Abstract：
OBJECTIVE:To explore why it is permissible for surgeons to "unilaterally withhold" surgery, whereas it is not commonplace (in the United States) to unilaterally withhold cardiopulmonary resuscitation (CPR) for clinical situations with similar degrees of uncertainty and prognosis. DATA SOURCES:The medical literature was sampled using PubMed and Google search engines, employing a variety of search strategies to capture articles relating to medical/surgical decision-making, risk aversion, acute care surgery, and withholding life-saving therapies. These topics are used to highlight interprovider variability that affects all practitioners-not just surgeons-and to consider why we deem it permissible for surgeons to withhold surgery, whereas-in the United States, at least-it is not routinely permissible for clinicians to unilaterally withhold mechanical ventilation and CPR for cases with similar prognoses. CONCLUSIONS:While there are no published research studies that deal directly with this topic, knowledge, heuristics, experience, variable aversion to risk, and other features inherent in medical-surgical education likely impact decisions to offer or withhold potentially life-saving therapies of all kinds. Both surgeons and clinicians, who request surgical consultation for hospitalized patients, should consider these issues and politely pursue second opinions when there is any doubt whether forgoing surgery is in the patient's best interests. Similarly, while unilateral withholding of CPR is not commonly employed in some medical cultures, including the United States, beneficence can be facilitated through robust informed consent.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Manthous CA,Ivy Mdoi
10.1002/jhm.986subject
Has Abstractpub_date
2012-03-01 00:00:00pages
249-53issue
3eissn
1553-5592issn
1553-5606journal_volume
7pub_type
社论abstract：OBJECTIVE:Mortality in hospitalized human immunodeficiency virus (HIV)-infected patients is not well described. We sought to characterize in-hospital deaths among HIV-infected patients in the antiretroviral (ART) era and identify factors associated with mortality. METHODS:We reviewed the medical records of hospitalize...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2409
更新日期：2015-09-01 00:00:00
abstract：BACKGROUND:High-flow nasal cannula (HFNC) is increasingly used to treat children hospitalized with bronchiolitis; however, the best practices for feeding during HFNC and the impact of feeding on time to discharge and adverse events are unknown. The study objective was to assess whether feeding exposure during HFNC was ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3306
更新日期：2019-09-18 00:00:00
abstract：:1. We recommend that ultrasound guidance should be used for paracentesis to reduce the risk of serious complications, the most common being bleeding. 2. We recommend that ultrasound guidance should be used to avoid attempting paracentesis in patients with an insufficient volume of intraperitoneal free fluid to drain. ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3095
更新日期：2019-01-02 00:00:00
abstract：BACKGROUND:Approximately 83% of hospitalist groups around the country utilize advanced practice providers; however, the demand for hospitalists continues to exceed the supply, and this has led to increased utilization of advanced practice providers in hospital medicine. Advanced practice providers receive very limited ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3183
更新日期：2019-06-01 00:00:00
abstract：:Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addit...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2750
更新日期：2017-06-01 00:00:00
abstract：:The Centers for Medicare and Medicaid Services awarded Hospital Medicine a Medicare specialty code, "C6", in 2016. We examined the early uptake of C6 code using the 2017 Medicare Part B utilization data. We also compared the actual C6 specialty code usage against estimated rates of overall hospitalist billing using th...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3303
更新日期：2020-02-01 00:00:00
abstract：BACKGROUND:More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. OBJECTIVES:Develop a list of medications associated with geriatric syndromes and describe their...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2614
更新日期：2016-10-01 00:00:00
abstract：:Pain management is a core competency of hospital medicine, and effective acute pain management should be a goal for all hospital medicine providers. The prevalence of opioid use in the United States, both therapeutic and non-medical in origin, has dramatically increased over the past decade. Although nonopioid medicat...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.12788/jhm.2733
更新日期：2017-05-01 00:00:00
abstract：BACKGROUND:Hip fractures typically occur in frail elderly patients. Preoperative specialty consults, in addition to hospitalist comanagement, are often requested for preoperative risk assessment. OBJECTIVE:Determine if preoperative specialty consults meaningfully influence management and outcomes in hip fracture patie...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3264
更新日期：2020-01-01 00:00:00
abstract：BACKGROUND/OBJECTIVE:Pediatric patients hospitalized with bacterial infections often receive intravenous (IV) antibiotics. Early transition to enteral antibiotics can reduce hospital duration, cost, and complications. We aimed to identify opportunities to transition from IV to enteral antibiotics, describe variation of...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3538
更新日期：2021-02-01 00:00:00
abstract：BACKGROUND:Outpatient parenteral antimicrobial therapy (OPAT) is a safe way to administer intravenous (IV) antimicrobial therapy to patients with the potential to decrease hospital length of stay (LOS). Often, homeless patients with complex infections, who could otherwise be treated as an outpatient, remain in the hosp...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.2597
更新日期：2016-08-01 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:The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.948
更新日期：2012-02-01 00:00:00
abstract：BACKGROUND:Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I. OBJECTIVE:To evaluate the factors and 30-day mortality risks associated with the postoperative nonresumption of an ACE-...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2182
更新日期：2014-05-01 00:00:00
abstract：BACKGROUND:Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR). METHO...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2068
更新日期：2013-09-01 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：:One emerging policy solution for deterring low-value care is to financially penalize physicians who prescribe it. However, physicians' willingness to support such policies may depend on whether they perceive that benefits accrue to patients or to insurers and hospitals. We surveyed physicians practicing hospital medic...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2878
更新日期：2018-01-01 00:00:00
abstract：BACKGROUND:Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE:To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay. DESIGN:Retrospective obser...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2592
更新日期：2016-10-01 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:The Centers for Disease Control and Prevention recommends routinely offering HIV testing to inpatients at hospitals with an HIV seroprevalence rate of greater than 1% or an AIDS diagnosis rate of greater than 1.0 per 1000 discharges. This recommendation has not been widely adopted, perhaps because of one of ...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,评审
doi：10.1002/jhm.66
更新日期：2006-03-01 00:00:00
abstract：BACKGROUND:Unplanned (unexpected) transfers to the intensive care unit (ICU) are typically preceded by physiologic instability. However, trends toward instability may be subtle and not accurately reflected by changes in vital signs. The shock index (SI) (heart rate/systolic blood pressure as an indicator of left ventri...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.779
更新日期：2010-10-01 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：IMPORTANCE:There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences wit...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2297
更新日期：2015-03-01 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:Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in childhood. Few studies have addressed the association of antimicrobial treatment and outcomes. OBJECTIVE:To determine whether macrolide therapy is associated with improved outcomes among children hospitalized with M. pneumoniae pneum...
journal_title：Journal of hospital medicine
pub_type： 杂志文章,多中心研究
doi：10.1002/jhm.1904
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs. OBJECTIVE:To sequentially examine...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2303
更新日期：2015-03-01 00:00:00
abstract：BACKGROUND:Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow. DESIGN:We performed a tim...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.613
更新日期：2010-07-01 00:00:00
abstract：IMPORTANCE:Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. OBJECTIVE:To characterize inpatient adaptations to care for non-ICU COVID-19 patients. DES...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.3476
更新日期：2020-08-01 00:00:00
abstract：BACKGROUND:Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE:To understand impact of radiologic incidental findings on resource utilization in patients hospitaliz...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.12788/jhm.2722
更新日期：2017-05-01 00:00:00
abstract：BACKGROUND:Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems. OBJECTIVE:To examine whether length...
journal_title：Journal of hospital medicine
pub_type： 杂志文章
doi：10.1002/jhm.2535
更新日期：2016-06-01 00:00:00
