Abstract:
BACKGROUND:Warfarin reduces stroke in patients with atrial fibrillation. However, its narrow therapeutic index and need for chronic monitoring are barriers to its optimal utilization in many patients. The recent introduction of 3 novel oral anticoagulants (NOACs), as alternatives to warfarin, may change the eligibility and management of patients with nonvalvular atrial fibrillation (NVAF) who require systemic anticoagulation. PURPOSE:To summarize contemporary indications for anticoagulation in NVAF, and to help provide patient-centered clinical decision making for selecting warfarin or 1 of the NOACs (dabigatran, rivaroxaban, apixaban) based on randomized trials and mechanistic data for each drug. DATA SOURCES AND STUDY SELECTION:The primary clinical outcome trials of warfarin and the NOACs, pharmacologic studies, and briefing documents from the US Food and Drug Administration were reviewed. DATA EXTRACTION AND DATA SYNTHESIS:In randomized trials, NOACs were consistently noninferior to warfarin for reducing stroke or systemic embolism in patients with NVAF, with reductions in intracranial bleeding as well. However, NOACs have several important drug-drug interactions, exclusion criteria for specific patient subgroups (eg, severe renal disease), and each medication may have a different impact on other clinical outcomes such as myocardial infarction or gastrointestinal bleeding. Benefits of the new drugs are particularly pronounced when international normalized ratio levels on warfarin are labile. CONCLUSIONS:Warfarin continues to play an important role in the prevention of stroke or systemic embolism in NVAF. Among selected patients, the use of NOACs provides equal or superior benefit, without the need for chronic anticoagulation monitoring or ongoing dose titration.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Patel KK,Mehdirad AA,Lim MJ,Ferreira SW,Mikolajczak PC,Stolker JMdoi
10.1002/jhm.2201subject
Has Abstractpub_date
2014-06-01 00:00:00pages
400-6issue
6eissn
1553-5592issn
1553-5606journal_volume
9pub_type
杂志文章,评审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:: ...
journal_title:Journal of hospital medicine
pub_type: 评论,社论
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更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs. METHODS:We developed the ACUTE Center at D...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2012-04-01 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: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
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更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Nearly two-thirds of hospitals in the United States are served by hospitalist physicians. How hospitalist work patterns and job satisfaction vary across various practice models is unknown. METHODS:We administered the Hospitalist Worklife Survey to a randomized stratified sample of 3105 potential hospitalist...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2012-05-01 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...
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pub_type: 杂志文章
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更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Little is known about the state of research in academic hospital medicine (HM) despite the substantial growth of this specialty. METHODS:We used the Society of Hospital Medicine (SHM) membership database to identify research programs and their leadership. In addition, the members of the SHM Research Committ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.12788/jhm.3136
更新日期:2019-04-01 00:00:00
abstract::Acute decompensated heart failure (ADHF) is one of the most common conditions managed by hospitalists. Here we review the most recent evidence applicable to hospitalists for the diagnosis, risk stratification, and management of patients presenting with ADHF. By following a structured approach based on the patient's sy...
journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
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更新日期:2012-05-01 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:WHAT'S NEW:This is the first study of a pediatric hospitalist preoperative clinic. Pediatric hospitalists frequently make significant recommendations for patients with neuromuscular scoliosis prior to spinal surgery, especially those with medical complexity. Certain clinical criteria are statistically significantly ass...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2013-12-01 00:00:00
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journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2015-09-01 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
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更新日期:2013-09-01 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:Initiation of enteral feeding is an important part of the best practice model for critically ill patients. Although nasogastric feeding is appropriate for the majority of patients requiring short-term nutrition support, certain patients benefit greatly from postpyloric feeding. OBJECTIVE:To determine which ...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2122
更新日期:2014-01-01 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
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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::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::Outcomes for patients hospitalized on weekends are often worse for adults-the so-called "weekend effect." Less is known about the weekend effect for children. We examined 55,383 hospitalizations at a tertiary care children's hospital. We used logistic regression to examine the associations of weekend admission and wee...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
doi:10.1002/jhm.2426
更新日期:2015-11-01 00:00:00
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 wa...
journal_title:Journal of hospital medicine
pub_type: 社论
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更新日期:2012-03-01 00:00:00
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journal_title:Journal of hospital medicine
pub_type: 杂志文章,多中心研究
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journal_title:Journal of hospital medicine
pub_type: 杂志文章,评审
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更新日期:2012-04-01 00:00:00
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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
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journal_title:Journal of hospital medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1002/jhm.688
更新日期:2010-09-01 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
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journal_title:Journal of hospital medicine
pub_type: 杂志文章,meta分析
doi:10.1002/jhm.450
更新日期:2009-05-01 00:00:00
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journal_title:Journal of hospital medicine
pub_type: 杂志文章,随机对照试验
doi:10.1002/jhm.250
更新日期:2007-11-01 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::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
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更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Hospital-acquired (HA) venous thromboembolism (VTE) is a common source of morbidity/mortality. Prophylactic measures are underutilized. Available risk assessment models/protocols are not prospectively validated. OBJECTIVES:Improve VTE prophylaxis, reduce HA VTE, and prospectively validate a VTE risk-assessm...
journal_title:Journal of hospital medicine
pub_type: 杂志文章
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更新日期:2010-01-01 00:00:00