MedWorm: Hospitalists

Times have changed

Clinical Cases and Images — Thu, 18 Mar 2010 13:50:00 +0100

@ConanOBrien: http://twitpic.com/17lx53 - I no longer have health care. Could someone show this to a dermatologist and get back to me?@pyknosis: I'm a hematologist, not a dermatologist, but looking at that, I give you 7 months. Don't worry. That's a really long time.That's just good humor, as Happy Hospitalist likes to say. Posted at Clinical Cases and Images. Stay updated and subscribe, follow on Twitter and Buzz, and connect on Facebook. (Source: Clinical Cases and Images)

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The critical role of hospitalists in controlling healthcare costs

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Do hospitalists affect clinical outcomes and efficiency for patients with acute upper gastrointestinal hemorrhage (UGIH)?

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Care by hospitalists has been associated with improved/similar clinical outcomes and efficiency. However, less is known about their effect on conditions dependent upon specialists for procedures/treatment plans. Our objective was to compare care for upper gastrointestinal hemorrhage (UGIH) patients attended by academic hospitalists and nonhospitalists.The study included 450 UGIH patients admitted to general medical services of 6 teaching hospitals. Outcomes included in-hospital mortality and complications (ie, recurrent bleeding, intensive care unit [ICU] transfer, decompensation, transfusion, reendoscopy, 30-day readmission). Efficiency was measured by hospital costs and length of stay (LOS).Of 450 patients, 40% (177) were cared for by hospitalists with no differences between groups by en...

Hospitalist use of hand-carried ultrasound: Preparing for battle

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

Hand-carried ultrasound (HCU) is a burgeoning technology at a critical point in its development as a general diagnostic technique. Despite the known safety and accuracy of ultrasound in radiology and echocardiography, the use of HCU to augment physical diagnosis by all physicians has yet unrealized potential. In order to incorporate ultrasound into a diagnostic model of routine bedside application, simple imaging and training protocols must first be derived and validated. Simplified cardiac ultrasound exams have already been validated to detect evidence-based targets such as subclinical atherosclerosis, heart failure, and elevated central venous pressures. However, for general examination of the acutely ill patient, it is the internist-hospitalist who should derive a full-body ultrasound e...

"On the other hand [hellip]": The evidence does not support the use of hand-carried ultrasound by hospitalists

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

In the right hands, ultrasound is a safe and helpful diagnostic imaging tool. However, evidence supporting the use of hand-carried ultrasound (HCU) by hospitalist physicians has not kept pace with expanding application of these devices. In spite of its strategic point-of-care benefit, use of this technology by hospitalists may not ultimately translate into improved efficiency and better clinical outcomes. Optimal levels of training in image acquisition and interpretation remain to be established. Novelty, availability, and the results of a few small studies lacking patient-centered outcomes remain insufficient grounds to justify the expanded clinical utilization of these medical imaging devices by nonspecialists. Journal of Hospital Medicine 2010;5:168-171. © 2010 Society of Hospital Medi...

The ethics of the hospitalist model

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

The hospitalist model was founded on the premise that it could improve the quality and reduce the cost of hospital care. Many randomized studies have all but definitively proven this original assertion. Nevertheless, the hospitalist specialty raises lingering classical ethical issues: protecting the patient-physician relationship in an environment of increasing specialization and discontinuity of care, preserving patient autonomy and choice when structural changes are made in the provision of care, and ensuring that a model founded on efficiency and cost-effectiveness does not erode the public trust in hospitalists to always serve their patients' best interests. This work aims to serve as an update of these initial criticisms, showing how some questions have been answered, while some have ...

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Hospitalist physician leadership skills: Perspectives from participants of a leadership conference

Journal of Hospital Medicine — Tue, 16 Mar 2010 00:00:00 +0100

To characterize how the use of behavioral contracts may serve to focus individuals' intentions to grow as leaders.Between 2007 and 2008, participants of the Society of Hospital Medicine Leadership Academy courses completed behavioral contracts to identify 4 action plans they wanted to implement based on things learned at the Academy. Contracts were independently coded by 2 investigators and compared for agreement. Content analysis identified several major themes that relate to professional growth as leaders. Follow-up surveys assessed fulfillment of personal goals.The majority of respondents were male (84; 70.0%), and most were hospitalist leaders (76; 63.3%). Their median time practicing as hospitalists was 4 years, 14 (11.7%) were Assistant Professors, and 80 (66.7%) were in private prac...

Hospital Psychiatrists Dedicated Solely to Inpatient Care Can Reduce Violence

Medscape Today Headlines — Tue, 02 Mar 2010 14:55:53 +0100

Replacing multiple psychiatrist consultants with a single psychiatric hospitalist dedicated to inpatient care can reduce violence in psychiatric wards, new research suggests. Medscape Medical News (Source: Medscape Today Headlines)

Studies Examine Team Approaches To Hospital Care

Health News from Medical News Today — Mon, 01 Mar 2010 17:00:00 +0100

Multidisciplinary care teams consisting of clinicians, nurses and other health care professionals appear to be associated with a lower risk of death among patients in the intensive care unit, according to a report in the February 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A second report finds that an increasing number of surgical patients are being managed jointly by a surgeon and another clinician, such as a hospitalist or internal medicine sub-specialist... (Source: Health News from Medical News Today)

Hospitalists and costs

Journal of Hospital Medicine — Mon, 01 Mar 2010 00:00:00 +0100

No abstract. (Source: Journal of Hospital Medicine)

Rapid Response Systems Now Established at 2,900 Hospitals

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

In the years since rapid response teams made their debut in U.S. hospitals, the teams have become hugely popular, even as researchers have raised doubts about their ability to reduce mortality. (Source: Hospitalist News)

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Risk Management Plan for ESAs Begins This Month

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

The Food and Drug Administration is requiring a risk management plan for erythropoietin-stimulating agents that addresses the potential hazards and benefits associated with these anemia drugs, the agency has announced. (Source: Hospitalist News)

Delirium Tremens Treated With High Sedative Doses in ICU

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SAN DIEGO — Patients with delirium tremens accounted for 2% of all intensive care unit admissions at a busy New York inner-city hospital over the course of a year—and they often needed prodigious doses of benzodiazepines as well as second-line sedatives to manage signs and symptoms of alcohol withdrawal. (Source: Hospitalist News)

Vital Signs: Hospital Care Expenditures Topped $700 Billion in 2008

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

(Source: Hospitalist News)

Cost of Antibiotic Resistance Hits Private Payers

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

Major Finding: The cost of antimicrobial resistance is rising, but many patients now are younger and living longer, so the burden is shifting from Medicare to private insurance. (Source: Hospitalist News)

Lactate Clearance Measure Simplifies Severe Sepsis Therapy

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

A simpler method to monitor tissue oxygenation in severe sepsis led to short-term survival rates similar to those of the standard approach, and could ease initial management of critically ill patients, according to a report in JAMA. (Source: Hospitalist News)

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Risk Factors Identified for Postop Pneumonia

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SAN DIEGO — Postoperative pneumonia is an uncommon complication with daunting morbidity and mortality—and a fair number of previously unrecognized modifiable preoperative risk factors, according to a large national study. (Source: Hospitalist News)

Atrial Arrhythmia Strikes 13% After Lung Cancer Surgery

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

FORT LAUDERDALE, FLA. — Patients undergoing lung resection for non–small cell lung cancer had a 13% risk for developing a new atrial arrhythmia in a review of nearly 14,000 patients in a nationwide database involving 111 centers. (Source: Hospitalist News)

Prostacyclin Errors Rampant In PAH Patients

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SAN DIEGO — Serious errors in prostacyclin infusion therapy are extremely common even at large pulmonary arterial hypertension centers, according to a national survey. “These findings suggest that infusion therapy for pulmonary hypertension is problematic and that an opportunity exists to improve safety. The development of treatment standards of care and/or guidelines should be considered,” Martha S. Kingman, R.N., concluded at the annual meeting of the American College of Chest Physicians. (Source: Hospitalist News)

Delaying Surgery After PCI Cuts Kidney Injury

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

FORT LAUDERDALE, FLA. — Combining coronary artery catheterization and cardiac surgery in the same hospital admission was linked to a significantly increased risk for acute kidney injury, compared with performing the surgery during a second, later hospitalization, a single-center study of more than 600 patients showed. (Source: Hospitalist News)

Primary PCI in STEMI: Stick to Culprit Lesions

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SNOWMASS, COLO. — Primary percutaneous coronary intervention for patients with ST-elevation MI and multivessel disease is best limited to the culprit vessel in hemodynamically stable patients, according to the first large population-based study on this issue to include long-term outcomes. (Source: Hospitalist News)

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Time to Shut Down Low-Volume Heart Transplantation Centers?

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SNOWMASS, COLO. — Heart transplantation is one of the greatest operations ever devised—but the number of heart transplant centers in the United States needs to be cut by about two-thirds. (Source: Hospitalist News)

Good Leaders Build Good Teams

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

DR. BEERS is an assistant professor of pediatrics at Children's National Medical Center in Washington. Great leaders never work alone. Success occurs when a group of people work together as a high-functioning team toward a shared vision. But achieving this unity is usually much easier said than done. Many think of team building as something only for cheery consultants with an arsenal of group games and activities. This type of team building has its place, but the real work occurs in routine day-to-day interactions. (Source: Hospitalist News)

Rate of Invasive CA-MRSA Increasing in Children

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

BETHESDA, MD. — Invasive infections in children caused by community-acquired methicillin-resistant Staphylococcus aureus are on the rise. Though still far less common than simple skin and soft tissue CA-MRSA infections, increasing reports of serious infections such as osteomyelitis, bacteremia, and pneumonia have been raising concern in recent years. The increase appears to be related at least in part to the emergence of the “USA300” S. aureus clone containing the Panton-Valentine leukocidin (PVL) genes, Dr. Sheldon L. Kaplan said at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases. (Source: Hospitalist News)

Keep Tabs on CA-MRSA Infection by Obtaining Cultures

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

BETHESDA, MD. — Draining abscesses and obtaining cultures are now more important to the management of pediatric skin and soft tissue infections in the era of community-acquired methicillin-resistant Staphylococcus aureus infections. (Source: Hospitalist News)

Swallowing Evaluation Useful After Ventilation

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

PITTSBURGH — A simple bedside swallowing evaluation can be used to safely clear patients for oral food and drink after they have been on mechanical ventilation, and it can identify those who need additional evaluation, based on results of a prospective study of almost 300 trauma patients. (Source: Hospitalist News)

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Trauma Resuscitation Study to Test Hypothermia

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

CHANDLER, ARIZ. — The idea of using suspended animation in trauma care was unthinkable just 5 years ago, but surgeons now stand at the cusp of the first clinical trial in humans. (Source: Hospitalist News)

Analysis Shows That Trauma Center Care Is Cost Effective, Saves QALYs

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

PITTSBURGH — Treatment at trauma centers was associated with 70 additional life-years per 100 patients, compared with care at nontrauma centers in a large, multistate study. Although care at a trauma center was found to be more expensive than care at a nontrauma hospital, trauma center costs were well within widely accepted benchmarks used to judge cost-effectiveness, Ellen MacKenzie, Ph.D., said at the annual meeting of the American Association for the Surgery of Trauma. (Source: Hospitalist News)

CDC Will Track Adverse Events From Transfusions

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

Officials at the Centers for Disease Control and Prevention are asking U.S. hospitals to enroll in a new national surveillance system for monitoring adverse events in patients receiving blood transfusions. (Source: Hospitalist News)

Progesterone Shows Promise For Traumatic Brain Injury

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

SAN DIEGO — One of the reasons Dr. David W. Wright entered the field of traumatic brain injury research was that he grew weary of telling family members of patients with TBI that there was nothing he could do to improve their loved one's clinical outcome. (Source: Hospitalist News)

More Stroke Patients Get TPA on Weekends

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

Patients presenting to the hospital with acute ischemic stroke were more likely to receive tissue plasminogen activator on weekends than on weekdays, but mortality rates were similar regardless of admission day, according to a retrospective study. (Source: Hospitalist News)

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Intraventricular Hemorrhage May Best Predict Patient's Need for Neurocritical Care

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

BALTIMORE — Patients with intracranial bleeding who are in true need of neurosurgical or neurocritical interventions are most often those with intraventricular hemorrhage or a symptom duration of less than 3 hours, according to a retrospective study. (Source: Hospitalist News)

INR Rise Tied to Hemorrhage Risk After Ischemic Stroke Tx

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

BALTIMORE — A slightly elevated international normalized ratio in the hours following the administration of recombinant tissue plasminogen activator to patients with acute ischemic stroke could be associated with an increased risk of hemorrhagic conversion, the results of a small, retrospective study suggest. (Source: Hospitalist News)

FDA Tracking Excess Radiation Exposure From Brain Imaging

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

The Food and Drug Administration continues to investigate cases of excess radiation exposure during CT brain perfusion imaging, with more than 250 potential cases identified at several hospitals in California and Alabama, according to an agency teleconference. (Source: Hospitalist News)

Urine NGAL May Reveal Kidney Failure Etiology

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

BOSTON — Measuring urine neutrophil gelatinase–associated lipocalin upon hospital admission in patients with cirrhosis and renal failure can distinguish hepatorenal syndrome and acute kidney injury from other forms of kidney dysfunction and might help predict inpatient mortality, a study has shown. (Source: Hospitalist News)

Project Gives BOOST to Discharge Planning

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

NATIONAL HARBOR, MD. — The Society of Hospital Medicine wants to give hospitals a boost when it comes to discharge planning and preventing hospital readmissions. “The field of hospital medicine has been characterized by some as the worst thing to ever happen to continuity of care,” Dr. Winthrop F. Whitcomb, cofounder and past president of the SHM, said at the World Health Care Congress Leadership Summit on Hospital Readmissions. “We really want to be part of the solution, not just part of the problem.” (Source: Hospitalist News)

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Medicare Working to Prevent Beneficiary Readmissions

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

NATIONAL HARBOR, MD. — Medicare wants to save money and improve quality of care by reducing the number of patients readmitted to the hospital within 30 days after their initial stay, Dr. Michael Rapp said. (Source: Hospitalist News)

Giving Pediatric Patients the VIP Treatment

Hospitalist News — Mon, 01 Mar 2010 00:00:00 +0100

Dr. Steve Narang, a pediatric hospitalist in Baton Rouge, La., has a deceptively simple philosophy about delivering care to his patients: He wants them to get the best care available, even if that isn't the latest and supposedly greatest therapy. (Source: Hospitalist News)

Preface: Integrative Medicine in Primary Care

Primary Care: Clinics in Office Practice — Fri, 26 Feb 2010 15:19:25 +0100

In recent years, we have been hearing about—and directly experiencing—many trends that affect primary care. Primary care providers are in short supply. We do a great deal of uncompensated work. Some say we are the key to “fixing” the broken US health care system. We are encouraged to build medical homes, recruit more students into primary care, and adopt new technologies, such as electronic medical records. Meanwhile, primary care providers continue to confront the never-ending daily challenge of seeing as many patients as possible without compromising the quality of care we provide or the balance between our professional and personal lives. It is no surprise that we are said to be at high risk for burnout, with many of us transitioning to hospitalist medicine, intermediate care, o...

Beth Israel Deaconess HealthCare launch point-of-care charge capture

Healthcare IT News Press Releases — Wed, 24 Feb 2010 14:57:13 +0100

MedAptus, a provider of charge capture technologies, announced that Needham-based Beth Israel Deaconess HealthCare (BIDHC) has selected the company's Professional Intelligent Charge Capture technology for its hospitalist group. BIDHC, a network of primary care physicians, will roll-out the web-based version of MedAptus' Inpatient Edition for the timely and compliant capture of inpatient charges originating at three area hospitals. (Source: Healthcare IT News Press Releases)

Studies Examine Team Approaches To Hospital Care

Health News from Medical News Today — Tue, 23 Feb 2010 11:00:00 +0100

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Hospitalists help in Haiti

MD Consult: News: Top Stories — Tue, 16 Feb 2010 00:00:00 +0100

Read the full story on MD Consult: Hospitalists help in Haiti (Source: MD Consult: News: Top Stories)

Hospitalist Recruitment And Retention: Building A Hospital Medicine Program

Health News from Medical News Today — Sat, 13 Feb 2010 08:00:00 +0100

Recruitment and retention of physicians in all specialties is a national challenge, and it is expected to become even more difficult due to an impending physician shortage. As relative newcomers to the long line of medical specialists, hospitalists pose special challenges. What will convince a hospitalist to join one organization over another? What might prevent a hospitalist from considering a certain assignment? Now, recruiters can benefit from the experience of Kenneth G. Simone, the pioneer who founded the first successful hospitalist program in Maine... (Source: Health News from Medical News Today)

Hospitalist Recruitment And Retention: Building A Hospital Medicine Program

Nursing News From Medical News Today — Sat, 13 Feb 2010 08:00:00 +0100

New book shows how to build and sustain a successful hospital medicine program

EurekAlert! - Medicine and Health — Thu, 11 Feb 2010 05:00:00 +0100

(Wiley-Blackwell) Recruitment and retention of physicians in all specialties is a national challenge, and it is expected to become even more difficult due to an impending physician shortage. As relative newcomers to the long line of medical specialists, hospitalists pose special challenges. What will convince a hospitalist to join one organization over another? What might prevent a hospitalist from considering a certain assignment? (Source: EurekAlert! - Medicine and Health)

Heim Discusses Academy Goals, Priorities for 2010

Inside AAFP — Fri, 05 Feb 2010 21:05:00 +0100

The Academy will continue to fight for family physicians and their patients in 2010 because patients need better access to health care and primary care physicians deserve fair payment for their services. That's according to AAFP President Lori Heim, M.D., who currently serves as a hospitalist at Scotland Memorial Hospital in Laurinburg, N.C. Heim sat down recently with AAFP News Now to discuss what's coming down the health care pike this year. (Source: Inside AAFP)

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COMSEP: An Overview of Its History, Mission, and Relationship to Pediatrics

PEDIATRICS — Mon, 01 Feb 2010 16:03:19 +0100

The reader may wonder, "What is COMSEP, and how does an article from COMSEP affect me?" COMSEP, the Council on Medical Student Education in Pediatrics, is a community of pediatric clerkship directors and other educators whose mission is to improve the health of children and their families by advancing the art and science of medical student education in pediatrics.1 This is the first in what is envisioned to be a quarterly report from the COMSEP to the readership of Pediatrics. In writing these articles, we hope to accomplish 3 key objectives. First, we want to keep the readership updated on trends that could affect both practice and pediatric education, whether they involve the rise of the pediatric hospitalist service or use of electronic medical records. Second, we hope to share educatio...

Letters

Ob.Gyn. News — Mon, 01 Feb 2010 00:00:00 +0100

Congratulations on the success of your obstetrics hospitalist program, Dr. Pelletier (“OB Hospitalist Program Is a Go!” December 2009, p. 14). It should serve as a great model across the country. The flexibility that the private practice physicians have in allowing the hospitalists to take care of as much or as little of their patient care is very appealing. This is great for emergency department call and unattended patients, and it is great to know that there is a physician in house to take care of an emergency for a laboring patient until the attending ob.gyn. can be present. (Source: Ob.Gyn. News)

Primary care physicians and hospitalists: two branches of the same tree.

Pediatric Annals — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Seelbach EB, Ottolini MC PMID: 20166637 [PubMed - in process] (Source: Pediatric Annals)

Haitian Patients Receive Help From U.S. Hospitalists

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

When Dr. Lisa V. Luly-Rivera admitted the 14-year-old girl to the University of Miami's tent hospital at the airport in Port-au-Prince, the girl's leg was edematous and she had some hyperpigmentation. But between one day and the next, her leg became warm, and the warmth started moving up toward her thigh. The leg was clearly infected. (Source: Hospitalist News)

Infections Tied to STEMI Mortality And Length of Stay

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

ORLANDO — Infection following acute hospitalization for ST-segment elevation myocardial infarction was linked with prolonged hospitalization and significantly increased risk of death, in a review of more than 11,000 patients in Florida hospitals in 2006. (Source: Hospitalist News)

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Discharge Measures Don't Predict Readmission Rates

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

Hospitals that do well on publicly reported measures on discharge planning do not necessarily have fewer readmissions, according to analysis of Medicare data. Dr. Ashish K. Jha and his associates at the Harvard School of Public Health, Boston, studied the association between hospital performance on discharge planning measures and readmission rates for heart failure and pneumonia, the two most common reasons Medicare patients are readmitted. (Source: Hospitalist News)

Funds Will Support Infection Control

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

The Centers for Disease Control and Prevention will use about $40 million in funds from the American Recovery and Reinvestment Act of 2009 to help states develop programs for preventing hospital-acquired infections. (Source: Hospitalist News)

Vital Signs: Hospital Care Spending Growth Continues to Decelerate

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

(Source: Hospitalist News)

Slow Gait Flags Elderly With High Cardiac Surgery Risk

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

ORLANDO — Five-meter gait speed is a simple and effective test to identify a subset of elderly patients at threefold increased risk of in-hospital mortality and major morbidity after cardiac surgery, according to a multicenter prospective study. (Source: Hospitalist News)

ICU: The New Hospice

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

DR. LEVIN is an assistant professor in the Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, and the Weill Cornell Medical College, New York, where he conducts communication skill training and research that focuses on the ICU. (Source: Hospitalist News)

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Reexamining Readmissions

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

DR. LINDENAUER, director of the Center for Quality of Care Research at Baystate Medical Center, Springfield, Mass., is an associate professor of medicine at Tufts University School of Medicine, Boston. He reported no conflicts of interest. (Source: Hospitalist News)

Hearing Loss Seen in Meningitis Despite Therapy

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

Patient age and presenting status—not dexamethasone or glycerol treatment—have the greatest impact on whether a child with bacterial meningitis will develop hearing loss, even in cases due to Haemophilus influenzae type b, according to the largest clinical trial yet to tackle the question. (Source: Hospitalist News)

Older Red Blood Cells Pose Risks for Children

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

Major Finding: Transfusion of red blood cells stored 14 days or longer increases risk of multiple organ failure in critically ill children nearly twofold, compared with fresher RBCs. (Source: Hospitalist News)

Hospitalized Children With IBD Face Thrombosis Risk

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

NATIONAL HARBOR, MD. — Hospitalized children and adolescents with inflammatory bowel disease had more than twice the risk for thrombotic events, compared with other hospitalized youth, in a retrospective cohort study that utilized a nationwide inpatient database. (Source: Hospitalist News)

Panel: Care After Cardiac Arrest Needs Upgrade

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

An expert panel convened by the American Heart Association issued a call to action for the creation of U.S. regional systems of care for patients resuscitated from out-of-hospital cardiac arrest. (Source: Hospitalist News)

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Pneumocystis Detected in 16% of Clinicians

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN FRANCISCO — A year-long pilot study found Pneumocystis carinii DNA in initial oropharyngeal wash results of 10 of 104 health care workers, and 7 more converted from negative to positive tests on subsequent gargle tests. (Source: Hospitalist News)

Inappropriate Rx For Candidemia Can Be Costly

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — Inappropriate antifungal therapy for candidemia in the ICU is the rule rather than the exception—and it leads to prolonged hospital length of stay and higher costs. (Source: Hospitalist News)

Two Treatments Curbed Surgical Site Infections

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

Two unrelated preoperative treatments sharply reduced the number of surgical site infections in patients at facilities in the United States and the Netherlands, according to the results of two randomized trials. (Source: Hospitalist News)

Comorbidity, Obesity Linked to H1N1 Influenza Hospitalizations

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

More than half of the adults hospitalized in the early days of the 2009 influenza A (H1N1) pandemic in New York City were obese, and 92% of the obese patients had underlying medical conditions, according a recent review. (Source: Hospitalist News)

ED Blood Cultures May Not Help in Pneumonia

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — The cost-effectiveness of obtaining initial blood cultures in the emergency department in all pneumonia patients before giving the first dose of antibiotics has been called into question. (Source: Hospitalist News)

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Doripenem Eases Ventilator-Related Pneumonia

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — The use of doripenem as initial therapy in patients with ventilator-associated pneumonia shortened the duration of mechanical ventilation and hospital length of stay, according to a pooled analysis of the two randomized trials that compared the drug with imipenem or piperacillin/tazobactam. (Source: Hospitalist News)

In Respiratory Failure, RA May Boost Mortality

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — Much has been made of late of rheumatoid arthritis patients' substantially reduced life expectancy because of cardiovascular disease. Far less widely known is that they also have increased in-hospital mortality following acute respiratory failure. (Source: Hospitalist News)

Extended VTE Prophylaxis Helpful After Surgery

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — Two-thirds of patients placed on thromboprophylaxis after total hip or knee replacement surgery receive it for 2 weeks or less—and their venous thromboembolic event rate is markedly higher than in patients on prophylaxis for longer, according to a retrospective study of more than 3,000 patients. (Source: Hospitalist News)

Surgical Safety Training Program Can Foster Increased Vigilance

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

A training program modeled on airline industry initiatives can change behavior and cultivate a culture of safety in the operating room, based on data from a survey and follow-up study. (Source: Hospitalist News)

Inadequate VTE Prophylaxis Makes Costs Soar

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

SAN DIEGO — Partial venous thromboembolic event prophylaxis in at-risk medical and surgical inpatients is associated with a mean 2-day greater hospital length of stay and $22,000 more per patient in total hospital charges than for recipients of best-practice appropriate prophylaxis, according to a large national study. (Source: Hospitalist News)

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U.S. Hospitals Resume Care for Injured Haitians

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

Medical evacuations of patients critically injured in Haiti's devastating earthquake to hospitals in the United States resumed on Feb. 1, following a 5-day interruption. The exact cause of the interruption appears to be under dispute. According to published reports, some sources said the issue involved how hospitals would be reimbursed for caring for these patients. Other sources cited a lack of capacity at hospitals in Florida, where most of the patients had been sent. (Source: Hospitalist News)

Joint Commission Reports More Gains on Quality Measures

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

U.S. hospitals have improved the care they provide for patients with myocardial infarction, heart failure, and pneumonia, according to a report issued last month by the Joint Commission. (Source: Hospitalist News)

Exploring the Effects of Secondhand Smoke

Hospitalist News — Mon, 01 Feb 2010 00:00:00 +0100

For Dr. Karen Wilson, research holds the key to improving the care of hospitalized children. As an assistant professor of pediatric hospital medicine at the University of Rochester (N.Y.), Dr. Wilson has spent the last few years studying how secondhand smoke affects children, especially the high-risk children who end up hospitalized for respiratory illnesses. (Source: Hospitalist News)

Green Giant

Medscape Urology Headlines — Wed, 27 Jan 2010 21:32:08 +0100

The first rule of healthcare is to do no harm, so "going green" is a logical step for hospitals to take. What can a hospital do to reduce waste, save energy, and be more eco-friendly? The Hospitalist (Source: Medscape Urology Headlines)

Management of ischemic stroke: Part 2. The inpatient stay

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients both acutely and in secondary prevention. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally and emphasizes many elements of the inpatient stay and discharge process.After admission, the focus changes to avoidance of complications and the appropriate initiation of allied therapies and secondary prevention.Primary trials, current guidelines.The hospitalist is well-positioned to play a major role in the treatment of stroke patients as well as the systems work that aids in the management of this population. Journal of Hospital Med...

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A hospitalist postgraduate training program for physician assistants

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

Many hospitalist groups are hiring physician assistants (PAs) to augment their physician services. Finding PAs with hospitalist experience is difficult. Employers often have to recruit PAs from other specialties or hire new graduates who have limited hospital experience. Furthermore, entry-level PA training focuses on primary care, with more clinical rotations centered in the outpatient setting. In light of these challenges, our institution created a 12-month postgraduate training program in Hospital Medicine for 1 PA per year. It is the first reported postgraduate PA hospitalist fellowship to offer a certificate of completion. The program's curriculum is based on the Society of Hospital Medicine (SHM) "Core Competencies," and is comprised of 12 one-month rotations in different aspects of ...

Nonphysician providers in the hospitalist model: A prescription for change and a warning about unintended side effects

Journal of Hospital Medicine — Tue, 26 Jan 2010 00:00:00 +0100

(Source: Journal of Hospital Medicine)

Health News of the Day

Clinical Cases and Images — Fri, 22 Jan 2010 13:04:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day: Shaving 3 grams off the daily salt intake of Americans could prevent 66,000 strokes and 99,000 heart attacks http://bit.ly/7TTsPm "The Stanford Mini Med School: A Free Course Now Online" http://bit.ly/63CABZ and direct iTunes link: http://bit.ly/8IFfWO Dr Wes: Hospitalist services are increasingly finding themselves overwhelmed with admissions and are introducing "caps" http://bit.ly/5qC5bo Women devastated by their husbands' secret lives - CNN http://bit.ly/5a8biv - Drug-abusing surgeon caught selling infected body parts... 49.6% of Americans exercise regularly vs. 31.3% who don't exe...

All Grown Up

Medscape Today Headlines — Wed, 20 Jan 2010 12:04:38 +0100

Pediatric HM programs are growing around the country. What unique challenges does the pediatric hospitalist face? The Hospitalist (Source: Medscape Today Headlines)

Medical Mistakes, 10 Years Post-Op

Medscape Allergy Headlines — Fri, 15 Jan 2010 22:13:42 +0100

This article examines what still needs to be done to improve patient safety. The Hospitalist (Source: Medscape Allergy Headlines)

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Hospitalists Can Help Reduce ED Crowding

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

With emergency departments overflowing and inpatient units struggling to control their patient flow, more hospitals are creating observation and short-stay units and looking to hospitalists to play a leading role. (Source: Hospitalist News)

Dabigatran Cuts Bleeding Risk in VTE Prophylaxis: Rate 29% lower than with warfarin.

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

NEW ORLEANS — Dabigatran etexilate had comparable efficacy and significantly lower or comparable bleeding rates to warfarin in patients with acute venous thromboembolism, according to data from the RE-COVER trial. (Source: Hospitalist News)

Hospitalist News Updates Its Look: News at a Glance

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

HOSPITALIST NEWS is changing its look and content to meet your information needs. Over the last year, we listened as our readers and editorial advisers described how they want to read the news. (Source: Hospitalist News)

Hospitalist Vacancy Rate 11% In National Survey of CEOs

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

Hospitals have an 11% physician vacancy rate, and 95% of hospital chief executive officers believe that during the first 6 months of 2009, the shortage of hospitalists got worse or did not improve. (Source: Hospitalist News)

Vital Signs: Commonly Performed Procedures With the Greatest Increases in Inpatient Costs, 2004–2007

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

(Source: Hospitalist News)

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Hospitalists Face Challenges in 2010

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

DR. MICHOTA is the Director of Academic Affairs in the Department of Hospital Medicine at the Cleveland Clinic. As we look to the year ahead, hospital medicine is changing almost as much as it did when the movement first began. The specialty is launching a pathway to certification, we are rethinking our roles as we comanage complex patients, and new medicines could change the way we treat common diseases. But with all this progress, we are still struggling to make a difference in areas like patient safety. (Source: Hospitalist News)

Many Patients at Risk Never Receive VTE Prophylaxis

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

NEW ORLEANS — Nearly two-thirds of 9,675 medical patients at risk for venous thromboembolism received no inpatient pharmacologic prophylaxis and more than 98% received no outpatient prophylaxis, a retrospective analysis showed. (Source: Hospitalist News)

NSAIDs Ineffective for Postop Pericardial Effusion

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

ORLANDO — Diclofenac, widely prescribed to reduce pericardial effusion volume and prevent tamponade following cardiac surgery, proved ineffective in a double-blind randomized trial. (Source: Hospitalist News)

IV Drugs During Life Support Don't Improve Survival

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

Intravenous drugs given as part of advanced cardiac life support failed to improve long-term survival in the first randomized, controlled trial to test outcomes of this nearly universal procedure, according to a report published in JAMA. (Source: Hospitalist News)

Add Steroids to H1N1-Related ARDS Therapy

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

SAN DIEGO — Patients with suspected pandemic influenza A(H1N1)–associated acute respiratory distress syndrome responded favorably overall to an ICU treatment course of high-dose oseltamivir and prolonged low- to moderate-dose corticosteroids in a pilot study. (Source: Hospitalist News)

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Some Health Care Workers Still Not Immune to Myths About Flu Vaccine

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

Fears and misconceptions about influenza vaccination became apparent in a survey of health care workers conducted at a large tertiary children's hospital in the Midwestern United States. (Source: Hospitalist News)

Reduced Flu Mortality Linked to Statin Use

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

PHILADELPHIA — Patients taking a statin at the time they were hospitalized for an influenza infection were significantly less likely to die while in the hospital or immediately after, compared with their counterparts who were not on a statin, in an observational study of 2,800 patients. (Source: Hospitalist News)

Assay Could Speed Diagnosis of Bacterial Sepsis

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

A testing method that uses positive blood cultures and an automated DNA-based polymerase chain reaction and microarray system accurately identified bacteria in sepsis much faster than a standard culture-based process. (Source: Hospitalist News)

Ceftaroline Shows Promise In the Treatment of CAP

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

SAN FRANCISCO — Ceftaroline demonstrated a higher clinical cure rate, compared with ceftriaxone in patients hospitalized with community-acquired pneumonia, according to combined results from two phase III studies. (Source: Hospitalist News)

Nonsustained Hypotension May Be Red Flag in Sepsis Treatment

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

NEW ORLEANS — Nonsustained hypotension in emergency department patients with sepsis was associated with a threefold increased rate of in-hospital mortality in a large prospective study. (Source: Hospitalist News)

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Penicillin-Allergic Women Often Get Wrong Rx

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

MONTREAL — Pregnant women with group B streptococcal infection and allergy to penicillin frequently receive inappropriate antibiotic therapy despite established guidelines, said Dr. Jennifer Verani, a medical epidemiologist at the Centers for Disease Control and Prevention. (Source: Hospitalist News)

Discharge to Institution Tied to Mortality Risk

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

CHICAGO — One in four elderly patients discharged to an institution after undergoing elective surgery died within 6 months, investigators found in a study designed to identify the incidence of and risk factors for postoperative admission to a skilled nursing center, rehabilitation center, or nursing home. (Source: Hospitalist News)

Risk Factors Identified for Hernia Repair Outcomes

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

CHICAGO — Controlling preoperative wound infections prior to repair of ventral hernias might reduce the risk of severe adverse outcomes, according to an analysis based on records from the American College of Surgeons' National Surgical Quality Improvement Program. (Source: Hospitalist News)

Low Hemoglobin After Cardiac Surgery Increases Stroke Risk

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

BALTIMORE — A low hemoglobin level following cardiac surgery is associated with significantly increased odds of experiencing a stroke after cardiopulmonary bypass, results of a case-control study suggest. (Source: Hospitalist News)

Contrast Agent Restrictions May Help Curb NSF

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

Findings: No new cases of nephrogenic systemic fibrosis were reported after reduction in use of gadolinium-based contrast agents, as well as substitution of new agents. (Source: Hospitalist News)

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NSF Uncommon After Contrast Agent Black Box Warnings

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

GAITHERSBURG, MD. — Black box warnings that have been added to the labels of all gadolinium-based MRI contrast agents have reduced the number of reported nephrogenic systemic fibrosis events to almost none during the past year, according to an analysis by Dr. James Kaiser. (Source: Hospitalist News)

Serum Lactate Doesn't Detect Pediatric Injuries

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

BOSTON — Initial serum lactate measurements are not reliable predictors of major injuries in children with severe blunt trauma, based on data from a prospective study of 200 children in a university pediatric emergency department. (Source: Hospitalist News)

Pediatricians Not Savvy About Passenger Safety

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

WASHINGTON — Relatively few pediatric emergency physicians could correctly answer all questions regarding the American Academy of Pediatrics' child passenger safety recommendations, and these instructions are frequently not included in discharge instructions to parents, based on a survey of 274 physicians. (Source: Hospitalist News)

Split-Dose Bowel Prep Better for Inpatients

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

SAN DIEGO — Split-dose bowel preparation was found to be superior to a conventional whole-dose bowel cleansing regimen in a randomized, prospective study of 43 hospital inpatients. (Source: Hospitalist News)

Don't Blame H. pylori for Ulcers After Bypass

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

GRAPEVINE, TEX. — Helicobacter pylori infection is not involved in marginal ulceration formation after laparoscopic Roux-en-Y gastric bypass, results from a large retrospective study suggest. (Source: Hospitalist News)

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MDCT Reveals Site, Cause of GI Perforations

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

CHICAGO — Multidetector computed tomography can identify the site and etiology of gastrointestinal perforations correctly in a high percentage of patients with acute abdominal pain who present to an emergency department, according to a prospective study. (Source: Hospitalist News)

Hospitalist Puts Spotlight on Comanagement

Hospitalist News — Fri, 01 Jan 2010 00:00:00 +0100

Dr. Sylvia McKean was on the ground floor of the hospitalist movement in the mid-1990s, and now she is helping to spearhead a new trend: comanagement of patients with surgeons and other specialists. (Source: Hospitalist News)

Hospitalist model offers structure, predictability

bizjournals.com Health Care:Health Insurance headlines — Mon, 21 Dec 2009 05:00:00 +0100

The nation’s health care industry continues to see a rise in hospitalists, and Nashville seems poised to help drive that trend. (Source: bizjournals.com Health Care:Health Insurance headlines)

Hospitalist model offers structure, predictability

bizjournals.com Health Care:Biotechnology headlines — Mon, 21 Dec 2009 05:00:00 +0100

The nation’s health care industry continues to see a rise in hospitalists, and Nashville seems poised to help drive that trend. (Source: bizjournals.com Health Care:Biotechnology headlines)

Dermatology hospitalists revisited

Journal of the American Academy of Dermatology — Thu, 17 Dec 2009 14:02:45 +0100

To the Editor: Fox et al should be congratulated for reinvigorating the idea of dermatology hospitalists in the July 2009 issue of the Journal, which was initially proposed in 1997. For the past 20 years, the University of Miami has run an active inpatient dermatology unit, averaging 400 to 500 dermatology admissions annually. During this time, under the direction of Dr Francisco Kerdel, one to four dermatologists in any given year are responsible for both managing patients admitted to the dermatology service—including those needing intensive care unit care—and hospital consults. This system has been effective in terms of patient care and also elevating the specialty within the hospital. For example, the dermatology department runs the multidisciplinary wound center at the hospital, de...

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Health News of the Day

Clinical Cases and Images — Wed, 16 Dec 2009 11:12:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:3 popular sanitizers killed 46-60% of microbes on the students' hands, far short of the advertised 99.99% http://bit.ly/8Iem7715% of 12- to 17-year-olds have received sexually suggestive or nude images via text message, called "sexting" http://bit.ly/6Q9yOV -- 20% of teens age 13 to 19 said they had texted or posted online sexy photos or videos of themselves in a 2008 survey http://bit.ly/4F23cWCT scans may cause 29,000 new cancers per year in the U.S. http://bit.ly/4E7bL3The business of "liquid energy" has grown exponentially, 31% of 12-17 year olds regularly consume energy drinks. Most ene...

Health News of the Day

Clinical Cases and Images — Mon, 14 Dec 2009 11:21:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:Perceived age as a biomarker of ageing that predicts survival among those aged 70 and correlates with function http://bit.ly/6E6WaaThroughout his adult life Darwin endured a chronic, relapsing illness. We still don't know what it was. http://bit.ly/5WmurJFurther research is required to identify music that, when played during CPR training, provides optimal rate and depth http://bit.ly/6W1B9ANoise limits are expected to be imposed on all personal MP3 music players on sale in Europe http://bit.ly/4Wdl0gA good overview of the role of the medical triaging officer ("quarterback") at Cleveland Clin...

Social Media Related Tweets and Insights

Clinical Cases and Images — Mon, 07 Dec 2009 03:13:48 +0100

From my Twitter account:Scholarly Identity 2.0: What does the Web say about your research? http://bit.ly/VoEHT - Click to see the slideshare presentation.@doctorwes: The Inefficiency of Medical E-Mail http://bit.ly/4ZMzz6 - Another thoughtful blog post by Dr. Wes."Rediscovery" of pharyngitis in adolescents - a great summary by a hospitalist who truly enjoys teaching: http://bit.ly/4PNgDq@pkedrosky "Posted a link to a study on blog this morning. Got findings completely backwards. Some days my multitasker breaks down." - It happens to the best of us, hence the disclaimer at the bottom of this post.@ev "Many of the great businesses of next decade will be about making information about our behaviors more visible" - Will it be opt-in or opt-out?Glandular Alphabetum in Pathology - A to Z http://...

Physicians Named 2009 H. Richard Nesson Fellows

BWH News — Fri, 04 Dec 2009 00:00:00 +0100

Hospitalists Cheryl Clark, MD, SD, and LeRoi Hicks, MD, MPH, are this year’s 2009 H. Richard Nesson Fellowship recipients. (Source: BWH News)

OB Hospitalist Program Is a Go!

Ob.Gyn. News — Tue, 01 Dec 2009 00:00:00 +0100

DR. PELLETIER is director of the OB hospitalist program at Women's and Children's Hospital in Lafayette, La., and is a gynecologist in private practice. To comment, e-mail him at obnews@elsevier.com. (Source: Ob.Gyn. News)

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Michigan Project Cuts ICU Infections

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

Physicians and nurses in Michigan have sharply reduced health care–associated infections, and now researchers are looking to replicate that work around the country. Johns Hopkins University researchers recently partnered with the American Hospital Association and others in 28 states to try to reduce catheter-related bloodstream infections in intensive care units. The work builds on the success of the Michigan Keystone ICU Project, which was launched in 2003. Over the first 18 months of the Michigan initiative, 103 hospitals reduced catheter-related bloodstream infections by up to 66% by implementing a simple infection control checklist (N. Engl. J. Med. 2006;355:2725-32). (Source: Hospitalist News)

ACC/AHA Calls for Regional Systems Of Care for STEMI: PCI is underused for ST-elevation MI.

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

ORLANDO — A new fast-track update of ACC/AHA guidelines on percutaneous coronary intervention and management of ST-elevation MI includes a major new class I recommendation for every community to develop an organized system of emergency care for patients with STEMI. (Source: Hospitalist News)

Bedside Oculomotor Signs Can Detect Stroke in Acute Vestibular Syndrome

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

BALTIMORE — A test battery of three oculomotor signs for patients with acute vestibular syndrome can detect stroke with greater sensitivity than does MRI with diffusion-weighted imaging in the first 24–48 hours after symptom onset, according to a prospective, cross-sectional study. (Source: Hospitalist News)

Imaging Studies Expose MI Patients To High Doses of Ionizing Radiation

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

ORLANDO — Patients hospitalized for acute MI receive an average cumulative ionizing radiation dose from imaging studies that's equivalent to 725 chest x-rays, a study indicated. (Source: Hospitalist News)

Vital Signs: Average Length of Inpatient Stays Stabilized in 2000; Number of Stays Continued to Rise

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

(Source: Hospitalist News)

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Should stroke patients receive therapies that have not been shown to improve outcomes?

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

DR. FURLAN is the Gilbert W. Humphrey professor and chairman of the department of neurology at the Neurological Institute at University Hospitals Case Medical Center, Cleveland. He was a principal investigator in the DEDAS and PROACT II studies and was the North American P.I. for the DIAS 2 study. (Source: Hospitalist News)

Unneeded CT Scans Magnify Radiation Risks

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

CHICAGO — Patients undergoing abdominal/pelvic computed tomography frequently receive unindicated additional scans, resulting in excess radiation exposure, a review of 978 CT scans suggests. (Source: Hospitalist News)

Restricted CT Scans Did Not Harm Sensitivity

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

NEW ORLEANS — Abdominal computed tomography limited to the region of tenderness accurately delineates acute pathology while reducing radiation exposure, according to a double-blind study. (Source: Hospitalist News)

Mass. Registry Study Supports PCI Without On-Site Surgery

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

ORLANDO — In patients with ST-elevation MI who were treated with primary percutaneous coronary intervention and enrolled in a large Massachusetts registry study, the 1-year rates of mortality, MI, and target vessel revascularization were similar in hospitals with or without on-site cardiac surgery. (Source: Hospitalist News)

Isolate ICU Patients Until H1N1 Test Results Return

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN DIEGO — Antigen testing for the pandemic influenza A(H1N1) virus using nasopharyngeal swabs is not sensitive enough to be reliable in ICU patients, the experience at one busy inner-city New York hospital suggests. (Source: Hospitalist News)

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Rx Delay Increases Deaths In Bloodstream Infections

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN FRANCISCO — A delay in administering adequate antimicrobial therapy is strongly associated with elevated mortality in patients with bloodstream infections, according to a prospective study involving 381 patients. (Source: Hospitalist News)

Early Repeat C. difficile Testing Rarely Useful

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN FRANCISCO — Repeating a negative stool cytotoxicity assay for Clostridium difficile rarely returns a different result if done within the first 3 days, according to a retrospective study involving more than 10,000 patients. (Source: Hospitalist News)

Phase III Data Show Safety of Fidaxomicin for C. difficile

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN FRANCISCO — Fidaxomicin appears to be just as safe as vancomycin for the treatment of Clostridium difficile infection, results from a multicenter randomized trial showed. The finding comes from the first phase III study of fidaxomicin (Dificid), a first-in-class macrocyclic antibiotic for the treatment of C. difficile. A second phase III trial that is underway is expected to be completed by the end of the year, Pamela Sears, Ph.D., said in an interview during a poster session at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy. (Source: Hospitalist News)

Fidaxomicin Reduced C. difficile Recurrence Rate by 45%

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN FRANCISCO — Patients with Clostridium difficile infection who were treated with the novel macrocylic antibiotic fidaxomicin had a 45% lower rate of recurrence, compared with those who received vancomycin. (Source: Hospitalist News)

Probiotic May Prevent ICU Pneumonia, C. difficile

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN DIEGO — Giving the probiotic Lactobacillus GG to critically ill patients on mechanical ventilation resulted in markedly reduced rates of ventilator-associated pneumonia and Clostridium difficile disease in a double-blind, placebo-controlled study. (Source: Hospitalist News)

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Detection of Delirium in ICU Does Not Aid Treatment

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

SAN DIEGO — Daily systematic monitoring for delirium in a surgical ICU proved no more beneficial than did routine clinical judgment in identifying affected patients early and initiating effective therapy in a randomized trial. (Source: Hospitalist News)

FDA Advises Against Anesthetic Joint Infusions

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

Cases of chondrolysis diagnosed a median of 8.5 months after administration of a continuous intra-articular infusion of a local anesthetic for postsurgical pain with an infusion pump have prompted the Food and Drug Administration to issue a statement recommending against this practice. (Source: Hospitalist News)

Pancreatectomy Complication Rate Not Higher With Diabetes

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

CHICAGO — Patients with diabetes mellitus who undergo resection for pancreatic cancer do not have significantly increased risk for delayed gastric emptying, symptomatic fistulae formation, or extended length of hospital stay, compared with nondiabetic patients, data from a retrospective study suggest. (Source: Hospitalist News)

Unfractionated Heparin Best Deal for VTE Prophylaxis

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

PHOENIX — Low-dose unfractionated heparin for thromboprophylaxis following abdominopelvic cancer surgery gives the most protection for the lowest overall cost, a cost analysis showed. (Source: Hospitalist News)

Multidisciplinary ‘M and M’ More Beneficial

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

ROSEMONT, ILL. — Morbidity and mortality conferences can yield improvements more quickly than can any other quality or patient safety measure in a hospital, but only if all of the disciplines involved meet at the same table in a concerted effort to learn from errors and make lasting changes, according to Dr. Omar Lateef, director of the critical care safety program at Rush University Medical Center in Chicago. (Source: Hospitalist News)

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Alternate Facilities During a Disaster

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

The Agency for Healthcare Research and Quality offers two online tools for use when hospitals and clinics are overwhelmed or unable to function due to hurricanes, floods, or other disasters. (Source: Hospitalist News)

Creating a Laboratory for Better Patient Care

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

Dr. Sanjay Saint and his colleagues at the Veterans Affairs Medical Center in Ann Arbor, Mich., are turning the inpatient service there into a laboratory, trying to create the ideal hospital experience for patients. (Source: Hospitalist News)

Hospital ‘Report Cards’ Don't Improve Cardiac Care

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

Public release of hospital “report cards” did not measurably improve indicators of care for acute MI or chronic heart failure, according to a Canadian study. Even though most of the hospitals involved in the study undertook at least one quality improvement initiative in response to the report cards, only 1 of 12 indicators of care for acute MI and only 1 of 6 indicators of care for chronic heart failure improved, said Dr. Jack V. Tu, a professor in the department of health policy, management, and evaluation at the University of Toronto, and his associates. (Source: Hospitalist News)

Federal Rule Waivers Allowed During H1N1 Flu Pandemic

Hospitalist News — Tue, 01 Dec 2009 00:00:00 +0100

As a result of the public health emergency declared Oct. 23 by President Obama, hospitals and health providers may ask the Health and Human Services department to waive certain provisions required under federal health programs, including Medicare, Medicaid, the Children's Health Insurance Program, the Health Insurance Portability and Accountability Act (HIPAA), and the Emergency Medical Treatment and Labor Act (EMTALA). (Source: Hospitalist News)

Health News of the Day

Clinical Cases and Images — Sat, 21 Nov 2009 11:10:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:"The brains of human beings seem built to process stories better than other forms of input. Without numbers, stories are just anecdotes, but without stories, numbers are just dry statistics" http://bit.ly/4u93VJHow Much Do Doctors in Other Countries Make? NYT - http://bit.ly/3DDrz5 - Contrary to expectations, the U.S. doesn't top the list for specialists.75% of Italian and Canadian doctors report patients wait a long time to see specialists, 28% in the U.S. http://bit.ly/2tzz8xMovie Theater Popcorn a Calorie Bomb: A large popcorn tub packs more fat and calories than 2 Big Macs http://bit.ly/...

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H. Richard Nesson Fellowship Recipients Named

BWH News — Fri, 20 Nov 2009 00:00:00 +0100

Hospitalists Cheryl Clark, MD, SD, and LeRoi Hicks, MD, MPH, are this year’s 2009 H. Richard Nesson Fellowship recipients. (Source: BWH News)

Health News of the Day

Clinical Cases and Images — Thu, 19 Nov 2009 11:26:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:Exercise remodels the brain, making it more stress-resistant (in rats, at least) http://bit.ly/QHkMUAnother study: Regular consumption of alcohol reduces the risk of heart disease by 30-50% http://bit.ly/FZQl3Young athletes should be screened for heart disease with 2 tests rather than 1: ECG and echocardiogram http://bit.ly/176Nuu55% of adult Americans don't want to get the H1N1 flu vaccine according to a poll http://bit.ly/4qWyFjMorphine can increase tumor cell proliferation, inhibit immune system, and promote growth of new blood vessels http://bit.ly/n1uxLAustralian hospital staff set up a...

Health News of the Day

Clinical Cases and Images — Tue, 17 Nov 2009 11:29:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:Older people who walk slowly are 3 times more likely to die of heart disease than older people who walk faster - BMJ http://bit.ly/40mPqW)Battery of tests given to a single patient having a heart attack adds up to the radiation dose of 725 chest X-rays http://bit.ly/4tzuKWNew U.S. breast cancer guidelines recommend against routine mammograms for women in their 40s. Guidelines suggest women 50 to 74 only get a mammogram every other year http://bit.ly/2Qdecp)49 million Americans -- one in seven -- struggle to get enough to eat according to a government report http://bit.ly/2qVWIgTop 10 Hospita...

Two Boards Join to Offer Hospitalist Certification

Family Practice News — Sun, 15 Nov 2009 00:00:00 +0100

With the first board certification exam in hospital medicine less than a year away, the long-awaited program has grown in scope following the decision by the American Board of Family Medicine to allow family physicians to join internists in pursuing the new credential. (Source: Family Practice News)

Both ABIM, ABFM to Offer Hospitalist Certification

Internal Medicine News — Sun, 15 Nov 2009 00:00:00 +0100

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Health News of the Day

Clinical Cases and Images — Thu, 12 Nov 2009 11:57:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:U.S. primary care visit duration increased from 18 to 20.8 minutes from 1997 to 2005 http://bit.ly/AIP07Study Shows Just an Hour of Meditation Training Brings Results in Pain Management http://bit.ly/2zzJ7oWorkers exposed to high levels of bisphenol A (BPA) were 4-7 times more likely to report sexual function problems http://bit.ly/tNyxi"Should physicians pay for their own CME to avoid ethical entanglements?" http://bit.ly/4gCZc3Bob Wachter reviews the Japanese health system from a U.S. hospitalist point of view http://bit.ly/2pYS48 - This is a must read.The French and U.S. approaches to tra...

Feature: CMS cuts could make hospitalists out of cardiologists

Cardiovascular Business News — Thu, 05 Nov 2009 14:09:57 +0100

Since the Centers for Medicare & Medicaid Services (CMS) issued its 2010 physician fee final rule last week with cuts to cardiology practices averaging 27 percent, the American College of Cardiology has expressed adamant opposition, and its CEO, Jack Lewin, MD, said that this will cause the shuttering of practices. However, former CMS Administrator Thomas A. Scully explained how the agency is limited by finite funding and growing pressures to fund other areas of healthcare. (Source: Cardiovascular Business News)

Health News of the Day

Clinical Cases and Images — Wed, 04 Nov 2009 11:05:00 +0100

is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day:FDA Issues Warning for Diabetes Drug Byetta about possible kidney problems, including renal failure http://bit.ly/1UOjwB"Who are the sleepiest people in the US?" Source: Morbidity and Mortality Weekly Report http://bit.ly/4djMWPX-rays showed 78 different items of cutlery in a 52-year-old woman's stomach http://bit.ly/4iojkQMayo Clinic: 10 great health foods for eating well http://bit.ly/sGLgF"Hospitals with hospitalists have an easier time recruiting subspecialists" http://bit.ly/WapWE and http://bit.ly/G85PLSleep Changes with Aging http://bit.ly/4CPzGJWhat drug is best for initial treatment...

AAFP's 63rd President

Family Practice News — Sun, 01 Nov 2009 00:00:00 +0100

Shortly after Dr. Lori J. Heim was installed as the American Academy of Family Physicians' 63rd president, we sat down with her to find out her priorities for the year ahead. Here's what Dr. Heim, a hospitalist at Scotland Memorial Hospital in Laurinburg, N.C., had to say: (Source: Family Practice News)