Journal of hospital medicine最新文献

英文中文

Meningitis mirage 脑膜炎海市蜃楼。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-16 DOI: 10.1002/jhm.70134

Ren Kawamura MD, PhD, Takafumi Suzuki MD, Hadzki Matsuda MD, PhD, Kazuyuki Ishida MD, PhD, Andrew A. White MD, Taro Shimizu MD, PhD, MSc, MPH, MBA

引用次数: 0

Academic internal medicine hospitalist professional identity development 学术内科医院医师职业认同的发展。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-16 DOI: 10.1002/jhm.70132

Valerie J. Lang MD, MHPE, Kimberly Fluet PhD, Kimberly Bloom-Feshbach MD, Maria Klimenko MD

Background

Academic hospitalists have major roles in medical education, clinical care, and other academic medical center missions. Their professional identity development has implications for vitality, burnout, retention, and patient safety.

Objective

To characterize academic internal medicine hospitalist professional identity and its development.

Methods

Ten focus group interviews were conducted with 31 hospitalists in early-, mid-, and late-career stages at three academic medical centers. Data were analyzed using thematic analysis.

Results

Academic hospitalist identity development was characterized by (1) constant core clinician identity, (2) navigating interfaces between different spheres of knowledge, influence, and activity (patients, systems, learners, and multiple medical and psychosocial issues), (3) expanding identities in the “extension zone” outside of patient care, (4) variable and ambiguous academic identity, (5) ongoing negotiation between extrinsic factors (resources, relationships, and validation), intrinsic factors (personal identities and professional values), and identity development, (6) diverse career trajectories, and (7) professional identity driving career decision-making.

Conclusions

In contrast to a “deficit” view of generalists lacking focus on a specific disease or organ system, academic internal medicine hospitalist professional identity encompasses distinct roles and skills. While hospitalists individualize their activities outside the context of patient care, the core clinician identity remains a beacon guiding these activities. Hospitalists’ varied and ambiguous concepts of what it means to be academic may contribute to lagging academic progress. Organizations should support hospitalists’ unique professional identities, seek clarity around what it means to be academic, and foster ongoing professional identity development.

背景：学术医院医师在医学教育、临床护理和其他学术医疗中心任务中发挥着重要作用。他们的职业认同发展对活力、倦怠、留任和患者安全都有影响。目的：探讨专科内科医院医师职业认同及其发展特征。方法：采用10个焦点小组访谈，对3个学术医学中心31名职业生涯早期、中期和晚期的住院医师进行访谈。数据采用专题分析进行分析。结果:学术型医院医生身份发展的特征是：(1)核心临床医生身份不变；(2)在不同的知识、影响和活动领域（患者、系统、学习者和多种医疗和社会心理问题）之间导航界面；(3)在患者护理之外的“扩展区”扩展身份；(4)可变和模糊的学术身份；(5)在外在因素（资源、关系和验证）之间不断协商。内在因素（个人认同与职业价值观）与认同发展；(6)职业轨迹多元化；(7)职业认同驱动职业决策。结论：与多面手缺乏对特定疾病或器官系统的关注的“缺陷”观点相反，学术内科医院医生的职业身份包含了不同的角色和技能。虽然医院医生在病人护理之外个性化他们的活动，但核心临床医生身份仍然是指导这些活动的灯塔。医院医生对学术意义的不同和模糊的概念可能导致学术进步滞后。组织应该支持医院医生独特的职业身份，寻求明确的学术意义，并促进持续的职业身份发展。

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引用次数: 0

Variation in effectiveness of blood transfusion by hospital day: A multicenter retrospective study 医院日输血有效性的变化：一项多中心回顾性研究。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-14 DOI: 10.1002/jhm.70133

Nicholas A. Bosch MD, MSc, Anica C. Law MD, MS, Nareg H. Roubinian MD, S. Reza Jafarzadeh DVM, MPVM, PhD, Allan J. Walkey MD, MSc

Background

Transfusion of packed red blood cells (pRBCs) below a hemoglobin concentration of 7.0 g/dL is common, but it is unclear if the timing of transfusion during hospitalization modifies transfusion effectiveness. We sought to determine if effects of pRBC transfusion are heterogenous based on time from hospital admission.

Methods

Multicenter retrospective cohort study including hospitals in the Premier Inc. AI Healthcare Database between 2016 and 2022. Hospital encounters for adults with at least one hemoglobin concentration measured between hospital Days 1–7 were included. For each day, the lowest hemoglobin concentration was identified; patient-days were then separated into seven analytic cohorts based on the day in which a hemoglobin concentration was recorded (index day). We used regression discontinuity to quantify the effect of index day pRBC transfusion versus no transfusion on an outcome of hospital mortality or discharge to hospice (risk difference [RD]) at a hemoglobin concentration threshold of 7.0 g/dL in each cohort.

Results

A total of 2,293,021 index days across 997,277 inpatient encounters were included. The association between pRBC transfusion and hospital mortality or discharge to hospice differed based on days from admission, shifting from benefit on Day 1 (RD: −2.9 [95% CI: −5.9, −0.04] %) to harm on index Days 6 and 7 (Day 6, RD: 3.3 [95% CI: 0.4, 6.1] %; Day 7, RD: 4.1 [95% CI: 0.8, 7.3] %, p-interaction < .0001).

Conclusions

Transfusion during hospitalization was associated with benefit early in hospitalization and harm at later time points.

背景：血红蛋白浓度低于7.0 g/dL的填充红细胞（pRBCs）输注是常见的，但尚不清楚住院期间输注的时机是否会改变输注效果。我们试图确定pRBC输血的影响是否基于住院时间的异质性。方法：多中心回顾性队列研究。2016年至2022年的人工智能医疗保健数据库。在住院第1-7天期间至少测量过一次血红蛋白浓度的成人住院病例纳入研究。每天确定最低血红蛋白浓度；然后根据记录血红蛋白浓度的日期（指标日）将患者日分为七个分析队列。在每个队列中，当血红蛋白浓度阈值为7.0 g/dL时，我们使用回归不连续来量化指标日输血与不输血对医院死亡率或临终关怀出院结果（风险差异[RD]）的影响。结果：共纳入997,277例住院患者的2,293,021个索引日。pRBC输注与住院死亡率或出院至临终关怀之间的关联因入院天数而异，从第1天的获益（RD: -2.9 [95% CI: -5.9, -0.04] %）转变为指标第6和7天的危害(第6天，RD: 3.3 [95% CI: 0.4, 6.1] %；第7天，RD: 4.1 [95% CI: 0.8, 7.3] %， p相互作用结论：住院期间输血与住院早期获益和后期伤害相关。

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引用次数: 0

A costly gap in safety: Ending the practice of as-needed antihypertensive therapy 代价高昂的安全缺口：终止按需抗高血压治疗。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-13 DOI: 10.1002/jhm.70135

Michael Osnard MD, MS, MPH, Gregory W. Ruhnke MD, MS, MPH

引用次数: 0

Addressing gender disparities in academic hospital medicine: The role of micro-recognitions 解决学术医院医学中的性别差异：微识别的作用。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-13 DOI: 10.1002/jhm.70131

Kristina M. Krohn MD, Beth K. Thielen MD, PhD, Jessica Hane MD, Caitlin Bakker MLIS, AHIP, Katelyn M. Tessier MS, Sophia Gladding PhD, Elizabeth A. Rogers MD, Michael B. Pitt MD, Taj Mustapha MD

引用次数: 0

Hospitalist time and motion studies: Moving from descriptive to predictive 住院医生的时间和运动研究：从描述性到预测性。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-09 DOI: 10.1002/jhm.70125

Justin Porter MD, MPP

引用次数: 0

Addressing unsafe or disruptive inpatient behavior and workplace violence: Administrative discharge as a last resort 解决不安全或破坏性住院行为和工作场所暴力：行政出院作为最后手段。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-09 DOI: 10.1002/jhm.70128

Kellie Littlefield DO, FACP, Stephanie Gilliam RN, MN, NE-BC, Stacey Waitt MN, RN, CMSRN, Michael Hendricks MD

Healthcare workers face a disproportionately high risk of workplace violence compared to other industries, and disruptive patient behavior causes significant distress for care teams. To address this, we developed a structured, multidisciplinary response to unsafe inpatient behavior, that allows care teams to focus on patient care and maintain therapeutic relationships, while nonclinical administrators enforce hospital rules. In the event of recurrent violence, our framework also provides guidance for administrative discharge—the discharge of an adult inpatient from the hospital before medical readiness—which is available as a last resort to maintain a safe working and healing environment.

与其他行业相比，医疗工作者面临的工作场所暴力风险高得不成比例，患者的破坏性行为给护理团队带来了巨大的痛苦。为了解决这个问题，我们开发了一种结构化的、多学科的对不安全住院行为的反应，使护理团队能够专注于患者护理和维持治疗关系，而非临床管理人员则执行医院规则。在暴力反复发生的情况下，我们的框架还为行政出院提供指导，即在医疗准备好之前将成年住院患者从医院出院，这是维持安全的工作和治疗环境的最后手段。

引用次数: 0

Editorial for manuscript “Defusing disruption: A rapid qualitative analysis examining hospitalist experiences navigating behavioral escalation events” 编辑稿件“消除干扰：快速定性分析检查医院经验导航行为升级事件”。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-08 DOI: 10.1002/jhm.70130

Lisa J. Rosenthal MD, Rachel Cyrus MD, Leigh Berman MD

引用次数: 0

Herpes zoster ophthalmicus with dependent contralateral edema 伴对侧依赖性水肿的眼带状疱疹。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-08 DOI: 10.1002/jhm.70124

Tyler B. Larsen MD, FACP

A 72-year-old man with multiple myeloma presented with an acute, progressive, exquisitely painful vesicular rash on his left face (Figure 1). Intravenous acyclovir was started to treat herpes zoster ophthalmicus. The following day, new periorbital edema was noted around his right eye (Figure 2). No other vesicles or rash were observed to suggest disseminated herpes zoster. After serial ophthalmologic evaluations, the right-sided periorbital edema was determined to be dependent edema from the patient positioning himself exclusively on his right side due to the allodynia he felt on the left side of his face. The edema resolved spontaneously by changing sleeping position (Figure 3).

Herpes zoster ophthalmicus (HZO) results from reactivation of the varicella zoster virus in the ophthalmic (V1) branch of cranial nerve V. As cranial nerve V innervates the cornea, HZO can lead to sight-threatening keratitis, uveitis, or retinal necrosis. Vesicular lesions on the tip or side of the nose, known as “Hutchinson's sign,” indicate nasociliary branch involvement and predict a higher risk of ocular complications.¹ HZO constitutes an ophthalmologic emergency that requires close evaluation by ophthalmology. Although the vesicular lesions of herpes zoster remain confined to a dermatomal distribution, the inflammation-associated edema can freely cross fascial planes. Acute periorbital edema in the contralateral eye should raise concern for disseminated disease, preseptal cellulitis due to bacterial superinfection, or acute angioedema. These diagnoses were considered however the clinical picture combined with the rapid onset and resolution in this case supported a benign, positional cause.

The author declares no conflicts of interest.

The images featured in this manuscript were obtained and published with written informed consent of the patient.

72岁男性多发性骨髓瘤患者表现为左面部出现急性进行性、极度疼痛的水疱疹（图1）。开始静脉注射阿昔洛韦治疗眼带状疱疹。第二天，右眼周围出现新的眶周水肿（图2）。未见其他囊泡或皮疹提示播散性带状疱疹。经过一系列的眼科检查，右侧眶周水肿被确定为依赖性水肿，这是由于患者在左侧面部感到异常性疼痛而仅靠右侧定位所致。通过改变睡姿，水肿自然消退（图3）。眼带状疱疹（HZO）是由颅V神经眼部（V1）分支水痘带状疱疹病毒的再激活引起的。颅V神经支配角膜，HZO可导致威胁视力的角膜炎、葡萄膜炎或视网膜坏死。鼻尖或鼻侧的水泡性病变，称为“哈钦森征”，表明鼻纤毛支受累，并预示眼部并发症的高风险HZO构成眼科急症，需要眼科密切评估。尽管带状疱疹的水疱性病变仍然局限于皮皮分布，但炎症相关的水肿可以自由地穿过筋膜平面。对侧眼的急性眶周水肿应引起对弥散性疾病、由细菌重复感染引起的隔膜前蜂窝织炎或急性血管性水肿的关注。这些诊断被认为是然而临床图片结合快速发作和解决在这个病例支持良性的，位置的原因。作者声明无利益冲突。本手稿中的图像是在患者书面知情同意的情况下获得和发表的。

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引用次数: 0

A salty revelation 咸的启示。

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine

Pub Date : 2025-07-07 DOI: 10.1002/jhm.70122

James M. McCluskey III, MD, MPH, Whitney L. Bossert MD, Keri T. Holmes-Maybank MD, MSCR, SFHM, Andrew P. J. Olson MD, SFHM, FACP, FAAP

引用次数: 0

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