http://www.jhcme.com Johns Hopkins Consultative Medicine for Hospitalists Mon, 06 Feb 2012 15:51:58 GMT http://www.jhcme.com/betax/site/article.cfm?ID=41 Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This module, which focuses on the critically ill hospitalized patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss how to formulate preoperative and postoperative intensive care unit plans. In addition, a thorough review of the evidence for intraoperative glycemic control and a discussion of how to transition patients off of an insulin drip are provided. http://www.jhcme.com/betax/site/article.cfm?ID=41 http://www.jhcme.com/betax/site/article.cfm?ID=40 Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This module, which focuses on the noncritically ill patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss which medications are best for controlling blood glucose levels in the hospital. A thorough discussion of how to determine the appropriate insulin dose and develop an insulin regimen for hospitalized patients is provided, as well as strategies for developing a discharge plan for patients on insulin. http://www.jhcme.com/betax/site/article.cfm?ID=40 http://www.jhcme.com/betax/site/article.cfm?ID=39 Pain is probably the most common presenting or associated symptom in patients in the hospital, and they are often more concerned about being in pain than they are about the primary reason for admission. Pain is always a subjective experience that is the consequence of the filtering, modulating, and distorting of the afferent nerve activity (nociceptive input) through the affective (limbic system) and cognitive processes unique to each individual. The following educational module discusses why postoperative pain requires treatment, outlines methods for performing a proper assessment of pain, provides strategies for utilizing patient-controlled analgesia safely and effectively, and summarizes the use of opioid and non-opioid analgesics in the postoperative setting to help hospitalists improve patient quality of recovery and life. http://www.jhcme.com/betax/site/article.cfm?ID=39 http://www.jhcme.com/betax/site/article.cfm?ID=38 Hyponatremia is the most common electrolyte abnormality that occurs in hospitalized patients, and it is recognized as a serious in-hospital complication. It is a complex electrolyte disorder that results mainly from water imbalances and dysregulation of arginine vasopressin. Hyponatremia is associated with increased morbidity and mortality among the elderly and in patients with heart, liver, or neurologic diseases. The following educational module discusses the pathophysiology of hyponatremia, outlines methods for differentiating the cause, and provides examples of how to manage hyponatremia in a variety of situations commonly faced by hospitalists. http://www.jhcme.com/betax/site/article.cfm?ID=38 http://www.jhcme.com/betax/site/article.cfm?ID=37 Anemia is frequently seen in patients undergoing surgery, and patients with preoperative anemia are more likely to receive perioperative allogeneic blood transfusions than patients with normal hemoglobin levels. Allogeneic blood transfusions are associated with an increase in the rate of postoperative complications.<br/> <br/> Evaluation of anemia should be performed in the preoperative period and begins with taking a detailed history and physical examination. All efforts must be used to correct anemia or reduce blood loss during surgery to avoid allogeneic blood transfusion. In this module we will discuss many scenarios commonly faced in perioperative practice. http://www.jhcme.com/betax/site/article.cfm?ID=37 http://www.jhcme.com/betax/site/article.cfm?ID=36 Therapeutic advances in cancer therapy have led to an increase in the number of patients undergoing surgery as part of their cancer treatment. These patients present several unique challenges, including weighing risks against adverse effects of delaying time-sensitive treatment and taking the patient’s cancer and its treatment into account when determining postoperative management. The following module discusses these topics, with an emphasis on cardiovascular and pulmonary toxicities of radiation and chemotherapeutic agents as well as common hematologic problems encountered in patients with cancer. http://www.jhcme.com/betax/site/article.cfm?ID=36 http://www.jhcme.com/betax/site/article.cfm?ID=35 Hospitalists are uniquely positioned to ensure in-hospital vaccinations for diseases ranging from tetanus to influenza. The following module discusses appropriate tetanus, pertussis, pneumococcal, influenza, hepatitis, and post-splenectomy immunizations. Moreover, strategies for improving compliance with recommended protocols and indications and contraindications for various vaccines are reviewed. http://www.jhcme.com/betax/site/article.cfm?ID=35 http://www.jhcme.com/betax/site/article.cfm?ID=33 Atrial fibrillation (AF), a cardiac complication following non-cardiothoracic surgery, is more common and better characterized following cardiac surgery. Postoperative AF often prompts surgeons to consult hospitalists because it can be associated with serious surgical complications such as sepsis and venous thromboembolism. Although typically self-limited, AF can persist to discharge and can lead to an increased length of stay. Furthermore, conditions that are associated with AF contribute to increased mortality. The following module addresses the frequency and risk factors for AF, initial management and evaluation of postoperative AF, and the management of persistent postoperative AF that is still present at discharge. http://www.jhcme.com/betax/site/article.cfm?ID=33 http://www.jhcme.com/betax/site/article.cfm?ID=34 As the use of prednisone to treat various medical illnesses has expanded, so has the concern for hypothalamic-pituitary-adrenal (HPA) axis suppression and subsequent adrenal insufficiency (AI). Despite the fact that most clinicians clearly recognize the potential for AI, many find the sometimes subtle presentation challenging. Furthermore, clinicians often struggle with assessing the likelihood of perioperative AI risk and with preventing it. The following module will address the perioperative management of both patients with known AI and those at risk for HPA axis suppression. http://www.jhcme.com/betax/site/article.cfm?ID=34 http://www.jhcme.com/betax/site/article.cfm?ID=25 http://www.jhcme.com/betax/site/article.cfm?ID=25 http://www.jhcme.com/betax/site/article.cfm?ID=30 Current estimates indicate that 2 to 3 million Americans take warfarin for prevention of thromboembolism from venous thromboembolism, atrial fibrillation, or prosthetic heart valves. Invasive procedures are performed in as many as 250 000 patients taking warfarin on annual basis in the United States. Antiplatelet agents such as aspirin and clopidogrel are taken by many more patients for prevention of myocardial infarction and stroke. Consequently, management of antithrombotic agents in the perioperative period is a common and vexing challenge for physicians. Because not all patients are at the same risk of thromboembolism and not all procedures are associated with the same risk of bleeding, it is important for hospitalists to know how to weigh these risks in their patients. The purpose of this module is to review risk factors for thromboembolism and bleeding associated with different thromboembolic disorders and invasive procedures. http://www.jhcme.com/betax/site/article.cfm?ID=30 http://www.jhcme.com/betax/site/article.cfm?ID=24 http://www.jhcme.com/betax/site/article.cfm?ID=24 http://www.jhcme.com/betax/site/article.cfm?ID=23 http://www.jhcme.com/betax/site/article.cfm?ID=23 http://www.jhcme.com/betax/site/article.cfm?ID=22 http://www.jhcme.com/betax/site/article.cfm?ID=22 http://www.jhcme.com/betax/site/article.cfm?ID=21 http://www.jhcme.com/betax/site/article.cfm?ID=21 http://www.jhcme.com/betax/site/article.cfm?ID=20 http://www.jhcme.com/betax/site/article.cfm?ID=20 http://www.jhcme.com/betax/site/article.cfm?ID=19 http://www.jhcme.com/betax/site/article.cfm?ID=19 http://www.jhcme.com/betax/site/article.cfm?ID=17 Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, and those related to urinary or central venous catheters. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following module will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities. http://www.jhcme.com/betax/site/article.cfm?ID=17 http://www.jhcme.com/betax/site/article.cfm?ID=10 Perioperative cardiac complications are the most widely feared medical issues for the anesthesiologist, surgeon, and medical consultant as they approach a patient with the option of surgery. Yet, only recently have management strategies been addressed in high-quality studies. The following module explains the roles of medical and interventional treatments in lowering perioperative cardiac event rates. This module also discusses the typical presentation of coronary syndromes postoperatively and the management of antiplatelet and cardiac medications. http://www.jhcme.com/betax/site/article.cfm?ID=10