Goal
Readers want to know timely, concise updates of literature relevant to hospital medicine. Additionally, they want the take-home message without reading the article and perhaps even your entire review. The goal of this column is to alert them to the important research that is being published that could affect their practice. It should be expected that practitioners would personally evaluate new diagnostic, management, or therapeutic options (and not depend solely on this column) before using them. Of course, as the reviewer, it’s your responsibility to review the paper for validity and to note any important limitations of the study. Think of these reviews as the bare minimum anyone should know, namely the bottom line. As such, our goal is to summarize in an easy-to-read format the most relevant articles, understanding that if the readers want or need to read more or follow up on a detail, they can pull the article themselves.
Guiding Principles
- Timely—should focus on recent articles
- Concise—featured articles should be less than 150 words per article
- Relevant—to hospital medicine; the hope is that by allowing the individual groups to select their articles, the compiled work in the ITLs will reflect the interests of HM groups around the country, rather than that of a small group of individuals
- Comprehensive—Attempt to include everything of significant importance to practicing hospitalists such that if they review the column monthly, they should feel comfortable that they are aware of the most significant articles in the literature. To accomplish this while keeping the amount of work and size of the column manageable we will include about 10 articles per month (but will leave it to your discretion based on the above guiding principles).
Overview
- We typically cover 8-10 “long takes” and 2-4 “short takes” (examples below).
- Your group will select these articles based on your group’s focus, interest, etc. Please ensure these topics have not been covered recently.
- As soon as you have selected your articles, email the list of articles to me, and I will enter them into the table referenced above.
- Please cut and paste the reference from the PubMed citation (use the “CITE” button from a PubMed reference, please use AMA style)
- Please send me the articles no earlier than six months before the due date, and make sure the article is no more than 12 months old at the time of submission (some exceptions are possible)
- Please include completed Copyright Transfer Agreements, Disclosure, bios, and headshots for each author.
- Please identify the individual author for each review, with name, medical credential, job title, and workplace information (including city and state).
- Make sure that topics haven’t been covered recently. Full issues of The Hospitalist are available here for review.
Article Format
- Author
- Title (summarize the findings of the study, one sentence)
- Clinical question (what does the study address)
- Background (what do we already know about this topic)
- Study design (few words)
- Setting (few words, include location)
- Synopsis (<175 words, include # and type of patients, intervention, outcomes, limitations, and relevance to what’s currently known regarding this problem)
- Bottom line (one sentence, what is the take-home message)
- Citation (AMA style, see general guidelines for reference)
- Author’s brief bio
If you have a preference, include author names in the order in which you would like them published.
Example “Long Take”
By Jane Smith, MD, SFHM
Preoperative Hematocrit Predicts Perioperative Mortality
Clinical question: Does preoperative hematocrit predict perioperative outcomes in patients undergoing non-cardiac surgery?
Background: Studies have outlined the risk of preoperative anemia prior to non-cardiac surgery in elderly patients but have not linked anemia to the risk of death unless cardiac disease is present. At the same time, little is known about the risks of polycythemia in the perioperative setting.
Study design: A retrospective cohort study
Setting: Veterans Affairs Hospitals
Synopsis: Using the NSQIP database of 310,311 veterans aged 65+ from 132 VA hospitals this study showed that there is an incremental relationship between both positive and negative deviation of hematocrit levels with 30-day postoperative mortality. Specifically, they found a 1.6% increase (95% CI, 1.1%-2.2%) in 30-day mortality for every % increase or decrease in hematocrit from the normal range.
Since observational, no causal relationship can be established from this data; Hospitalists involved in perioperative care should not necessarily plan interventions to treat abnormal levels of hematocrit without careful consideration of the risks and benefits.
Bottom line: Preoperative abnormalities in hematocrit predict 30-day mortality in patients undergoing non-cardiac surgery.
Citation: Wu WC, et. al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2007;297(22):2481-8.
Dr. Smith is a hospitalist in the department of hospital medicine at XYZ Hospital, in City, State, and an associate professor of medicine at ABC University in City, State.
Example “Short Take”
By Jane Smith, MD, SFHM
Abnormal preoperative hematocrit predicts mortality
Observational trial shows that every 1% positive or negative deviation of preoperative hematocrit from the norm results in a 1.6% increase in 30-day mortality in patients undergoing non-cardiac surgery.
Citation: Wu WC, et. al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2007;297(22):2481-8.
Rapid response teams remain unproven
The meta-analysis did not demonstrate a statistically significant benefit of rapid-response systems in rates of hospital mortality but did show a benefit in reducing in-hospital cardiac arrests.
Citation: Winters BD, Johnson DJ. Rapid response systems: a systematic review. Crit Care Med 2007; 35: 1238-1243.
Perioperative statins show promise
Meta-analysis of over 800,000 patients suggests considerable benefits from perioperative statin use yet the evidence from the randomized trials is not definitive.
Citation: Kapoor AS, et. al. Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ. 2006 Dec 2;333(7579):1149.
Dr. Smith is a hospitalist in the department of hospital medicine at XYZ Hospital, in City, State, and an associate professor of medicine at ABC University in City, State.