Whether, when and how to implement contact precautions on the ward and in the ICU is a continual topic of debate, as Stacey Butterfield reports in our cover story. Research on these precautions is mixed, with a recent large study in JAMA suggesting that use of gowns and gloves can help ward off some bacteria but not others. Meanwhile, use of contact precautions can inadvertently cause health care workers to visit isolated patients less, which can have unintended negative consequences. There are no easy answers to what one should do at her own hospital, but our article will help you think through the issues in order to help implement a clear-minded policy.
Clearer evidence exists to support the creation of stroke units, especially at the large, resource-intensive academic centers in which these units are usually housed. However, a recent study suggested community hospitals also can improve survival and discharge rates by creating stroke units. Our article examines what a successful stroke unit at a community hospital looks like in terms of resources, staff time, and capabilities, as well as what hospitalists can do to set up a stroke unit in this setting and ensure its success.
Our clinical spotlight this month is on insulin. An increasing number of patients with insulin pumps are showing up at the hospital, according to a November 2013 article in the Journal of Hospital Medicine. As such, it's important for hospitalists to understand how best to use insulin pumps in the hospital setting; learn the main issues you need to consider. Also, our Test Yourself feature is all about insulin.
With warmer weather approaching and people looking to spend more time outdoors, Rocky Mountain spotted fever is a concern, particularly in southern states. Our Expert Analysis, written by ACP Hospitalist editorial board member Dawn Brezina, MD, FACP, of Duke University, offers a primer on the disease that will help you “spot” and treat the disease quickly. And speaking of impending changes, the ICD-10 transition is in October; our Perspectives piece explains why you should care and how to prepare.
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Editor-in-Chief, ACP Hospitalist