Journal of hospital medicine最新文献

Background: Sleep is essential for recovery in hospitalized patients, yet frequent disruptions from medical care make rest difficult. Most prior efforts have focused on environmental modifications, often overlooking patients' role in advocating for their sleep.

Objectives: This study evaluated the effectiveness of the Inpatient Sleep Loss: Educating and Empowering Patients (I-SLEEP) intervention in improving sleep duration and reducing medical care disruptions among hospitalized patients.

Methods: In this single-center randomized controlled trial (NCT04151251), general medicine patients at the University of Chicago were randomized to either I-SLEEP (sleep education, advocacy questions, and a sleep kit) or standard care (sleep kit alone) between July 2019 and March 2023. The primary outcome was patient-reported sleep duration. Secondary outcomes included actigraphy-measured sleep duration and continuity (efficiency and wake after sleep onset), as well as patient-reported sleep disruptions. Mixed effects models adjusted for covariates were used for analysis.

Results: A total of 194 participants were enrolled. There were no significant differences in demographic characteristics between groups. Sleep duration and continuity did not differ significantly between groups. However, patients receiving I-SLEEP reported fewer disruptions from vital sign monitoring (63% vs. 75%, p = .004), medication administration (49% vs. 61%, p = .003), and laboratory draws (57% vs. 68%, p = .009). These findings remained significant after adjusting for covariates.

Conclusions: I-SLEEP did not increase sleep duration or continuity but reduced medical care disruptions. These findings suggest that patient education and empowerment may be effective strategies for reducing preventable care-related sleep disruptions in hospitals. Further research should examine implementation at scale and potential long-term benefits.

Disparities in risk and access to care can lead to a greater incidence of cancer, higher stage at diagnosis, and more frequent cancer-related deaths in communities with high poverty levels. Risk prediction tools that do not take into consideration social determinants of health may underestimate mortality in these populations. We sought to determine whether an association exists between poverty and the ability of the end-of-life index (EOLI) to predict 6-month mortality in hospitalized patients with cancer. Using a sample of 802 patients admitted to oncology in an urban hospital over a 6-month period, we categorized patients according to the percentage of families living at or below the federal poverty line in their zone improvement plan codes. We applied an EOLI score of ≥40 as an indicator of higher risk of 6-month mortality. We found that the EOLI score remained equally predictive of mortality across area poverty level groups. This finding suggests that the score can be used broadly as a screening tool to predict mortality risk in hospitalized patients with cancer.

Low salt diets are a common practice in the management of acute heart failure (HF), founded in classical pathophysiologic teaching related to neurohormonal alterations and associated sodium and fluid avidity in HF. However, trials comparing dietary salt restriction in patients hospitalized with acute HF showed no improvement in outcomes for those randomized to lower salt targets. Outpatient HF data also fails to show a reduction in HF admissions and mortality with salt restrictions. Routine use of dietary salt restrictions, especially those that are stringent, should be avoided to improve patient outcomes and experience.

The recent Acute Hospital Care at Home (AHCaH) initiative has increased Hospital-at-Home (HaH) access and utilization, but it is unknown how care delivery differs between AHCaH-compliant HaH programs and brick-and-mortar (BaM) inpatient care-specifically for common, costly hospital conditions like chronic obstructive pulmonary disease (COPD). In this retrospective cohort study, we compared management and outcomes for adults hospitalized with COPD treated in HaH and BaM settings in 2022. We analyzed EHR data from 297 adults who were eligible for HaH, including 119 who remained in BaM and 178 in HaH. HaH patients had higher likelihood of orders for supplemental oxygen (risk ratio [RR]: 1.04, 95% confidence interval [CI]: 1.01-1.09) and bronchodilators (RR: 1.12, 95% CI: 1.04-1.20), compared to BaM. HaH patients also had higher mean 30-day acute care-free days alive (mean ratio [MR]: 1.04, 1.01-1.08). Our findings suggest similar or improved guideline-directed therapy and outcomes for COPD patients treated in HaH.

Background: Sleep deprivation significantly impacts millions of hospitalized patients and is a critical factor in their recovery process. One major contributor to sleep disturbances is early morning blood draws.

Objective: This study investigated the effect of delaying early morning blood draws by 2 h on both sleep quality and quantity.

Methods: In this quasi-experimental study, we recruited adult medical patients admitted to two similar acute medical units. Patients in one unit were assigned to have their routing morning blood draws at the usual time of 4:00 a.m., while those in the other unit had their blood draws delayed until 6:00 a.m. Primary outcomes of sleep quality and quantity were evaluated using two primary measures: the Richards-Campbell Sleep Questionnaire (RCSQ) and self-reported sleep duration.

Results: A total of 128 patients were included (64 in the 4:00 a.m. group and 64 in the 6:00 a.m. group). The timing of blood draws was significantly associated with sleep quality, with a higher mean sleep quality score in the 6:00 a.m. group of 63.7 (standard deviation [SD] = 21.8) compared with a mean of 53.2 (SD = 22.1) (p = .006) in the 4:00 a.m. group. Additionally, the 6:00 a.m. group averaged 7.0 h of sleep (SD = 2.6), while the 4:00 a.m. group averaged 5.9 h (SD = 2.5) (p = 0.02).

Conclusions and relevance: This study found that among hospitalized adult patients, later morning blood draw times were associated with better sleep quality and longer sleep duration compared with earlier morning blood draw times.

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.