Hybrid Ambient Clinical Documentation and Physician Performance: Work Outside of Work, Documentation Delay, and Financial Productivity

Journal of General Internal Medicine · 2025-11-17 · 5 citations

MACRO SOLUTIONS TO A MICRO PROBLEM: DRUG-RESISTANT PNEUMOCOCCAL PNEUMONIA.

PubMed · 2025-01-01

threatened to render standard empiric antibiotic therapy ineffective. One of the biggest drivers of pneumococcal drug resistance is antibiotic overuse, among both adults and children. While the introduction of the pneumococcal conjugate vaccine in 2000 dramatically impacted the overall incidence of pneumococcal pneumonia in both children and adults, the levels of antibiotic resistance have remained significant. To reduce the overuse of antibiotics requires multidimensional interventions targeting patients, clinicians, and health systems. Studies have demonstrated improvement in this area, but the quality gap remains high. Future work will focus on organizational strategies and policies that optimize antibiotic use for patients with antibiotic responsive acute illnesses.

Agreement Between Telehealth and In-Person Evaluations of Patients with Acute Respiratory Infections

Telemedicine Journal and e-Health · 2025-11-10

How the absence of a physical examination in telehealth visits influences clinical decision-making in telehealth visits is not known. The aim of this study was to examine whether provision of patient self-collected vital signs influences telehealth management decisions for acute respiratory tract infections (ARIs). A consecutive sample of adult patients seeking care for ARIs completed a simulated telehealth visit either before or after their scheduled in-person evaluation. Patients were given instructions and devices to collect their vital signs before the telehealth visit. We compared the telehealth physician diagnostic and treatment recommendations with those made by the in-person treating physician. Forty-five patients completed the study. Compared to the in-person management decisions, telehealth evaluations yielded perfect agreement for when patients needed hospital admission. However, there was significant disagreement around the need for chest imaging and antibiotic treatment, with modest differences following the provision of patient self-collected vital signs.

Procalcitonin in the management of lower respiratory tract infection and sepsis

Journal of Antimicrobial Chemotherapy · 2025-08-09 · 1 citations

Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline

American Journal of Respiratory and Critical Care Medicine · 2025-07-18 · 54 citations

BACKGROUND: Understanding of the diagnosis and treatment of adults with community-acquired pneumonia (CAP) has evolved thanks to new evidence, experience, and emerging technologies. This document updates evidence-based clinical practice guidelines on four key questions for the diagnosis and management of adult patients with CAP. METHODS: A multidisciplinary panel integrated systematic reviews of comparative evidence with other relevant research and clinical experience, then applied Grading of Recommendations, Assessment, Development and Evaluation methodology to produce recommendations using the Evidence to Decision Framework. RESULTS: The panel formulated clinical recommendations that address questions related to CAP, including lung ultrasound for diagnosis, empiric antibacterial therapy if a test result for a respiratory virus is positive, antibiotic duration, and the use of systemic corticosteroids. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with CAP.

National Survey of Factors Associated with Physician Antibiotic Prescribing Preferences

Journal of General Internal Medicine · 2024-11-25 · 1 citations

Accuracy of Patient-Collected Vital Signs

Telemedicine Journal and e-Health · 2024-08-16 · 3 citations

Introduction: Telehealth has emerged as an important clinical setting for managing acute respiratory tract infections (ARIs), potentially reducing emergency department and urgent care overcrowding, and reducing nosocomial transmission. Many current algorithms for ARI management incorporate information on patient vital signs. However, the accuracy of vital signs collected by patients using readily available home devices and techniques has not been studied. Methods: A cross-sectional sample of patients seen for urgent conditions at a hospital emergency and urgent care center were given instructions and low-cost, readily available devices to collect their vital signs. A trained research coordinator collected a parallel set of vital signs using standard hospital equipment, serving as the gold standard. We analyzed the performance of patient-collected vital signs compared with vital signs collected by a trained research coordinator. Results: A total of 300 patients completed the study. Patient-collected vital signs were highly specific for traditional levels of abnormalities (HR >100 beats per min, RR >24 breaths per min, temperature >100.4 degrees Fahrenheit, oxygen saturation <94 percent); however, sensitivity was poor for elevated heart rate by pulse estimation (25%) and elevated respiratory rate (60%). Heart rate and oxygen saturation by pulse oximeter and oral temperature had higher sensitivity. Conclusions: Vital signs measured and provided by patients are not uniformly accurate, particularly when using manual techniques rather than automated devices. Telehealth algorithms that rely on these values could provide incorrect triage and management advice.

Implementation of wireless continuous vital sign monitoring after cesarean delivery in uganda

American Journal of Obstetrics and Gynecology · 2023-01-01

Time to Treat Severe Community-Acquired Pneumonia with Steroids?

New England Journal of Medicine · 2023-05-24 · 7 citations

Guidelines for the treatment of community-acquired pneumonia (CAP) focus primarily on the choice of antibiotic therapy. However, the 2019 guidelines of the American Thoracic Society and the Infectious Diseases Society of America for adult CAP was the first version to address the role of glucocorticoids as adjunct therapy. The guideline committee (which we cochaired) did not recommend the use of glucocorticoids for most patients with CAP,1 but it did endorse the use of glucocorticoids for adults with refractory septic shock that is resistant to fluid resuscitation and vasopressor support, consistent with the suggested use of these drugs in previously released . . .

Hospital medicine: It's gotten bigger, but can we make it better?

Journal of Hospital Medicine · 2022-10-07

The authors declare no conflict of interest.