Shakeema Edwards

What do Clostridium difficile, Staphylococcus aureus, and acute pulmonary embolism have in common? They were all topics of discussion at the 2015 Mid-Atlantic Hospital Medicine Symposium, held at the Icahn School of Medicine at Mount Sinai in New York City.

Vikas Saini, MD, FACC, president of the Lown Institute in Brookline, Mass., and associate physician at Brigham and Women’s Hospital in Boston, gave the keynote address on high-value care.

“We’re asking you to do hard things: to be kind to complete strangers, to feel their pain, to be compassionate when you’re on the run,” Dr. Saini said as he urged his fellow physicians to be more personable with patients. “Pull up a chair and sit down. It takes you 30 seconds, but for the patient, it feels like an eternity.” Dr. Saini, a guest lecturer at the symposium, also stressed the importance of being collaborative and encouraged clinicians to join their colleagues in implementing RightCare Rounds.

Following the keynote address, Louis DePalo, MD, an associate professor of pulmonary, critical care, and sleep at Icahn School of Medicine, gave a 30-minute presentation on the management of acute pulmonary embolism (PE). 

Dr. DePalo said that in his early days of practicing medicine, PE patients were usually hospitalized without debate. Today, thanks to indices such as the Pulmonary Embolism Severity Index, there are algorithms to determine the severity of PE in patients, allowing doctors to determine whether patients should be discharged or hospitalized. Still, Dr. DePalo added, “Discussions about sending a patient home are complicated.”

If a patient has severe PE, Dr. DePalo advised doctors to analyze studies such as the Pulmonary Embolism Thrombolysis (PEITHO) trial and the Moderate Pulmonary Embolism Treated with Thrombolysis (MOPPETT) trial to determine when to use advanced treatments. “One study may not be sufficient for administering advanced therapies,” Dr. DePalo said. “One study doesn’t make us feel good, so get a lot of data.”

After Dr. DePalo’s presentation, physicians gave presentations on common healthcare-associated infections. Gopi Patel, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed Clostridium difficile infection (CDI). “CDI is the most common [healthcare-associated infection] in the United States,” Dr. Patel said as she urged physicians to “be a role model” by practicing good hand hygiene.

Using the updated practice guidelines from the Infectious Diseases Society of America, Tim Sullivan, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed skin and soft tissue infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). The guidelines “make a very important distinction between purulent and nonpurulent infections,” Dr. Sullivan said. “The majority of nonpurulent infections are caused by strep, [and] treating for strep seems to be sufficient to cure the infection … Adding extra coverage for MRSA is either not helpful or may actually be harmful to patients.”

Purulent infections, which require drainage, “are mostly caused by Staph aureus, including MRSA,” Dr. Sullivan said. “You don’t always have to give antibiotics, but they are recommended when the patient is sick.”

Dr. Sullivan said although “it can be sort of confusing trying to choose the right antibiotics for your patient … almost everyone should just receive vancomycin.” The drug is well-studied, inexpensive at $2.80 per dose for a five-day treatment, and well-tolerated by patients, he added. Yet vancomycin should not be administered to everyone as some patients experience devastating adverse reactions, and vancomycin could potentially cause irreversible hearing loss, he said.

Dr. Sullivan mentioned three new antibiotic treatments for MRSA: telavancin, which the U.S. Food and Drug Administration approved in 2009, costs 75 times more than vancomycin; dalbavancin, which was approved last May, costs $5,300 for two doses; and oritavancin, which was approved last August, costs $3,400 for one dose.

The arguments for using these newer drugs “may be that you can discharge the patient home, assuming they’ll have an active antibiotic in their system for a week, and maybe that will be more cost-effective,” Dr. Sullivan said. “The role that these should play in the management of your inpatients is still not clear, but they’re very new and interesting developments in treatment.” TH

Visit our website for more information on antibiotic stewardship and hospitalists.

What do Clostridium difficile, Staphylococcus aureus, and acute pulmonary embolism have in common? They were all topics of discussion at the 2015 Mid-Atlantic Hospital Medicine Symposium, held at the Icahn School of Medicine at Mount Sinai in New York City.

Vikas Saini, MD, FACC, president of the Lown Institute in Brookline, Mass., and associate physician at Brigham and Women’s Hospital in Boston, gave the keynote address on high-value care.

“We’re asking you to do hard things: to be kind to complete strangers, to feel their pain, to be compassionate when you’re on the run,” Dr. Saini said as he urged his fellow physicians to be more personable with patients. “Pull up a chair and sit down. It takes you 30 seconds, but for the patient, it feels like an eternity.” Dr. Saini, a guest lecturer at the symposium, also stressed the importance of being collaborative and encouraged clinicians to join their colleagues in implementing RightCare Rounds.

Following the keynote address, Louis DePalo, MD, an associate professor of pulmonary, critical care, and sleep at Icahn School of Medicine, gave a 30-minute presentation on the management of acute pulmonary embolism (PE). 

Dr. DePalo said that in his early days of practicing medicine, PE patients were usually hospitalized without debate. Today, thanks to indices such as the Pulmonary Embolism Severity Index, there are algorithms to determine the severity of PE in patients, allowing doctors to determine whether patients should be discharged or hospitalized. Still, Dr. DePalo added, “Discussions about sending a patient home are complicated.”

If a patient has severe PE, Dr. DePalo advised doctors to analyze studies such as the Pulmonary Embolism Thrombolysis (PEITHO) trial and the Moderate Pulmonary Embolism Treated with Thrombolysis (MOPPETT) trial to determine when to use advanced treatments. “One study may not be sufficient for administering advanced therapies,” Dr. DePalo said. “One study doesn’t make us feel good, so get a lot of data.”

After Dr. DePalo’s presentation, physicians gave presentations on common healthcare-associated infections. Gopi Patel, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed Clostridium difficile infection (CDI). “CDI is the most common [healthcare-associated infection] in the United States,” Dr. Patel said as she urged physicians to “be a role model” by practicing good hand hygiene.

Using the updated practice guidelines from the Infectious Diseases Society of America, Tim Sullivan, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed skin and soft tissue infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). The guidelines “make a very important distinction between purulent and nonpurulent infections,” Dr. Sullivan said. “The majority of nonpurulent infections are caused by strep, [and] treating for strep seems to be sufficient to cure the infection … Adding extra coverage for MRSA is either not helpful or may actually be harmful to patients.”

Purulent infections, which require drainage, “are mostly caused by Staph aureus, including MRSA,” Dr. Sullivan said. “You don’t always have to give antibiotics, but they are recommended when the patient is sick.”

Dr. Sullivan said although “it can be sort of confusing trying to choose the right antibiotics for your patient … almost everyone should just receive vancomycin.” The drug is well-studied, inexpensive at $2.80 per dose for a five-day treatment, and well-tolerated by patients, he added. Yet vancomycin should not be administered to everyone as some patients experience devastating adverse reactions, and vancomycin could potentially cause irreversible hearing loss, he said.

Dr. Sullivan mentioned three new antibiotic treatments for MRSA: telavancin, which the U.S. Food and Drug Administration approved in 2009, costs 75 times more than vancomycin; dalbavancin, which was approved last May, costs $5,300 for two doses; and oritavancin, which was approved last August, costs $3,400 for one dose.

The arguments for using these newer drugs “may be that you can discharge the patient home, assuming they’ll have an active antibiotic in their system for a week, and maybe that will be more cost-effective,” Dr. Sullivan said. “The role that these should play in the management of your inpatients is still not clear, but they’re very new and interesting developments in treatment.” TH

Visit our website for more information on antibiotic stewardship and hospitalists.

What do Clostridium difficile, Staphylococcus aureus, and acute pulmonary embolism have in common? They were all topics of discussion at the 2015 Mid-Atlantic Hospital Medicine Symposium, held at the Icahn School of Medicine at Mount Sinai in New York City.

Vikas Saini, MD, FACC, president of the Lown Institute in Brookline, Mass., and associate physician at Brigham and Women’s Hospital in Boston, gave the keynote address on high-value care.

“We’re asking you to do hard things: to be kind to complete strangers, to feel their pain, to be compassionate when you’re on the run,” Dr. Saini said as he urged his fellow physicians to be more personable with patients. “Pull up a chair and sit down. It takes you 30 seconds, but for the patient, it feels like an eternity.” Dr. Saini, a guest lecturer at the symposium, also stressed the importance of being collaborative and encouraged clinicians to join their colleagues in implementing RightCare Rounds.

Following the keynote address, Louis DePalo, MD, an associate professor of pulmonary, critical care, and sleep at Icahn School of Medicine, gave a 30-minute presentation on the management of acute pulmonary embolism (PE). 

Dr. DePalo said that in his early days of practicing medicine, PE patients were usually hospitalized without debate. Today, thanks to indices such as the Pulmonary Embolism Severity Index, there are algorithms to determine the severity of PE in patients, allowing doctors to determine whether patients should be discharged or hospitalized. Still, Dr. DePalo added, “Discussions about sending a patient home are complicated.”

If a patient has severe PE, Dr. DePalo advised doctors to analyze studies such as the Pulmonary Embolism Thrombolysis (PEITHO) trial and the Moderate Pulmonary Embolism Treated with Thrombolysis (MOPPETT) trial to determine when to use advanced treatments. “One study may not be sufficient for administering advanced therapies,” Dr. DePalo said. “One study doesn’t make us feel good, so get a lot of data.”

After Dr. DePalo’s presentation, physicians gave presentations on common healthcare-associated infections. Gopi Patel, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed Clostridium difficile infection (CDI). “CDI is the most common [healthcare-associated infection] in the United States,” Dr. Patel said as she urged physicians to “be a role model” by practicing good hand hygiene.

Using the updated practice guidelines from the Infectious Diseases Society of America, Tim Sullivan, MD, an assistant professor of infectious diseases at Icahn School of Medicine, discussed skin and soft tissue infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). The guidelines “make a very important distinction between purulent and nonpurulent infections,” Dr. Sullivan said. “The majority of nonpurulent infections are caused by strep, [and] treating for strep seems to be sufficient to cure the infection … Adding extra coverage for MRSA is either not helpful or may actually be harmful to patients.”

Purulent infections, which require drainage, “are mostly caused by Staph aureus, including MRSA,” Dr. Sullivan said. “You don’t always have to give antibiotics, but they are recommended when the patient is sick.”

Dr. Sullivan said although “it can be sort of confusing trying to choose the right antibiotics for your patient … almost everyone should just receive vancomycin.” The drug is well-studied, inexpensive at $2.80 per dose for a five-day treatment, and well-tolerated by patients, he added. Yet vancomycin should not be administered to everyone as some patients experience devastating adverse reactions, and vancomycin could potentially cause irreversible hearing loss, he said.

Dr. Sullivan mentioned three new antibiotic treatments for MRSA: telavancin, which the U.S. Food and Drug Administration approved in 2009, costs 75 times more than vancomycin; dalbavancin, which was approved last May, costs $5,300 for two doses; and oritavancin, which was approved last August, costs $3,400 for one dose.

The arguments for using these newer drugs “may be that you can discharge the patient home, assuming they’ll have an active antibiotic in their system for a week, and maybe that will be more cost-effective,” Dr. Sullivan said. “The role that these should play in the management of your inpatients is still not clear, but they’re very new and interesting developments in treatment.” TH

Visit our website for more information on antibiotic stewardship and hospitalists.

A study that examines Project BOOST’s effectiveness at decreasing rehospitalization rates was the top-cited article from the Journal of Hospital Medicine (JHM) in 2014. Titled “Project BOOST: Effectiveness of a Multihospital Effort to Reduce Rehospitalization,” the study has been cited 33 times since its publication in July 2013. The article concludes that hospitals participating in SHM’s Project BOOST (Better Outcomes for Older adults through Safe Transitions) experienced lower readmission rates.

“Project BOOST showed the effectiveness of physician-mentored implementation at reducing rehospitalization rates by improving the quality of patient care,” the study’s senior author, Mark V. Williams, MD, MHM, of Northwestern University Feinberg School of Medicine in Chicago, writes in an email to The Hospitalist eWire.

While researching the article, Dr. Williams says he knew it would be especially interesting to hospitalists. “I know hospitalists want to do the best job possible and not have patients be forced to return to the hospital because of problems with the hospital discharge process,” he writes. “Also, since hospitalists led this research as a nationwide quality improvement initiative, it is of particular interest to them.”

JHM Editor in Chief Andrew Auerbach, MD, MPH, and his editorial team publish some 30% of the 40-odd submissions they receive on average each month. “It was a very good paper,” Dr. Auerbach says of the Project BOOST study. Because of the importance of Project BOOST transitional care interventions, Dr. Auerbach and his team “knew it was going to be important to the field,” he adds.

In addition to its 33 citations, the Project BOOST article has received significant online attention. With an Altmetric score of 72, it is “one of the highest-scoring articles from [JHM] (#9 of 686),” according to its Altmetric page. This score reflects the article’s mentions in social media, newspapers, policy documents, and other sources.

Other factors such as the “number of tweets and downloads, the number of times people go to our website, those are also things that we look at very carefully to make sure that the journal is providing a service to people who may not be citing the papers but who want to use it just to read and to use in clinical care,” Dr. Auerbach says.

The four other top-cited articles discuss reducing inpatient falls, predicting mortality in ward patients through emergency medical records, detecting delirium to reduce hospitalization of dementia patients, and decreasing the use of non–evidence-based theories in treating bronchiolitis in pediatric patients.

The quality of researched published in JHM has changed since the journal’s debut in 2006, Dr. Auerbach says. “I think the field has developed quite a bit,” he adds. “I think the quality of research that’s happening in the field of hospital medicine is improving quite a bit, which is reflected in the type of papers we’re getting at the journal.”

In addition to 2014’s top-cited articles, the editorial team highlighted JHM’s new impact factor (IF) of 2.304, up from last year’s IF of 2.081. An IF indicates how many times the articles in a journal are cited elsewhere. “It is a very important metric for the journal, it’s very important for our authors, it’s important to our field,” Dr. Auerbach says. “It talks about how important the things we’re publishing are to other researchers.”

This increased IF ranks JHM 37 out of 153 journals in the General and Internal Medicine category of professional, peer-reviewed journals. Dr. Auerbach, whose five-year term will end in 2016, says he is “very happy with the pace of [JHM’s] improvement” and hopeful of the journal’s continued success. “We’re confident in our strategies,” he says. “I think if we keep focusing on really great papers and continue to grow the number of papers that come to the journal, we’ll be on track.”

Visit our website for more information on the Project BOOST study.

A study that examines Project BOOST’s effectiveness at decreasing rehospitalization rates was the top-cited article from the Journal of Hospital Medicine (JHM) in 2014. Titled “Project BOOST: Effectiveness of a Multihospital Effort to Reduce Rehospitalization,” the study has been cited 33 times since its publication in July 2013. The article concludes that hospitals participating in SHM’s Project BOOST (Better Outcomes for Older adults through Safe Transitions) experienced lower readmission rates.

“Project BOOST showed the effectiveness of physician-mentored implementation at reducing rehospitalization rates by improving the quality of patient care,” the study’s senior author, Mark V. Williams, MD, MHM, of Northwestern University Feinberg School of Medicine in Chicago, writes in an email to The Hospitalist eWire.

While researching the article, Dr. Williams says he knew it would be especially interesting to hospitalists. “I know hospitalists want to do the best job possible and not have patients be forced to return to the hospital because of problems with the hospital discharge process,” he writes. “Also, since hospitalists led this research as a nationwide quality improvement initiative, it is of particular interest to them.”

JHM Editor in Chief Andrew Auerbach, MD, MPH, and his editorial team publish some 30% of the 40-odd submissions they receive on average each month. “It was a very good paper,” Dr. Auerbach says of the Project BOOST study. Because of the importance of Project BOOST transitional care interventions, Dr. Auerbach and his team “knew it was going to be important to the field,” he adds.

In addition to its 33 citations, the Project BOOST article has received significant online attention. With an Altmetric score of 72, it is “one of the highest-scoring articles from [JHM] (#9 of 686),” according to its Altmetric page. This score reflects the article’s mentions in social media, newspapers, policy documents, and other sources.

Other factors such as the “number of tweets and downloads, the number of times people go to our website, those are also things that we look at very carefully to make sure that the journal is providing a service to people who may not be citing the papers but who want to use it just to read and to use in clinical care,” Dr. Auerbach says.

The four other top-cited articles discuss reducing inpatient falls, predicting mortality in ward patients through emergency medical records, detecting delirium to reduce hospitalization of dementia patients, and decreasing the use of non–evidence-based theories in treating bronchiolitis in pediatric patients.

The quality of researched published in JHM has changed since the journal’s debut in 2006, Dr. Auerbach says. “I think the field has developed quite a bit,” he adds. “I think the quality of research that’s happening in the field of hospital medicine is improving quite a bit, which is reflected in the type of papers we’re getting at the journal.”

In addition to 2014’s top-cited articles, the editorial team highlighted JHM’s new impact factor (IF) of 2.304, up from last year’s IF of 2.081. An IF indicates how many times the articles in a journal are cited elsewhere. “It is a very important metric for the journal, it’s very important for our authors, it’s important to our field,” Dr. Auerbach says. “It talks about how important the things we’re publishing are to other researchers.”

This increased IF ranks JHM 37 out of 153 journals in the General and Internal Medicine category of professional, peer-reviewed journals. Dr. Auerbach, whose five-year term will end in 2016, says he is “very happy with the pace of [JHM’s] improvement” and hopeful of the journal’s continued success. “We’re confident in our strategies,” he says. “I think if we keep focusing on really great papers and continue to grow the number of papers that come to the journal, we’ll be on track.”

Visit our website for more information on the Project BOOST study.

A study that examines Project BOOST’s effectiveness at decreasing rehospitalization rates was the top-cited article from the Journal of Hospital Medicine (JHM) in 2014. Titled “Project BOOST: Effectiveness of a Multihospital Effort to Reduce Rehospitalization,” the study has been cited 33 times since its publication in July 2013. The article concludes that hospitals participating in SHM’s Project BOOST (Better Outcomes for Older adults through Safe Transitions) experienced lower readmission rates.

“Project BOOST showed the effectiveness of physician-mentored implementation at reducing rehospitalization rates by improving the quality of patient care,” the study’s senior author, Mark V. Williams, MD, MHM, of Northwestern University Feinberg School of Medicine in Chicago, writes in an email to The Hospitalist eWire.

While researching the article, Dr. Williams says he knew it would be especially interesting to hospitalists. “I know hospitalists want to do the best job possible and not have patients be forced to return to the hospital because of problems with the hospital discharge process,” he writes. “Also, since hospitalists led this research as a nationwide quality improvement initiative, it is of particular interest to them.”

JHM Editor in Chief Andrew Auerbach, MD, MPH, and his editorial team publish some 30% of the 40-odd submissions they receive on average each month. “It was a very good paper,” Dr. Auerbach says of the Project BOOST study. Because of the importance of Project BOOST transitional care interventions, Dr. Auerbach and his team “knew it was going to be important to the field,” he adds.

In addition to its 33 citations, the Project BOOST article has received significant online attention. With an Altmetric score of 72, it is “one of the highest-scoring articles from [JHM] (#9 of 686),” according to its Altmetric page. This score reflects the article’s mentions in social media, newspapers, policy documents, and other sources.

Other factors such as the “number of tweets and downloads, the number of times people go to our website, those are also things that we look at very carefully to make sure that the journal is providing a service to people who may not be citing the papers but who want to use it just to read and to use in clinical care,” Dr. Auerbach says.

The four other top-cited articles discuss reducing inpatient falls, predicting mortality in ward patients through emergency medical records, detecting delirium to reduce hospitalization of dementia patients, and decreasing the use of non–evidence-based theories in treating bronchiolitis in pediatric patients.

The quality of researched published in JHM has changed since the journal’s debut in 2006, Dr. Auerbach says. “I think the field has developed quite a bit,” he adds. “I think the quality of research that’s happening in the field of hospital medicine is improving quite a bit, which is reflected in the type of papers we’re getting at the journal.”

In addition to 2014’s top-cited articles, the editorial team highlighted JHM’s new impact factor (IF) of 2.304, up from last year’s IF of 2.081. An IF indicates how many times the articles in a journal are cited elsewhere. “It is a very important metric for the journal, it’s very important for our authors, it’s important to our field,” Dr. Auerbach says. “It talks about how important the things we’re publishing are to other researchers.”

This increased IF ranks JHM 37 out of 153 journals in the General and Internal Medicine category of professional, peer-reviewed journals. Dr. Auerbach, whose five-year term will end in 2016, says he is “very happy with the pace of [JHM’s] improvement” and hopeful of the journal’s continued success. “We’re confident in our strategies,” he says. “I think if we keep focusing on really great papers and continue to grow the number of papers that come to the journal, we’ll be on track.”

Visit our website for more information on the Project BOOST study.