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Introduction: Medical residents, as part of their job to balance the demands of their work with caring for themselves so as to be mentally, emotionally, and physically sound to stay clinically competent. While regulatory and legislative attempts at limiting medical resident work hours have materialized but have yet to attain passage, there are fairly little data looking into how residents cope up with their demands and yet attend to their own personal health. Design: Anonymous mailed survey. Subjects: Three hundred and thirty-seven residents from all internal medicine residency programs within United States. Methods: We conducted a survey in the form of a questionnaire that was sent by e-mail to the program directors of various internal medicine residency programs within the United States, and responses were collected between May 19 and June 21, 2009. Response was well appreciated with total number of participants of 337 with even demographical distribution in gender, residency year, AMG/IMG, age group. Seventy-one percent of the residents felt that they would prefer getting admitted to their own hospital for any acute medical or surgical condition. Of the 216 residents who have had received health care in the past, almost half of them chose their own hospital because of the proximity, while 45% did not choose their own hospital despite proximity. Two out of three residents missed their doctors appointments or cancelled them due to demands of medical training. Only half of the residents have a primary care physician and almost 80% of them did not have their yearly health checkup. Close to 30% held back information regarding their social and sexual history from their provider because of privacy and confidentiality concerns. Eighty percent of residents never received information about barriers that physicians may face in obtaining care for their socially embarrassing conditions. Seventy percent felt that their performance then was suboptimal because of that health condition and also felt sick but did not drop the call. Half of the residents had concerns that they might be having a psychiatric illness, but only 5% of them received a formal evaluation at their own hospital and 23 (12.4%) at an outside hospital. Conclusions: It is very important to have more studies to emphasize on resident's physical and mental health and encourage them to have a primary care physician. There are several reasons preventing residents from getting a formal evaluation, confidentiality reasons, lack of time - schedule constraints, fear of being labeled, and social repercussions are few of them. Program directors should encourage the residents to not only care of the health of their patients but also be enthusiastic about their personal health issues for upgraded, revised patient care, and ultimately for their overall well-being. [ABSTRACT FROM AUTHOR]

The article discusses that hospitalists are frontline providers involved in newly diagnosed incidents of patients with end-stage renal disease (ESRD). It mentions about the risk of Covid-19 spread in health care facilities like outpatient dialysis units. It also mentions that uric acid is one of the potential drivers of kidney function decline.

Hospitalists and primary care physicians encounter renal disease daily. Although most cases of acute kidney injur)' (AKI) are secondary to dehydration and resolve by giving fluids, many cases of AKI are due to not uncommon but unfamiliar causes needing nephrology evaluation. Common indications to consult a nephrologist on an emergency basis include hyperkalemia or volume overload in end stage renal disease patients (ESRD). Other cause for urgent consultation are cresenteric glomerulonephritis/and rapidly progressive glomerulonephritis in which renal prognosis of the patient depends on timely intervention. The following are evidence-based pearls which could improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Guideline scope: A guideline developed by the American College of Physicians (ACP) Clinical Guidelines Committee with recommendations for managing adults with acute or recurrent gout. Guideline development methods: The guideline was based on a systematic review* of nonpharmacologic (e.g., lifestyle interventions, dietary supplements, or alternative treatments) and pharmacologic treatments for acute gout attacks, management of hyperuricemia to prevent attacks, and discontinuation of drug treatments for chronic gout in adults ≥ 18 years of age; searches were done from Jan 2010 to March 2016. Evidence was rated using the GRADE criteria. The guideline was reviewed by journal peer reviewers and ACP Regents and Governors. Recommendations: Recommendations are summarized in the Table. Due to insufficient evidence, no recommendations were made for dietary and lifestyle management of gout or criteria for discontinuing urate-lowering therapy in chronic gout. Conclusions: The American College of Physicians recommends corticosteroids, NSAIDs, or low-dose colchicine for patients with acute gout. It recommends against starting long-term urate-lowering therapy in most patients after a first gout attack or those with infrequent attacks and that clinicians discuss benefits, harms, costs, and individual preferences with patients before starting urate-lowering therapy. [ABSTRACT FROM AUTHOR]

Masks are widely discussed during the course of the ongoing COVID-19 pandemic. Most hospitals have implemented universal masking for their healthcare workers, and the Center for Disease Control currently advises even the general public to wear cloth masks when outdoors. The pertinent need for masks arises from plausible dissemination of the SARS-CoV-2 through close contacts, as well as the possibility of virus transmission from asymptomatic, pre-symptomatic, and mildly symptomatic individuals. Given current global shortages in personal protective equipment, the efficacy of various types of masks: N95 respirators, surgical masks, and cloth masks are researched. To accommodate limited supplies, techniques for extended use, reuse, and sterilization of masks are strategized. However, masks alone may not greatly slow down the COVID-19 pandemic unless they are coupled with adequate social distancing, diligent hand hygiene, and other proven preventive measures.

Objective: To develop and validate a clinical prediction scale for hospital-onset Clostridium difficile infection (CDI)., Methods: A community-based, 360-bed hospital located in the suburbs of a metropolitan area in the United States served as the setting for the present retrospective cohort study. The cohort consisted of patients admitted to the adult medical service over a six-year period from October 2005 to September 2011. The cohort was divided into derivation (October 2005 to September 2009) and validation (October 2009 to September 2011) groups. The primary outcome measure was hospital-onset CDIs identified as stool positive for C difficile after 48 h of hospital admission ordered for new-onset unformed stool by the treating physician., Results: In the derivation phase, 35,588 patients were admitted to the medical service and 21,541 stayed in hospital beyond 48 h. A total of 266 cases of CDI were identified, 121 of which were hospital onset. The developed clinical prediction scale included the onset of unformed stool (5 points), length of hospital stay beyond seven days (4 points), age >65 years (3 points), long-term care facility residence (2 points), high-risk antibiotic use (1 point) and hypoalbuminemia (1 point). The scale had an area under the receiver operating curve (AUC) of 0.93 (95% CI 0.82 to 0.94) in predicting hospital-onset CDI, with a sensitivity of 0.94 (95% CI 0.88 to 0.97) and a specificity of 0.80 (95% CI 0.79 to 0.80) at a cut-off score of 9 on the scale. During the validation phase, 16,477 patients were admitted, of whom 10,793 stayed beyond 48 h and 58 acquired CDI during hospitalization. The predictive performance of the score was maintained in the validation cohort (AUC 0.95 [95% CI 0.93 to 0.96]) and the goodness-to-fit model demonstrated good calibration., Conclusion: The authors developed and validated a simple clinical prediction scale for hospital-onset CDI. This score can be used for periodical evaluation of hospitalized patients for early initiation of contact precautions and empirical treatment once it is validated externally in a prospective manner.