Abstract:
BACKGROUND:Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE:To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES:Medline, EMBASE, CINAHL, Scopus. STUDY SELECTION:Articles published between January 1960 and August 2009 involving superficial wound cultures and deeper comparison cultures. DATA EXTRACTION:Two reviewers independently searched for abstracted information pertaining to the microbiology of lower extremity wounds sufficient to calculate the sensitivity and specificity of superficial wound cultures versus comparison cultures. DATA SYNTHESIS:Data pooled using a random-effects meta-analysis model. RESULTS:Of 9032 unique citations, 8 studies met all inclusion criteria. Inter-rater reliability was substantial (Kappa = 0.78). Pooled test sensitivity for superficial wound swabs was 49% (95% confidence interval [CI], 37-61%], and specificity was 62% (95% CI, 51-74%). The pooled positive and negative likelihood ratios (LRs) were 1.1 (95% CI, 0.71-1.5) and 0.67 (95% CI, 0.52-0.82). The median number of isolates for surface cultures (2.7, interquartile range [IQR] 1.8-3.2) was not significantly different than that for comparison cultures, (2.2, IQR 1.7-2.9) (P = 0.75). CONCLUSION:Few studies show a strong relationship between superficial wound swabs and deep tissue cultures, and the current data demonstrate poor overall sensitivity and specificity. The positive and negative LRs were found to provide minimal utility in influencing pretest probabilities. Results of this analysis show that wound cultures should not be used in lieu of local antibiograms to guide initial antibiotic therapies.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Chakraborti C,Le C,Yanofsky Adoi
10.1002/jhm.688subject
Has Abstractpub_date
2010-09-01 00:00:00pages
415-20issue
7eissn
1553-5592issn
1553-5606journal_volume
5pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticu...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2296
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To develop a valid instrument to assess morale and explore the relationship between morale and intent to leave employment due to unhappiness. PATIENTS AND METHODS:An expert panel identified 46 drivers of hospitalist morale. In May 2009, responders of our single-site pilot survey rated each driver in terms of...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.2543
更新日期:2016-06-01 00:00:00
abstract::For more than 20 years, the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program has been identifying and synthesizing evidence to inform evidence-based healthcare. Recognizing that many healthcare settings continue to face challenges in disseminating and implementing evidence...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3157
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Approaches of trainees to diagnosis in teaching hospitals are poorly understood. Identifying cognitive and system-based barriers and facilitators to diagnosis may improve diagnosis in these settings. METHODS:We conducted a focused ethnography of trainees at 2 academic medical centers to understand the barri...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2966
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Interhospital transfer is an understudied area within transitions of care. The process by which hospitals accept and transfer patients is not well described. National trends and best practices are unclear. OBJECTIVE:To describe the demographics of large transfer centers, to identify common handoff practices...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2577
更新日期:2016-06-01 00:00:00
abstract::Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven a...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2483
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Meta-analyses of randomized trials have found that antibiotics are effective in acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but there is insufficient evidence to guide antibiotic selection. Current guidelines offer conflicting recommendations. OBJECTIVE:To compare the effectivenes...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究
doi:10.1002/jhm.628
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Dexmedetomidine is a potentially useful sedative for hospitalized children, but there is little published data regarding its safety, dosage, or efficacy. OBJECTIVE:To report our experience with dexmedetomidine for the sedation of hospitalized children. DESIGN:Retrospective case series. SETTING:Pediatric I...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.282
更新日期:2008-03-01 00:00:00
abstract::Patients who deteriorate outside the intensive care unit (ICU) are known to have elevated mortality and morbidity. Rapid response teams (RRTs) were developed to address such deterioration. It has not been possible to establish that RRTs employing manual detection methods have definitively improved hospital outcomes. B...
journal_title:Journal of hospital medicine
pub_type:
doi:10.1002/jhm.2653
更新日期:2016-11-01 00:00:00
abstract::For generations, American hospitals have been considered recession-proof, but there is reason to believe the current economic crisis is an exception. Hospitals have shown declining financial margins and decreased admissions. The severe recession has adversely affected many hospitals' finances, creating a risk of closu...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.654
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. DESIGN, SETTING, PATIENTS:Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED. METHODS:Evaluation of...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.1979
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Patients with low-risk chest pain are frequently readmitted for evaluation of recurrent chest pain. It is unknown whether stress testing during the first admission for chest pain is a cost-effective means of reducing readmissions. METHODS:Using a hospital administrative database, we conducted a retrospectiv...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2081
更新日期:2013-10-01 00:00:00
abstract::We examined whether placing a painting in the line of vision of a hospitalized patient improves patient outcomes and satisfaction and whether having patients choose their paintings offers greater benefit. From 2014 to 2016, we enrolled 186 inpatients with cancer diagnoses from Pennsylvania State University Cancer Inst...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,随机对照试验
doi:10.12788/jhm.2915
更新日期:2018-08-01 00:00:00
abstract::Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. We conducted a comprehensive search of 7 databases, including MEDLINE, Embase, a...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.2313
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND: OBJECTIVE: DESIGN, SETTING, PATIENTS: INTERVENTION: MEASUREMENTS: CONCLUSIONS: ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3102
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Specialty hospitals are a subset of acute-care hospitals that provide a narrower set of services than general medical hospitals (GMHs), predominantly in areas such as cardiac disease and surgery. Although specialty hospitals also advertise high patient satisfaction, this has not been examined using national ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2225
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:The National Acute Medicine Programme (NAMP) was established to address the unsatisfactory management of acutely ill medical patients in Ireland. It aimed to improve quality of care and patient safety, streamline access to healthcare, and reduce cost through efficiency gains. METHOD:A model of care was deve...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2443
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Best practice alerts (BPAs) provide clinical decision support (CDS) at the point of care to reduce unnecessary blood product transfusions, yet substantial transfusions continue outside of recommended guidelines. OBJECTIVE:To understand why providers order blood transfusions outside of recommended guidelines...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2236
更新日期:2015-01-01 00:00:00
abstract::Interstitial lung disease (ILD) is a diverse group of disorders typically with insidious onset. Diagnosis and management largely occur in the outpatient setting; however, ILD can present acutely necessitating hospitalization. Effective inpatient management requires the clinician to establish an accurate diagnosis and ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.12788/jhm.2774
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Obese patients are thought to be at higher risk of postoperative medical complications. We determined whether body mass index (BMI) is associated with postoperative in-hospital noncardiac complications following urgent hip fracture repair. METHODS:We conducted a population-based study of Olmsted County, Min...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.527
更新日期:2009-10-01 00:00:00
abstract::Non-housestaff medicine services are growing rapidly in academic medical centers (AMCs), partly driven by efforts to comply with resident duty hour restrictions. Hospitalists have emerged as a solution to providing these services given their commitment to delivering efficient and high-quality care and the field's rapi...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.311
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Patients with suspected thiamine deficiency should receive treatment with parenteral thiamine to achieve the high serum thiamine levels necessary to reverse the effects of deficiency and to circumvent problems with absorption common in the medically ill. OBJECTIVE:To quantify rates of parenteral administrat...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究
doi:10.1002/jhm.2324
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. OBJECTIVE:To ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3190
更新日期:2019-03-01 00:00:00
abstract::Hyponatremia is relatively common in patients admitted with pneumonia, and it is associated with higher disease severity. The precise mechanism is incompletely understood, but the syndrome of inappropriate antidiuretic hormone secretion is felt to play a significant role. Traditional options to manage hyponatremia in ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
doi:10.1002/jhm.1933
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Experts and national regulatory bodies have deemed femoral vein catheterization (FVC) unsafe, and recommend avoiding it whenever possible. OBJECTIVE:To assess rates of catheter-related bloodstream infections (CRBI) and deep venous thrombosis (DVT) complicating FVC. DESIGN:Prospective observational cohort s...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.696
更新日期:2011-01-01 00:00:00
abstract::Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during th...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2972
更新日期:2018-06-01 00:00:00
abstract::The growth of hospital medicine has led to new challenges, and recent graduates may feel unprepared to meet the expanding clinical duties expected of hospitalists. At our institution, we created a resident-inspired hospitalist curriculum to address the training needs for the next generation of hospitalists. Our progra...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2590
更新日期:2016-09-01 00:00:00
abstract::Efforts to improve the patient experience are increasingly focusing on engaging patients and their "care partners" by using patient portals. The Acute Care Patient Portal Task Force was supported by the Gordon and Betty Moore Foundation to convene a national meeting of an interdisciplinary group of stakeholders, inclu...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.2860
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Sepsis, the most expensive cause of hospitalization in the United States, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood. OBJECTIVE:To identify patient-level factors that contribute to postsepsis mortality and healthcare utili...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究
doi:10.1002/jhm.2197
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There i...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.979
更新日期:2012-04-01 00:00:00