The Pulse - April 2026

Keep your finger on it

Author

Jonathan Kooiman
May 01, 2026

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The pulse is a monthly online newsletter summarizing key literature curated for the hospitalist/inpatient provider. Given the brevity, this is not meant to supplant reading primary literature independently.

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  1. Minds Over Ammonia: Rethinking Hepatic Encephalopathy

    The 2026 ACG Clinical Guideline on Hepatic Encephalopathy — the first major update since 2014 — consolidates 24 formal recommendations and 29 expert-opinion "key concepts" for managing one of cirrhosis's most burdensome complications, responsible for up to half of all 90-day readmissions. Diagnosis of covert/minimal HE requires neuropsychological testing (serum ammonia, despite its popularity, doesn't make the cut), and overt HE demands cognitive changes beyond a lone asterixis finding. First-line treatment remains lactulose ± rifaximin, with polyethylene glycol as an acceptable understudy, while patients not responding within 48–72 hours warrant a deeper look for hidden precipitants or misdiagnosis. Notably, the guideline muscles past pharmacology to emphasize nutrition (1.2–1.5 g protein/kg/day) and physical conditioning, recognizing that sarcopenia and frailty are bona fide risk factors. Bajaj JS et al. American J Gastroent 2026 March.

    Study Type: American Journal of Gastroenterology Clinical Guideline

    Link

  2. Shaving Minutes Off the Sisyphean EHR Boulder: AI Scribes

    A multicenter longitudinal study of 8,600 ambulatory clinicians found that AI scribe adopters saved approximately 2 minutes of EHR time per hour of clinical care — modest on its face, but a statistically meaningful dent in what amounts to nearly 1:1 screen-to-patient time for primary care. Primary care clinicians fared best, reclaiming ~4 minutes per hour, while surgical and medical specialists saw roughly 1 minute of relief. Crucially, the benefit scaled with usage: clinicians applying scribes to >75% of notes saved four times as much time as light users, suggesting a meaningful learning curve at play. Beyond raw time savings, adopters reported greater patient-facing attention and improved EHR data review — qualitative gains that don't show up in the stopwatch but matter clinically. Rotenstein LS et al. JAMA 2026 April.

    Study Type: Multisite, longitudinal cohort study of AI scribe adoption conducted at 5 US academic health care institutions among ambulatory physicians

    Link

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