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This JAMA Clinical Guidelines Synopsis summarizes the 2023 American College of Gastroenterology guidelines on management of patients with acute lower gastrointestinal bleeding.
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OBJECTIVES: In the United States, falls are the leading cause of fatal and nonfatal injuries for geriatric patients. With a growing aging population, medical trainees must gain experience with geriatric assessments, including fall risk and prevention. To the authors' knowledge, no prior studies have explored who most often initiates fall discussions between Internal Medicine (IM) residents and geriatric (age 65 years and older) patients. Our objective was to determine who most often initiates fall discussions between IM residents and geriatric patients and the barriers to having these discussions. METHODS: This 2023 quantitative needs assessment used surveys distributed to ambulatory geriatric patients, IM residents, and attending physicians within an urban IM resident continuity clinic. We used the Stopping Elderly Accidents, Death & Injuries assessment from the Centers for Disease Control and Prevention to determine patient fall risk. RESULTS: Response rates were 46%, 51%, and 67% for patients, residents, and attendings, respectively. Of the 39 patients who were assessed, 51% were at risk of falling. Eighty-seven percent of patients have had a fall discussion with their residents, and 59% reported these were resident initiated; however, 75% of 28 residents reported initiating fall conversations rarely, and all 4 attendings said that they started these discussions most of the time while staffing patients with residents. Modifiable resident-identified barriers to discussing falls included forgetfulness and lack of knowledge regarding completing a fall risk assessment. CONCLUSIONS: Most patients have conversations about falling with their physicians, but discrepancies exist regarding who initiates them. Data from this study suggest that attendings may be instrumental in starting these conversations. Reminder systems and fall risk didactic curricula may increase resident-initiated fall discussions.
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Internato e Residência , Pacientes , Humanos , Estados Unidos , Idoso , Determinação de Necessidades de Cuidados de Saúde , Medição de Risco , Currículo , Comunicação , Avaliação GeriátricaAssuntos
COVID-19 , Humanos , COVID-19/terapia , Soroterapia para COVID-19 , SARS-CoV-2 , Imunização PassivaRESUMO
Heparin-induced Anaphylactoid reactions are rare systemic reactions to heparin exposure. Although the exact pathogenesis of the reaction is unclear, in vivo platelet activation from inflammation may play a role. The reaction involves anti-platelet factor 4, a common factor also noted to be involved in heparin-induced thrombocytopenia (HIT). Like HIT, prompt identification of the reaction, immediate discontinuation of heparin, and supportive care are the mainstays of treatment to avoid severe and potentially fatal outcomes. Previous cases have described heparin-induced anaphylactoid reactions in the setting of heparin-induced thrombocytopenia. However, we will present a case of an isolated heparin-induced anaphylactoid reaction without HIT.
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Anafilaxia , Trombocitopenia , Humanos , Anticoagulantes/efeitos adversos , Anafilaxia/induzido quimicamente , Anafilaxia/complicações , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnósticoRESUMO
GUIDELINE TITLE: 2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association RELEASE DATE: May 2022 PRIOR VERSION: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association 2015 DEVELOPER: American Heart Association and American Stroke Association FUNDING SOURCE: None TARGET POPULATION: Adult Patients with Spontaneous Intracerebral Hemorrhage.
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Médicos Hospitalares , Acidente Vascular Cerebral , Adulto , Humanos , Estados Unidos , American Heart Association , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Pessoal de SaúdeRESUMO
Hypertriglyceridemia causing unexplained hypobicarbotinemia and elevated anion gap is rare. We report the case of a 33-year-old woman who presented with an unexplained high anion gap after a subacute gastrointestinal illness. An arterial blood gas showed a normal bicarbonate level, and a lipid panel resulted in a triglyceride level too high to read, establishing the diagnosis. Treatment included using triglyceride-lowering agents with normalization in the patient's serum bicarbonate levels.
