: Rubella","authors":"Adam E. Gailani MD, Walter Dehority MD, MSc, Sophie E. Katz MD, MPH","doi":"10.1002/jhm.70169","DOIUrl":"10.1002/jhm.70169","url":null,"abstract":"<p>Rates of rubella infection and congenital rubella syndrome decreased significantly since the introduction of the rubella vaccine in 1969. Endemic rubella was declared eliminated in the United States in 2004, and since 2012, all rubella cases in the United States have been associated with infections acquired abroad. With vaccine rates falling worldwide and outbreaks of vaccine preventable diseases increasing, it is important for clinicians to be prepared to recognize and manage diseases they may have never seen before, including rubella. This article reviews the clinical manifestations, complications, diagnosis, management, and prevention of acute rubella infection and congenital rubella syndrome.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"179-182"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristie J. Sun BA, Seamus P. Whelton MD, MPH, Leonard Feldman MD, Pamela T. Johnson MD, FACR, Javad R. Azadi MD
A 58-year-old man with no significant medical history or prescribed medications, including coronary artery disease, presented to the emergency department with hypoxemia due to COVID-19. A non-contrast chest computed tomography (CT) ordered to evaluate for the cause of the patient's hypoxemia revealed mild ground-glass opacities and moderate incidental coronary artery calcium (iCAC), noted in the body of the report. The CT report impression only reads “Peripheral ground glass opacities in keeping with COVID-19 infection.” The hospitalist, unsure of what do for moderate iCAC, discharged the patient to follow-up with his primary care provider without addressing it. Eighteen months later, the patient returned to the emergency department with an acute myocardial infarction.
{"title":"Things We Do for No Reason™: Overlooking incidental coronary artery calcification (iCAC)","authors":"Kristie J. Sun BA, Seamus P. Whelton MD, MPH, Leonard Feldman MD, Pamela T. Johnson MD, FACR, Javad R. Azadi MD","doi":"10.1002/jhm.70146","DOIUrl":"10.1002/jhm.70146","url":null,"abstract":"<p>A 58-year-old man with no significant medical history or prescribed medications, including coronary artery disease, presented to the emergency department with hypoxemia due to COVID-19. A non-contrast chest computed tomography (CT) ordered to evaluate for the cause of the patient's hypoxemia revealed mild ground-glass opacities and moderate incidental coronary artery calcium (iCAC), noted in the body of the report. The CT report impression only reads “Peripheral ground glass opacities in keeping with COVID-19 infection.” The hospitalist, unsure of what do for moderate iCAC, discharged the patient to follow-up with his primary care provider without addressing it. Eighteen months later, the patient returned to the emergency department with an acute myocardial infarction.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 12","pages":"1351-1354"},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Casey O'Hare BA, Amanda K. Gatewood PhD, MPH, Jennifer Baird PhD, MPH, MSW, RN, Roger Brown PhD, Ryan J. Coller MD, MPH, Arti Desai MD, MSPH, Anna Egan MD, Danielle Gerber BA, Troy McGuire MD, Kristina Devi Singh-Verdeflor MPH, Catherine Arnott Smith PhD, George Angelos Verdelis BS, Gemma Warner MSW, Sarah Wong, Michelle M. Kelly MD, PhD
Introduction
The 2021 Cures Act mandates caregiver access to their child′s medical notes with few exceptions, yet fewer than 10% access notes during hospitalization. Caregiver review of real-time notes facilitates identification of safety concerns and may enhance patient safety in pediatric hospitals. This trial will evaluate the Bedside Notes intervention—a multifaceted approach to enhance real-time access to inpatient notes—and its effects on caregiver activation, hospital experience, reporting of safety concerns found in notes, and anxiety.
Methods
This 5-year, multisite randomized controlled trial will enroll 600 English and Spanish-speaking caregivers of hospitalized children ≤11 years old and 30 hospital staff across three hospitals. Caregivers will be randomized to usual care or the Bedside Notes intervention, which includes real-time inpatient note access via a bedside tablet, a caregiver orientation video, and a glossary of terms commonly found in notes. Our primary outcome is note access; secondary outcomes are caregiver activation, hospital experience, safety concerns, and anxiety, measured through electronic health record audits, surveys, and interviews.
Discussion
We hypothesize that Bedside Notes will significantly improve caregiver note access, activation, hospital experience, and safety concern reporting without increasing caregiver anxiety. This study will also identify barriers and facilitators to accessing inpatient notes and inform scalable implementation strategies for caregiver engagement in hospital safety. Findings will advance efforts to reduce errors and improve family-centered care in pediatric hospital settings.
{"title":"A multicenter randomized trial to improve family clinical note access and outcomes for hospitalized children: The Bedside Notes study protocol","authors":"Casey O'Hare BA, Amanda K. Gatewood PhD, MPH, Jennifer Baird PhD, MPH, MSW, RN, Roger Brown PhD, Ryan J. Coller MD, MPH, Arti Desai MD, MSPH, Anna Egan MD, Danielle Gerber BA, Troy McGuire MD, Kristina Devi Singh-Verdeflor MPH, Catherine Arnott Smith PhD, George Angelos Verdelis BS, Gemma Warner MSW, Sarah Wong, Michelle M. Kelly MD, PhD","doi":"10.1002/jhm.70155","DOIUrl":"10.1002/jhm.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The 2021 Cures Act mandates caregiver access to their child′s medical notes with few exceptions, yet fewer than 10% access notes during hospitalization. Caregiver review of real-time notes facilitates identification of safety concerns and may enhance patient safety in pediatric hospitals. This trial will evaluate the Bedside Notes intervention—a multifaceted approach to enhance real-time access to inpatient notes—and its effects on caregiver activation, hospital experience, reporting of safety concerns found in notes, and anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This 5-year, multisite randomized controlled trial will enroll 600 English and Spanish-speaking caregivers of hospitalized children ≤11 years old and 30 hospital staff across three hospitals. Caregivers will be randomized to usual care or the Bedside Notes intervention, which includes real-time inpatient note access via a bedside tablet, a caregiver orientation video, and a glossary of terms commonly found in notes. Our primary outcome is note access; secondary outcomes are caregiver activation, hospital experience, safety concerns, and anxiety, measured through electronic health record audits, surveys, and interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We hypothesize that Bedside Notes will significantly improve caregiver note access, activation, hospital experience, and safety concern reporting without increasing caregiver anxiety. This study will also identify barriers and facilitators to accessing inpatient notes and inform scalable implementation strategies for caregiver engagement in hospital safety. Findings will advance efforts to reduce errors and improve family-centered care in pediatric hospital settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"20 11","pages":"1256-1264"},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin J. O'Leary MD, MS, Teresa Pollack MS, Cynthia Barnard PhD, MBA, Jane S. Kim MS, MEd, Lauren Leviton MA, LCSW, Luke Favia BA, Tara Lagu MD, MPH, Carol Haywood PhD, OTR/L
New policies require hospitals to identify and address patients' health-related social needs (HRSN) yet provide minimal guidance on how screening should be conducted. This observational study occurred at a large academic hospital serving a diverse population. Hospital and research staff independently screened newly admitted medical patients for six HRSNs using an instrument designed by a quality improvement team. We calculated κ statistics to assess HRSN agreement between hospital and research staff. Analysis of 413 patients revealed fair to moderate agreement between hospital and research staff screenings (κ = 0.25–0.54). Hospital staff identified fewer patients with needs related to medication affordability, housing, food, transportation, and mental health, but identified a higher proportion with needs related to the usual source of care. Hospital staff underestimate the proportion of patients with HRSN, potentially excluding patients from referral to social services.
{"title":"Hospitalized patients' health-related social needs: A comparison of screenings conducted by hospital staff and research staff","authors":"Kevin J. O'Leary MD, MS, Teresa Pollack MS, Cynthia Barnard PhD, MBA, Jane S. Kim MS, MEd, Lauren Leviton MA, LCSW, Luke Favia BA, Tara Lagu MD, MPH, Carol Haywood PhD, OTR/L","doi":"10.1002/jhm.70164","DOIUrl":"10.1002/jhm.70164","url":null,"abstract":"<p>New policies require hospitals to identify and address patients' health-related social needs (HRSN) yet provide minimal guidance on how screening should be conducted. This observational study occurred at a large academic hospital serving a diverse population. Hospital and research staff independently screened newly admitted medical patients for six HRSNs using an instrument designed by a quality improvement team. We calculated <i>κ</i> statistics to assess HRSN agreement between hospital and research staff. Analysis of 413 patients revealed fair to moderate agreement between hospital and research staff screenings (<i>κ</i> = 0.25–0.54). Hospital staff identified fewer patients with needs related to medication affordability, housing, food, transportation, and mental health, but identified a higher proportion with needs related to the usual source of care. Hospital staff underestimate the proportion of patients with HRSN, potentially excluding patients from referral to social services.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"171-174"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristel K. Tanhui-Manzana MD, Arlene C. Crisostomo MD, Irene S. Bandong MD, Vimar A. Luz MD, Bryian P. Paner MD, Jenn D. M. Gargar MD, Elaiza E. M. Dela Cruz MD, Kahlil C. A. Cruz MD, Oscar D. Naidas MD
Background
Concerns about contrast-associated acute kidney injury (CA-AKI) may lead to individuals not undergoing necessary contrast-enhanced imaging. Effective risk stratification plays a crucial role in patient management.
Objectives
To develop a prediction model combining the effects of multiple risk factors to predict risk of CA-AKI for individuals undergoing intravenous contrast-enhanced computed tomography (CECT) imaging.
Methods
In this retrospective cohort study, 906 inpatient and outpatient adults who underwent CECT imaging in two tertiary centers, St. Luke's Medical Center—Quezon City and St. Luke's Medical Center—Global City, located in Manila, Philippines, were included. Multivariate logistic regression was used to identify independent predictors for CA-AKI. A p-value ≤ 0.05 was considered significant. Based on the odds ratio, five parameters were identified and included in the model.
Results
The incidence of CA-AKI was 10.38%. A significant association was found between CA-AKI with in-hospital mortality (odds ratio [OR]: 4.23, confidence interval [CI]: 2.59–6.90, p = 0.001) and AKI requiring renal replacement therapy (OR: 3.57, CI: 1.94–6.59, p = 0.001) among admitted patients. Multivariate analysis included reduced estimated glomerular filtration rate (OR = 17.13, p = 0.005), acute heart failure (OR = 9.21, p = 0.006), hypotension (OR = 5.15, p = 0.011), anemia (OR = 4.34, p = 0.004), and use of nephrotoxic antibiotics (OR = 5.82, p = 0.009) in the final prediction model. The prediction model had fair predictive power (area under the curve = 0.737) and good calibration (Hosmer–Lemeshow p-value = 0.418).
Conclusions
This prediction model, incorporating clinical and laboratory parameters, provides a practical tool for estimating CA-AKI risk with fair discrimination and good internal calibration. It may support informed decision-making regarding the risks and benefits of intravenous CECT. External validation is recommended.
背景：对对比剂相关急性肾损伤（CA-AKI）的担忧可能导致个体不进行必要的对比增强成像。有效的风险分层在患者管理中起着至关重要的作用。目的：建立一个综合多种危险因素影响的预测模型，以预测接受静脉造影增强计算机断层扫描（CECT）的个体发生CA-AKI的风险。方法：在这项回顾性队列研究中，906名住院和门诊成年人在菲律宾马尼拉的两个三级医疗中心，奎松市圣卢克医疗中心和环球城圣卢克医疗中心接受了CECT成像。采用多元逻辑回归确定CA-AKI的独立预测因素。A p值≤0.05被认为是显著的。基于优势比，识别五个参数并将其纳入模型。结果：CA-AKI的发生率为10.38%。在住院患者中，CA-AKI与住院死亡率（比值比[OR]: 4.23，可信区间[CI]: 2.59-6.90, p = 0.001）和AKI需要肾脏替代治疗（比值比[OR]: 3.57, CI: 1.94-6.59, p = 0.001）存在显著相关性。多因素分析包括最终预测模型中肾小球滤过率降低（OR = 17.13, p = 0.005）、急性心力衰竭（OR = 9.21, p = 0.006）、低血压（OR = 5.15, p = 0.011）、贫血（OR = 4.34, p = 0.004）和肾毒性抗生素的使用（OR = 5.82, p = 0.009）。预测模型具有较好的预测能力（曲线下面积= 0.737）和较好的校准（Hosmer-Lemeshow p值= 0.418）。结论：该预测模型结合了临床和实验室参数，为估计CA-AKI风险提供了实用的工具，具有公平的区分和良好的内部校准。它可能支持关于静脉CECT的风险和益处的知情决策。建议使用外部验证。
{"title":"Development and internal validation of a prediction model for intravenous contrast-associated acute kidney injury","authors":"Kristel K. Tanhui-Manzana MD, Arlene C. Crisostomo MD, Irene S. Bandong MD, Vimar A. Luz MD, Bryian P. Paner MD, Jenn D. M. Gargar MD, Elaiza E. M. Dela Cruz MD, Kahlil C. A. Cruz MD, Oscar D. Naidas MD","doi":"10.1002/jhm.70136","DOIUrl":"10.1002/jhm.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Concerns about contrast-associated acute kidney injury (CA-AKI) may lead to individuals not undergoing necessary contrast-enhanced imaging. Effective risk stratification plays a crucial role in patient management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a prediction model combining the effects of multiple risk factors to predict risk of CA-AKI for individuals undergoing intravenous contrast-enhanced computed tomography (CECT) imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, 906 inpatient and outpatient adults who underwent CECT imaging in two tertiary centers, St. Luke's Medical Center—Quezon City and St. Luke's Medical Center—Global City, located in Manila, Philippines, were included. Multivariate logistic regression was used to identify independent predictors for CA-AKI. A <i>p</i>-value ≤ 0.05 was considered significant. Based on the odds ratio, five parameters were identified and included in the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of CA-AKI was 10.38%. A significant association was found between CA-AKI with in-hospital mortality (odds ratio [OR]: 4.23, confidence interval [CI]: 2.59–6.90, <i>p</i> = 0.001) and AKI requiring renal replacement therapy (OR: 3.57, CI: 1.94–6.59, <i>p</i> = 0.001) among admitted patients. Multivariate analysis included reduced estimated glomerular filtration rate (OR = 17.13, <i>p</i> = 0.005), acute heart failure (OR = 9.21, <i>p</i> = 0.006), hypotension (OR = 5.15, <i>p</i> = 0.011), anemia (OR = 4.34, <i>p</i> = 0.004), and use of nephrotoxic antibiotics (OR = 5.82, <i>p</i> = 0.009) in the final prediction model. The prediction model had fair predictive power (area under the curve = 0.737) and good calibration (Hosmer–Lemeshow <i>p</i>-value = 0.418).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prediction model, incorporating clinical and laboratory parameters, provides a practical tool for estimating CA-AKI risk with fair discrimination and good internal calibration. It may support informed decision-making regarding the risks and benefits of intravenous CECT. External validation is recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 2","pages":"142-151"},"PeriodicalIF":2.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>It was 1:45 p.m., and I had just returned from my rounds and was completing notes after a demanding day managing complex transplant patients. A senior colleague, well-respected at our institution, entered the workroom and asked if I would consider applying for an open administrative position on our team. He explained the scope, agreed it suited my goals and skills, encouraged me to apply, and mentioned that an announcement would be sent out shortly.</p><p>When the email arrived, I replied immediately, expressing genuine excitement and interest. I returned to clinical care feeling hopeful that this could mark a new chapter in my academic journey. Weeks later, I received a brief reply: “Thank you for your interest. After discussions among the leadership, we have decided to proceed with another candidate.” No feedback. No stated selection criteria. No context.</p><p>I can't claim certainty about why I wasn't selected. In the absence of feedback or transparent criteria, however, I'm left to wonder whether my status as an international medical graduate (IMG) played a role. That doubt isn't rooted in a single experience; it reflects a broader pattern. Colleagues with similar training backgrounds have described near-identical scenarios: roles that quietly disappear after interest is expressed, feedback that never arrives, or opportunities extended only to those with more conventional pedigrees. These moments accumulate not as isolated disappointments, but as signs of a system that remains opaque. What's often interpreted as a lack of readiness or fit may instead reflect a lack of access, sponsorship, or familiarity with institutional norms—barriers that are invisible, but no less real.</p><p>As a hospitalist who trained in the United States after completing medical school abroad, I have spent nearly a decade building a career in academic hospital medicine. Like many IMGs, I arrived without an established network or institutional pedigree. I volunteered for educational projects, collaborated on research, and embraced every role offered. Professional advancement has often felt like navigating a landscape without markers—where the path forward is not only unclear but shaped by invisible boundaries and shifting expectations. Colleagues at my institution and across the country with similar training backgrounds have echoed these experiences. Many are high-performing clinicians and educators who find themselves bypassed for advancement, unsure whether the gap lies in credentials, perception, or simply access to the right rooms.</p><p>These anecdotes reflect the well-documented, complex, and multifactorial nature of bias in academic medicine. Even groups that are not underrepresented in medicine overall, such as Asian American physicians, have been shown to face barriers to advancement and leadership roles despite strong pipeline representation.<span><sup>1</sup></span> Similarly, while gender equity has been the focus of sustained efforts and data collectio
{"title":"Institutional barriers to advancement in academic hospital medicine: A perspective from the margins","authors":"Hafiz Qurashi MD","doi":"10.1002/jhm.70159","DOIUrl":"10.1002/jhm.70159","url":null,"abstract":"<p>It was 1:45 p.m., and I had just returned from my rounds and was completing notes after a demanding day managing complex transplant patients. A senior colleague, well-respected at our institution, entered the workroom and asked if I would consider applying for an open administrative position on our team. He explained the scope, agreed it suited my goals and skills, encouraged me to apply, and mentioned that an announcement would be sent out shortly.</p><p>When the email arrived, I replied immediately, expressing genuine excitement and interest. I returned to clinical care feeling hopeful that this could mark a new chapter in my academic journey. Weeks later, I received a brief reply: “Thank you for your interest. After discussions among the leadership, we have decided to proceed with another candidate.” No feedback. No stated selection criteria. No context.</p><p>I can't claim certainty about why I wasn't selected. In the absence of feedback or transparent criteria, however, I'm left to wonder whether my status as an international medical graduate (IMG) played a role. That doubt isn't rooted in a single experience; it reflects a broader pattern. Colleagues with similar training backgrounds have described near-identical scenarios: roles that quietly disappear after interest is expressed, feedback that never arrives, or opportunities extended only to those with more conventional pedigrees. These moments accumulate not as isolated disappointments, but as signs of a system that remains opaque. What's often interpreted as a lack of readiness or fit may instead reflect a lack of access, sponsorship, or familiarity with institutional norms—barriers that are invisible, but no less real.</p><p>As a hospitalist who trained in the United States after completing medical school abroad, I have spent nearly a decade building a career in academic hospital medicine. Like many IMGs, I arrived without an established network or institutional pedigree. I volunteered for educational projects, collaborated on research, and embraced every role offered. Professional advancement has often felt like navigating a landscape without markers—where the path forward is not only unclear but shaped by invisible boundaries and shifting expectations. Colleagues at my institution and across the country with similar training backgrounds have echoed these experiences. Many are high-performing clinicians and educators who find themselves bypassed for advancement, unsure whether the gap lies in credentials, perception, or simply access to the right rooms.</p><p>These anecdotes reflect the well-documented, complex, and multifactorial nature of bias in academic medicine. Even groups that are not underrepresented in medicine overall, such as Asian American physicians, have been shown to face barriers to advancement and leadership roles despite strong pipeline representation.<span><sup>1</sup></span> Similarly, while gender equity has been the focus of sustained efforts and data collectio","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"78-79"},"PeriodicalIF":2.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tetanus is a pathogen with a significant global burden which has largely been eradicated in the developed world through safe and highly effective vaccination. In this era of increasing vaccine hesitancy, physicians should remain cognizant of this rare, preventable and high-consequence pathogen.
{"title":"Clinical progress note: Tetanus","authors":"Feargal Donaghy MB, BCh, BAO, Sharon Karunakaran MBBS","doi":"10.1002/jhm.70160","DOIUrl":"10.1002/jhm.70160","url":null,"abstract":"<p>Tetanus is a pathogen with a significant global burden which has largely been eradicated in the developed world through safe and highly effective vaccination. In this era of increasing vaccine hesitancy, physicians should remain cognizant of this rare, preventable and high-consequence pathogen.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"21 1","pages":"70-72"},"PeriodicalIF":2.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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