Abstract:
BACKGROUND:Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain. OBJECTIVE:To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD. DESIGN:A retrospective, pre-/post-intervention cohort study was conducted to compare the management of patients admitted with COPD exacerbations before and after implementation of PCT guidance. The pre-intervention period was March 1, 2014, through October 31, 2014, and the post-intervention period was March 1, 2015, through October 31, 2015. PARTICIPANTS:All patients with hospital admissions during the pre- and post-intervention period with COPD exacerbations were included. Patients with concomitant pneumonia were excluded. INTERVENTION:Availability of PCT laboratory values in tandem with a PCT guidance algorithm and education. MAIN MEASURES:The primary outcome was duration of antibiotic therapy for COPD. Secondary objectives included duration of inpatient length of stay (LOS) and 30-day readmission rates. KEY RESULTS:There were a total of 166 and 139 patients in the pre- and post-intervention cohorts, respectively. There were no differences in mean age (66.2 vs. 65.9; P = 0.82) or use of home oxygenation (34% vs. 39%; P = 0.42) in the pre- and post-intervention groups, respectively. PCT guidance was associated with a reduced number of antibiotic days (5.3 vs. 3.0; p = 0.01) and inpatient LOS (4.1 days vs. 2.9 days; P = 0.01). Respiratory-related 30-day readmission rates were unaffected (10.8% vs. 9.4%; P = 0.25). CONCLUSIONS:Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Bremmer DN,DiSilvio BE,Hammer C,Beg M,Vishwanathan S,Speredelozzi D,Moffa MA,Hu K,Abdulmassih R,Makadia JT,Sandhu R,Naddour M,Chan-Tompkins NH,Trienski TL,Watson C,Obringer TJ,Kuzyck J,Walsh TLdoi
10.1007/s11606-018-4312-2subject
Has Abstractpub_date
2018-05-01 00:00:00pages
692-697issue
5eissn
0884-8734issn
1525-1497pii
10.1007/s11606-018-4312-2journal_volume
33pub_type
杂志文章abstract:BACKGROUND:The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy. OBJECTIVE:To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2905-y
更新日期:2015-01-01 00:00:00
abstract::Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient's physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. This is concerning, because more comprehensiv...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3300-z
更新日期:2015-08-01 00:00:00
abstract::The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a popu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598274
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyal...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-010-1418-6
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2005.0277.x
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:In an effort to prevent medical errors, it has been recommended that all healthcare organizations implement a standardized approach to communicating patient information during transitions of care between providers. Most research on these transitions has been conducted in the inpatient setting, with relativel...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-012-2206-2
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Obesity and its related co-morbidities place a huge burden on the health care system. Patients who know they are obese may better control their weight or seek medical attention. Self-recognition may be affected by race/ethnicity, but little is known about racial/ethnic differences in knowledge of obesity's h...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-010-1623-3
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:Overall suicide mortality rates are higher among American Indians than in the general population and are particularly high among Indians residing in the upper Midwest. The identification, during encounters with health care providers, of individuals at high risk of suicide is a potential intervention strategy....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599598
更新日期:1996-09-01 00:00:00
abstract:IMPORTANCE:Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence. OBJECTIVE:To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV. D...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-014-2832-y
更新日期:2014-08-01 00:00:00
abstract::To evaluate the performance of serum iron studies as a diagnostic test for iron-deficiency anemia in a county hospital, the authors identified retrospectively all general medicine patients who had had bone-marrow aspirates for the work-up of non-macrocytic anemias from 1978 through 1983. Re-reading a sample of aspirat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596144
更新日期:1987-05-01 00:00:00
abstract:BACKGROUND:Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resou...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06007-6
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective coh...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1512-9
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:To assess the relationship between gender, background, and brief training and physicians' detection of and treatment for woman abuse. DESIGN:Quasi-experimental and correlational designs, plus control for background factors. SETTING:Two residency training programs: general internal medicine and family practi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599714
更新日期:1993-11-01 00:00:00
abstract::Polypharmacy occurs when a medical regimen includes at least one unnecessary medication. Factors that contribute to this problem include: patient characteristics of increasing age, multiple medical problems, therapy expectations, and decisions to self-treat; physician factors such as excessive prescribing; and system ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02600099
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVE:To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters. DESIGN:Cross-sectional study. SETTING:General internal medicine outpatient clinic associated with an urban, academic...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.07238.x
更新日期:1999-07-01 00:00:00
abstract:BACKGROUND:Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE:To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN:Prospective cohort stu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2168-4
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVE:To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers. DESIGN:National survey. SETTING AND PARTICIPANTS:The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/BF02640362
更新日期:1995-10-01 00:00:00
abstract:BACKGROUND:Previous studies indicate that medical trainees frequently experience discrimination by patients. Little is known about effective strategies to teach trainees to respond to this discrimination. AIM:To create a workshop for first-year residents utilizing standardized patients to improve skills in responding ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04881-3
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. OBJECTIVE:To describe regional variation in outpatient visits for individual specialties and the association between spec...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3745-8
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Noninferiority trials are increasingly common, though they have less standardized designs and their interpretation is less familiar to clinicians than superiority trials. OBJECTIVE:To empirically evaluate a cohort of noninferiority trials to determine 1) their interpretation as recommended by CONSORT, 2) ch...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-017-4161-4
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention. DESIGN:Randomized, controlled, pilot study. SETTING:Department of Veterans Affairs HIV clinic and community-based HIV clinical...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1046/j.1525-1497.2000.00127.x
更新日期:2000-12-01 00:00:00
abstract:BACKGROUND:The Department of Veterans Affairs (VA) mandates disclosure of large-scale adverse events to patients, even if risk of harm is not clearly present. Concerns about past disclosures warranted further examination of the impact of this policy. OBJECTIVE:Through a collaborative partnership between VA leaders, po...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3034-3
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05947-3
更新日期:2020-09-01 00:00:00
abstract::The purpose of the study was to develop a comprehensive program evaluation instrument. Following pilot work with residents, a 69-item instrument consisting of statements with 5-point strongly agree to strongly disagree response options was distributed to 107 residents; 104 responded. Psychometric analyses revealed no ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.07139.x
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN:Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING:White (N = 3,205) an...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30143.x
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Patients with mental health conditions (MHCs) experience poor anticoagulation control when using warfarin, but we have limited knowledge of the association between specific mental illness and warfarin treatment outcomes. OBJECTIVE:To examine the relationship between the severity of MHCs and outcomes of anti...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2784-2
更新日期:2014-06-01 00:00:00
abstract::Sarcoidosis is a multisystem disease of unknown etiology. Renal manifestation is rare and usually caused by hypercalcemia and nephrocalcinosis. Moreover, renal disease can occur as granulomatous interstitial nephritis (GIN), which is a histological diagnosis. We describe a case of sarcoidosis first presenting with mul...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0603-3
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Domestic violence (DV) is prevalent across all racial and socioeconomic classes in the United States. Little is known about whether physicians differentially screen based on a patient's race or socioeconomic status (SES) or about resident physician screening attitudes and practices. OBJECTIVE:To assess the ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00494.x
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE:To describe a high-cost Medicare Advantage population and iden...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4759-1
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN:Prospective observational study. SETTING:Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS:Thirty-one medical r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599915
更新日期:1995-08-01 00:00:00