Letter from the Editor

Some of this issue's topics include the role of localized fungi in pneumonia, identification and treatment of acute gout, and fluid management in sepsis.

Fungal diseases may seem to be a concern only for hospitalists who live in areas where a given disease is concentrated, like coccidioidomycosis in the Southwest or blastomycosis in the Mississippi River Valley. Yet the rising prevalence of retirement travel, coupled with the greater longevity of those with weakened immune systems, means more people are being exposed to fungi that can make them ill. These diseases can appear as standard pneumonia and, unless a travel history is elicited, be treated inadequately—to disastrous results. Hospitalists need to keep the possibility of fungal diseases on their diagnostic radars, as well as know a few basic facts about treatment. Our cover story brings you up to date on the most common fungal diseases, including how to spot and treat them.

Gout is not always identified properly in the hospital setting, either, experts say. Once it is, however, the condition is fairly easy to treat successfully. Read our story for a primer on how to distinguish gout from its mimics, and what to do once you've honed in on the correct diagnosis. Gout is also the topic of our MKSAP quiz and our Student Hospitalist column.

One thing that can help with diagnosis is having access to a patient's outpatient medical records. Several health systems are exploring ways to provide patients with their own medical records, which they can then share with physicians at the bedside via portable computer, thus painting a more complete picture of medical history. Read more about the preliminary results and impressions of “open access” programs that might help improve care both inside and outside the hospital.

What do you think of allowing patients to access their medical records? We'd love to hear your thoughts on this or any other issue. Please write to us.

Jessica Berthold Editor
ACP Hospitalist