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CDC issues ebola advisory

September 2014

Published in the September 2014 issue of Today’s Hospitalist

CDC issues ebola advisory

AS TWO U.S. HEALTH CARE WORKERS continued at press time to receive treatment in Atlanta for ebola contracted in Liberia, the CDC last month issued an advisory for physicians, hospitals and health departments.

That advisory said that doctors should suspect the virus in patients who have traveled to West Africa “the current outbreak is in Guinea, Liberia, Sierra Leone and Nigeria “and who present with a sudden onset of fever, abdominal or muscle pain, headache, vomiting, diarrhea, or unexplained hemorrhage. Ebola is transmitted through direct contact with bodily fluids, and the advisory states that the mortality rate in the West Africa outbreak is 60%.

The guidance also includes recommendations for patient isolation, provider protection and environmental protection control. If testing is indicated, the CDC recommends that health care workers contact state or local health departments as well as the CDC to determine how those samples should be shipped.

The CDC also issued a FAQ sheet on ZMapp, an experimental ebola treatment that hasn’t yet been tested in humans but was given to both infected Americans.

Hypoglycemia admissions on the rise

AN ANALYSIS of 12 years of data on admissions related to both hyper- and hypoglycemia among Medicare patients with diabetes revealed some good news: The number of admissions for hyperglycemia among patients age 65 and older fell almost 40% (38.6%) between 1999 and 2011.

However, the study, which was published in JAMA Internal Medicine in July, found that the number of admissions over that same time period for hypoglycemia rose 11.7% “and that admissions for hypoglycemia now outstrip those for hyperglycemia.

While admissions related to hypoglycemia fell modestly after 2007, hypoglycemia rates remained two-fold higher for older patients (75 and older) than for those between 65 and 74. Researchers also found that the rate of admissions for both hyper- and hypoglycemia was four-fold higher for blacks than for whites.

The trends uncovered in admissions for patients with diabetes, authors wrote, provide “a strong argument for incorporating hypoglycemia into future assessments of DM quality measures.” The database the authors used to assess admission trends included nearly 40 million Medicare beneficiaries.

Should patients taking dabigatran be monitored?

AN INVESTIGATIVE REPORT published this July in BMJ claims that dabigatran’s manufacturer didn’t disclose data about the benefits of monitoring blood levels and adjusting doses for patients taking the drug.

The report states that the company “Boehringer Ingelheim “withheld analyses on how many major bleeds could be prevented with dose adjustment. The withheld data, which were not given to the FDA when the drug was up for approval, have since come to light during U.S. litigation and through freedom of information requests.

An accompanying analysis accompanying analysis called on dabigatran’s manufacturer and the FDA to improve the safety of the drug by establishing a therapeutic range and recommending dose adjustments. The analysis also urged the FDA to approve the Hemoclot plasma level test, which can monitor dabigatran blood levels, and to also approve the 110-mg dose of dabigatran that is available in Europe but not in the U.S.

A press release issued by the drug’s manufacturer called the BMJ report and analysis “misleading.”

Do you need a better lounge?

HOSPITALS STRUGGLING with staff burnout and retention problems may want to consider a simple investment: making over staff lounges and break rooms.

According to an article published in July by Healthcare Design, hospitals are now designing break rooms to be more like business-class lounges in a bid to both improve staff productivity and boost recruitment prospects. Article sources noted that break rooms should offer a variety of seating options.

Those experts said that break rooms and lounges should also be conveniently located but separate from patient areas. One source suggested putting staff lounges at the end of hospital units so that family members don’t see staff relaxing instead of providing care.

Other amenities that some hospitals now provide staff include fitness rooms, rooftop gardens, outdoor eating areas, meditation rooms, bike racks and showers for those who bike to work, and lounges and break rooms with floor-to-ceiling windows. In addition to much plusher lounges, some hospitals offer staff concierge services like retail pharmacies and dry cleaning.