Miguel Villagra, MD

[WpProQuiz 13] [WpProQuiz_toplist 13]

[WpProQuiz 13] [WpProQuiz_toplist 13]

[WpProQuiz 13] [WpProQuiz_toplist 13]

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Daniel D. Dressler, MD, MSc, SFHM

Summary: This presentation focused on pulmonary updates specific to hospitalist practice, from end of 2014 to early 2016.

New research on community-acquired pneumonia suggest that only 38% of cases a presumptive pathogen will be isolated. Virus account for 23%, bacteria 11% (including S. pneumonia, S. Aureus and Enterobacteriaceae), both (virus and bacteria) 3%, and fungus or mycobacterium 1%. It is important to notice no recent data on etiology was available since mid-1990.

There is also a new pragmatic trial suggesting that B-lactam monotherapy is not inferior to either B-lactam in combination with macrolides or fluoroquinolones. The study reported an 11%, 90-day mortality with B-lactam monotherapy compared with 11% when combined with macrolides and 8.8% when using quinolones monotherapy.

Update evidence supports the use of corticosteroids for hospitalized patients with community-acquired pneumonia, at a dose of 20-60 mg day for 5-7 days. The study showed decreased mortality in patients with clinical criteria for severe pneumonia with NNT 7; it also showed decrease need for mechanical ventilation and development of ARDS.

An additional, interesting finding was a decrease in length of stay (LOS) in the steroid group. In patients with acute hypoxemic respiratory failure, high flow nasal cannula reduced mortality and likely reduces intubation in severely hypoxemic patients when compared to NPPV.

In patients with first unprovoked VTE, extending anticoagulation to two years or adding aspirin after initial anticoagulation might reduce recurrent VTE without significant increasing in risk for major bleeding.

Key Takeaways:

• B-lactam monotherapy for hospitalized non-ICU CAP might be reasonable choice.
• Moderate short course of steroids in CAP, reduce ARDS, intubation, LOS in all hospitalized patients (and mortality on severe CAP)
• A trial of high flow NC is indicated in acute hypoxemic respiratory failure
• Aspirin prophylaxis following anticoagulation (most benefit first year), or extended anticoagulation for 2 years reduce recurrent VTE without much additional bleeding risk.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.