Wellik, Kay E.

Background Results of animal studies assessing efficacy of bone marrow stromal cell therapy for ischemic stroke remain inconsistent. Aims The aims are to assess efficacy of bone marrow stromal cell therapy for ischemic stroke in animal studies. Methods Randomized controlled animal trials assessing efficacy of bone marrow stromal cell therapy were eligible. Stroke therapy academic industry round table was used to assess methodologic quality of included studies. Primary outcomes were total infarction volume and modified Neurological Severity Score. Multiple prespecified sensitivity analyses and subgroup analyses were conducted. Random effects models were used for meta-analysis. Results Thirty-three randomized animal trials were included with a total of 796 animals. The median quality score was 6 (interquartile range, 5–7). Bone marrow stromal cell therapy decreased total infarction volume (standardized mean difference, 0.897; 95% confidence interval, 0.553–1.241; P < .001) at follow-up. Overall standardized mean difference between animals treated with bone marrow stromal cell and controls was 2.47 (95% confidence interval, 1.84–3.11; P < .001) for modified Neurological Severity Score; 1.27 (95% confidence interval, 0.72–1.82; P < .001) for adhesive removal test; and 2.13 (95% confidence interval, 0.65–3.61; P < .001) for rotarod test. Significant heterogeneity among studies was observed. Effect of all outcomes stayed significant in various sensitivity analyses and subgroup analyses, except in a few subgroup analyses with small sample size or with short time follow-up. No significant difference between groups was observed except for study location, in which significantly larger estimates were found in Asian countries. On the basis of this meta-analysis, larger sample sizes are warranted for future animal studies. Conclusions Bone marrow stromal cell therapy significantly decreased total infarction volume and increased neural functional recovery in randomized controlled animal models of ischemic stroke.

Despite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

Many reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed “geoenvironmental diabetology.” Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.

BACKGROUNDBurnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published.PURPOSEA systematic review of the literature on burnout in inpatient‐based and outpatient‐based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians.DATA SOURCESFive medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects.STUDY SELECTIONTwo investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians.DATA EXTRACTIONFifty‐four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty‐eight studies used the same burnout measure and therefore were amenable to statistical analysis.DATA SYNTHESISOutpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies.CONCLUSIONSThe existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed. Journal of Hospital Medicine 2013;8:653–664. © 2013 Society of Hospital Medicine

The use of 2-way audiovisual telemedicine technology for the delivery of acute stroke care is well established in the literature and is a growing practice. The use of such technology for neurologic consultation outside the cerebrovascular specialty has been reported to a variable extent across most disciplines within the field of neurology, including that of the neurohospitalist medicine. A systematic review of these reports is lacking. Hence, the main purpose of this study was to conduct a systematic review of the literature on teleneurologic consultation in hospital neurology. The databases Ovid MEDLINE, EMBASE, PsychINFO, CINAHL, and Cochrane were used as data sources and were searched with key words “teleneurology” and its numerous synonyms and cognates. These key words were cross-referenced with subspecialties of neurology. The studies were included for further review only if the title or the abstract indicated that the study made use of 2-way audiovisual communication to address a neurologic indication. This search yielded 6625 abstracts. By consensus between the 2 investigators, 688 publications met the criteria for inclusion and further review. Four of those citations directly pertained to the inpatient hospital neurologic consultation. Each of the 4 relevant articles was scored with a novel rubric scoring functionality, application, technology, and evaluation phase. A subspecialty category score was calculated by averaging those scores. The use of 2-way audiovisual technology for general neurologic consultation of hospital inpatients, beyond stroke-related care, is promising, but the evidence supporting its routine use is weak. Further studies on reliability, validity, safety, efficacy, and cost-effectiveness are encouraged.