The Hospitalist

Clinical question: In patients with sleep apnea, does using positive airway pressure (PAP) treatment prevent adverse cardiovascular events and death?

Background: Previous observational studies have suggested that untreated sleep apnea is a factor in cardiopulmonary morbidity as well as cerebrovascular events. Guidelines advise its use for prevention of cerebrovascular events. However, not enough is known from trials about its impact on prevention of cardiovascular events.

Dr. Sata is a medical instructor, Duke University Hospital.

Clinical question: In patients with sleep apnea, does using positive airway pressure (PAP) treatment prevent adverse cardiovascular events and death?

Background: Previous observational studies have suggested that untreated sleep apnea is a factor in cardiopulmonary morbidity as well as cerebrovascular events. Guidelines advise its use for prevention of cerebrovascular events. However, not enough is known from trials about its impact on prevention of cardiovascular events.

Dr. Sata is a medical instructor, Duke University Hospital.

Clinical question: In patients with sleep apnea, does using positive airway pressure (PAP) treatment prevent adverse cardiovascular events and death?

Background: Previous observational studies have suggested that untreated sleep apnea is a factor in cardiopulmonary morbidity as well as cerebrovascular events. Guidelines advise its use for prevention of cerebrovascular events. However, not enough is known from trials about its impact on prevention of cardiovascular events.

Dr. Sata is a medical instructor, Duke University Hospital.

Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.

Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.

Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.

It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-­time longer length of stay compared to the average. The social-­psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.

When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.

My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.

My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-­depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.

Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.

Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.

Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.

Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.

It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-­time longer length of stay compared to the average. The social-­psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.

When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.

My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.

My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-­depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.

Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.

Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.

Last month I was able to conduct five interviews with key stakeholders, generate the patient flow diagram, define the problems, and propose potential interventions. The project is on time for the allotted time frame.

Interviewees include physicians and managers from infectious disease, hospital medicine, psychiatry and care management. They represent the services which admitted IVDU patients have contacts with: inpatient primary team, inpatient ID consult time, BIT (behavior intervention team), and OPAT (Outpatient Parenteral Antibiotic Therapy) program. I asked each interviewee about the specific challenges of care delivery during the inpatient, discharge, and outpatient follow up process.

It is not surprising that most would agree that discharge was the most difficult part. The ID service showed me data that those with IVDU history may have a one-­time longer length of stay compared to the average. The social-­psychological issues, including medication compliance, insurance coverage, and mental health comorbidities, are the most commonly mentioned factor for delayed discharge.

When asked about a suggestion for a particular area for quality improvement, different services came up with different recommendations. ID suggested looking at availability of community resources and improving patients’ access to them. Psychiatry has been trying to screen all admitted patients for substance use disorders, with an intention of early intervention. Hospital medicine and care management were contemplating the potential means for a repatriation program, i.e., making the transferring acute care facility agree to receive patients back once tertiary care was complete. Given that Dartmouth-Hitchcock Medical Center has a few satellite community hospitals, it would make sense to establish some institutional protocol to optimize patient flow within the system.

My next step would be to pursue one or two areas for improvement from the above options. I will work with the relevant stakeholders to define the problems and come up with a plan. I am excited about moving forward to the next phase.

My research approach has changed slightly during the process. Initially I was narrowly focused on the desired outcomes of decreasing length of stay and readmission rate. Dr. Huntington challenged me to understand the whole process thoroughly as well as to spend time on defining the problems before diving into interventions. I enjoyed my role of being a learner, researcher, and consultant in this project. I gained a very in-­depth perspective on how each service operates and coordinates. Also, it is both challenging and fun to coming up with an improvement plan. In my future residency and physician career, I am definitely going to pursue more care improvement initiatives.

Yun Li is an MD/MBA student attending Geisel School of Medicine and Tuck School of Business at Dartmouth. She obtained her Bachelor of Arts degree from Hanover College double-majoring in Economics and Biological Chemistry. Ms. Li participated in research in injury epidemiology and genetics, and has conducted studies on traditional Tibetan medicine, rural health, health NGOs, and digital health. Her career interest is practicing hospital medicine and geriatrics as a clinician/administrator, either in the US or China. Ms. Li is a student member of the Society of Hospital Medicine.

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform healthcare and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

This summer, my research project focused on the highly vulnerable patients who are transferred from the medical intensive care unit to the general floor. Patients who are readmitted tend to have worse health outcomes, longer stays, higher mortality rates, and higher health care costs. Previous research shows that higher quality handoffs, where receiving and transferring providers share the same shared mental model, result in better outcomes. We were interested in learning whether these shared mental models are being formed as a result of handoffs between the ward and the MICU.

Anton Garazha is a medical student at Chicago Medical School at Rosalind Franklin University in North Chicago. He received his bachelor of science degree in biology from Loyola University in Chicago in 2015 and his master of biomedical science degree from Rosalind Franklin University in 2016. Anton is very interested in community outreach and quality improvement, and in his spare time tutors students in science-based subjects.

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform healthcare and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

This summer, my research project focused on the highly vulnerable patients who are transferred from the medical intensive care unit to the general floor. Patients who are readmitted tend to have worse health outcomes, longer stays, higher mortality rates, and higher health care costs. Previous research shows that higher quality handoffs, where receiving and transferring providers share the same shared mental model, result in better outcomes. We were interested in learning whether these shared mental models are being formed as a result of handoffs between the ward and the MICU.

Anton Garazha is a medical student at Chicago Medical School at Rosalind Franklin University in North Chicago. He received his bachelor of science degree in biology from Loyola University in Chicago in 2015 and his master of biomedical science degree from Rosalind Franklin University in 2016. Anton is very interested in community outreach and quality improvement, and in his spare time tutors students in science-based subjects.

Editor’s Note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform healthcare and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the program, recipients are required to write about their experience on a biweekly basis.

This summer, my research project focused on the highly vulnerable patients who are transferred from the medical intensive care unit to the general floor. Patients who are readmitted tend to have worse health outcomes, longer stays, higher mortality rates, and higher health care costs. Previous research shows that higher quality handoffs, where receiving and transferring providers share the same shared mental model, result in better outcomes. We were interested in learning whether these shared mental models are being formed as a result of handoffs between the ward and the MICU.

Anton Garazha is a medical student at Chicago Medical School at Rosalind Franklin University in North Chicago. He received his bachelor of science degree in biology from Loyola University in Chicago in 2015 and his master of biomedical science degree from Rosalind Franklin University in 2016. Anton is very interested in community outreach and quality improvement, and in his spare time tutors students in science-based subjects.

Clinical question: Does exposure to a patient with a multidrug-resistant organism result in colonization of a health care provider?

Background: Multidrug-resistant organisms (MDROs) are growing threats in our hospitals, particularly vancomycin-resistant enterococci (VRE) and resistant gram-negative bacteria. The role of the health care team in preventing infection transmission is paramount. If a team member who is caring for a patient with an MDRO or handling lab specimens becomes colonized with these bacteria, he or she could potentially transmit them to the next patient.

Dr. Sata is a medical instructor, Duke University Hospital.

Clinical question: Does exposure to a patient with a multidrug-resistant organism result in colonization of a health care provider?

Background: Multidrug-resistant organisms (MDROs) are growing threats in our hospitals, particularly vancomycin-resistant enterococci (VRE) and resistant gram-negative bacteria. The role of the health care team in preventing infection transmission is paramount. If a team member who is caring for a patient with an MDRO or handling lab specimens becomes colonized with these bacteria, he or she could potentially transmit them to the next patient.

Dr. Sata is a medical instructor, Duke University Hospital.

Clinical question: Does exposure to a patient with a multidrug-resistant organism result in colonization of a health care provider?

Background: Multidrug-resistant organisms (MDROs) are growing threats in our hospitals, particularly vancomycin-resistant enterococci (VRE) and resistant gram-negative bacteria. The role of the health care team in preventing infection transmission is paramount. If a team member who is caring for a patient with an MDRO or handling lab specimens becomes colonized with these bacteria, he or she could potentially transmit them to the next patient.

Dr. Sata is a medical instructor, Duke University Hospital.

SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.

While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.

Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).

Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).

The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).

Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.

Of those studied, 444 (9%) died within 30 days of discharge.

Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.

Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.

Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.

The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.

Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.

The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”

Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.

Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.

[email protected]

SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.

SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.

While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.

Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).

Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).

The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).

Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.

Of those studied, 444 (9%) died within 30 days of discharge.

Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.

Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.

Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.

The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.

Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.

The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”

Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.

Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.

[email protected]

SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.

SAN DIEGO – Administering inpatient antiviral influenza treatment may reduce admissions to the ICU among adults hospitalized with flu, according to a study presented at ID Week 2017, an infectious diseases meeting.

While interventions did not directly affect flu-related deaths, lower ICU admission rates could reduce morbidity as well as ease the financial burden felt during the influenza season.

Investigators retrospectively studied 4,679 influenza patients admitted to Canadian Immunization Research Network Serious Outcomes Surveillance (SOS) Network hospitals during 2011-2014. Of the 54% of patients given inpatient antiviral treatment, the risk of being admitted to the ICU was reduced by 90% (odds ratio, 0.10;95% confidence interval, 0.08-0.13; P less than .001).

Antiviral treatment was not protective against death outcomes in patients with either influenza A or influenza B (OR, 0.9; 95% CI, 0.7-1.2; P =.454).

The median age of patients was 70 years, with a majority older than 75 years(41%); the majority presented with one or more comorbidities (89%), and had influenza A (72%).

Researchers found that, of the 4,679 patients studied, 798 (16%) were admitted to the ICU, 511 (11%) required mechanical ventilation, and the average length of hospital stay was 11 days.

Of those studied, 444 (9%) died within 30 days of discharge.

Researchers also found that only 38% of those studied had received the current seasonal vaccine upon admittance. However, these numbers may be skewed from the general population, because patients who have not taken the vaccine are more likely to be hospitalized.

Along with the results of antivirals on hospitalized patients, researchers wanted to uncover how the effectiveness of inpatient vaccine administration would vary based on treatment timing, said presenter Zach Shaffelburg of the Canadian Center for Vaccinology, Dalhousie University, Halifax, NS.

Even when administered 4.28 days after symptom onset, antiviral treatments in patients proved to be associated with significant reductions in ICU admissions and the need for mechanical ventilation.

The investigators concluded that antivirals show a strong association with positive effects on serious, influenza-related outcomes in hospitalized patients and, while therapy remained effective with later treatment start, patients would benefit the most from initiation as soon as possible.

Currently, the U.S. Centers for Disease Control and Prevention and the Canadian Immunization Research Network (CIRN) have guidelines instructing best practice for inpatient antiviral treatment, however the number of hospitalized patients given treatment has declined in Canada since 2009, according to Mr. Shaffelburg.

The reason more patients were not receiving inpatient antiviral treatment may be related to studies of different populations that failed to show significant impact, Mr. Shaffelburg suggested during a question and answer session following the presentation: “I think a lot of that comes from outpatient studies that involve patients who are younger and quite healthy [who received] antivirals, and it showed a very minimal impact,” Mr. Shaffelburg said. “So a lot of people saw that study and thought, ‘What’s that point of giving it if it’s not going to make an impact?’ ”

Mr. Shaffelburg and his colleagues are planning to continue their study of inpatient antiviral treatment, focusing more on the effectiveness of treatment in relation to time administered after onset.

Mr. Shaffelburg reported having no disclosures. The study was funded by the CIRN SOS network, Canadian Institutes for Health Research, and a partnership with GlaxoSmithKline Biologicals. Some of the investigators were GSK employees or received grant funding from the company.

[email protected]

SOURCE: Shaffelburg Z et al. IDWeek 2017 Abstract 890.

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

Clinical question: Can idarucizumab reverse anticoagulation effects of dabigatran in a timely manner for urgent surgery or in the event of bleeding?

Background: Reversing the anticoagulant properties of anticoagulants can be important in the event of a life-threatening bleed, or if patients taking these medications need urgent surgery or other interventions. Idarucizumab, a humanized monoclonal antibody fragment, can reverse anticoagulant activity of dabigatran, increasing its acceptance for prescribing physicians as well as patients.

Study design: Multicenter prospective single cohort study.

Setting: 173 sites, 39 countries.

Dr. Kamath is a hospitalist and medical director of quality and patient safety, Duke Regional Hospital, Duke University Health System.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.

State of Hospital Medicine Survey opens next month!

The 2018 State of Hospital Medicine Survey will begin in January and last through March with the release of the report in September 2018. Whether you are in a hospital medicine group in an academic or community setting, employed by a hospital or health system, a management company, a private group, or you serve adult or pediatric patients (or both), we need your participation.

Help us help you have the most comprehensive, up-to-date landscape of hospital medicine at your fingertips by participating. As a thank-you for your participation, your group will receive a free copy of the report. Sign up at hospitalmedicine.org/survey.
 

Apply for SHM’s MARQUIS Med Rec Collaborative kicking off in February 2018

SHM’s MARQUIS Med Rec Collaborative is designed to help hospitals across the United States implement evidence-based best practice medication reconciliation process change and improvement. The collaborative is a 14-month program, spanning from prelaunch to completion.

The staff has the expertise and experience of having completed two previous mentored implementation studies, involving 23 sites and thousands of patients. The collaborative also offers numerous resources, including training materials, project management and process improvement tools for hospitals to use to adapt for their needs to improve the medication reconciliation process. Visit hospitalmedicine.org/MARQUISrecruit to learn more.
 

Get engaged with public policy

Health care legislation is constantly evolving, and hospitalists play an important role in advocating for hospitalized patients and the hospital medicine movement. SHM is an active voice in many conversations on policy development and reform. Visit hospitalmedicine.org and sign up for the Grassroots Network to stay updated on developments in health care policy, share your experiences with health care programs and participate in policy forums.

Develop your career at Hospital Medicine 2018

Don’t miss SHM’s Annual Conference, Hospital Medicine 2018, to be held April 8-11, 2018. in Orlando. This year, the program was created to help you develop your hospital medicine career, no matter what stage you are in. Two new tracks include Seasoning Your Career and the Career Development Workshops.

Seasoning Your Career focuses on didactics designed to augment those committed to a career in hospital medicine, including topics such as career growth and development, resiliency, work-life balance, and how practical work matters such as schedules affect your career.

The new Career Development Workshops track includes six sessions that aim to help you use skills that will advance your career, such as: Leadership Essentials for Success in Hospital Medicine; Being Female in Hospital Medicine: Overcoming Individual and Institutional Barriers in the Workplace; Do You Have a Minute to Talk? Peer-to-Peer Feedback, and more.

Just starting out in hospital medicine? Back by popular demand, The Early-Career Hospitalists track has been designed for new hospitalists, resident physicians, and medical students interested in pursuing a career in hospital medicine. Designed by SHM’s Physicians-in-Training Committee, which includes nationally recognized hospitalists with expertise in scholarship, career development and medical education, this track aims to inspire future hospitalist leaders.

Visit shmannualconference.org/schedule to learn more.
 

Two new modules debut on SHM’s Learning Portal

SHM members have access to free continuing medical education (CME) and Maintenance of Certification (MOC) points with the SHM Learning Portal. Don’t miss two new modules: Role of the Medical Consultant and Anesthesia for Internists.

Medical consultation is an important clinical component for most hospitalists. Today, hospitalists also are asked to provide both “curbside” advice and more comprehensive comanagement of medical problems. Hospitalists who are effective consultants communicate skillfully and act professionally. The Role of the Medical Consultant module describes the different roles that hospitalists can perform as medical consultants and provides strategies for improving communications and referring physician satisfaction.

Looking for up-to-date information about surgical anesthesia? The Anesthesia for Internists module discusses the basic forms of surgical anesthesia and contraindications to each, as well as the most commonly used anesthetic drugs, their mechanisms of actions, and side effects.

Both modules are free for SHM members and $45.00 per module for nonmembers. Earn 2 AMA PRA Category 1 Credits™ and 2 MOC points per each module. Visit shmlearningportal.org to get started today.
 

Not a member? Join the movement today

More than 15,000 members have joined SHM to show their commitment to revolutionizing patient care. As a member, you will be connected with a wealth of opportunities designed to help you grow professionally, network with colleagues nationwide, and shape the practice of hospital medicine. See a full list of member benefits or become a member today at hospitalmedicine.org/join.

Join a chapter and connect to your local hospital medicine community

SHM hosts more than 50 local chapters nationwide to encourage networking, collaboration, and innovation within the hospital medicine community. Getting involved with your local chapter allows you to share knowledge, engage with colleagues, and stay current on the latest developments in hospital medicine.

Visit hospitalmedicine.org/chapters to find a chapter in your area.

Mr. Radler is marketing communications manager at the Society of Hospital Medicine.

Roughly 6 months ago, a primary care physician referred a patient to our clinic for an assessment for opioid use disorder and a recommendation for treatment. The patient estimated, likely underestimated, his daily heroin use to five bags and dropped positive, in addition to heroin, for benzodiazepines, amphetamines, and cannabis. He was in a profession in which public safety was a critical concern, and he refused to notify his employer’s employee assistance program. He also declined to voluntarily admit himself for detox and treatment at the local, fully accredited addiction program, which was affiliated with a major university medical center. Instead, after an Internet search, the patient opted for an opioid treatment center featuring massage therapy, acupuncture, a stable, a sweat lodge – and a magnificent view of the Pacific Ocean.

Dr. Marseille is a psychiatrist who works on the staff of a clinic in Wheaton, Ill. His special interests include adolescent and addiction medicine, eating disorders, trauma, bipolar disorder, and the psychiatric manifestations of acute and chronic medical conditions.

This article was updated 12/15/17.

Roughly 6 months ago, a primary care physician referred a patient to our clinic for an assessment for opioid use disorder and a recommendation for treatment. The patient estimated, likely underestimated, his daily heroin use to five bags and dropped positive, in addition to heroin, for benzodiazepines, amphetamines, and cannabis. He was in a profession in which public safety was a critical concern, and he refused to notify his employer’s employee assistance program. He also declined to voluntarily admit himself for detox and treatment at the local, fully accredited addiction program, which was affiliated with a major university medical center. Instead, after an Internet search, the patient opted for an opioid treatment center featuring massage therapy, acupuncture, a stable, a sweat lodge – and a magnificent view of the Pacific Ocean.

Dr. Marseille is a psychiatrist who works on the staff of a clinic in Wheaton, Ill. His special interests include adolescent and addiction medicine, eating disorders, trauma, bipolar disorder, and the psychiatric manifestations of acute and chronic medical conditions.

This article was updated 12/15/17.

Roughly 6 months ago, a primary care physician referred a patient to our clinic for an assessment for opioid use disorder and a recommendation for treatment. The patient estimated, likely underestimated, his daily heroin use to five bags and dropped positive, in addition to heroin, for benzodiazepines, amphetamines, and cannabis. He was in a profession in which public safety was a critical concern, and he refused to notify his employer’s employee assistance program. He also declined to voluntarily admit himself for detox and treatment at the local, fully accredited addiction program, which was affiliated with a major university medical center. Instead, after an Internet search, the patient opted for an opioid treatment center featuring massage therapy, acupuncture, a stable, a sweat lodge – and a magnificent view of the Pacific Ocean.

Dr. Marseille is a psychiatrist who works on the staff of a clinic in Wheaton, Ill. His special interests include adolescent and addiction medicine, eating disorders, trauma, bipolar disorder, and the psychiatric manifestations of acute and chronic medical conditions.

This article was updated 12/15/17.

The Food and Drug Administration has approved a premixed sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution (Clenpiq) for cleansing of the colon in adults preparing to undergo colonoscopy, according to Ferring Pharmaceuticals.

The sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution is a relatively low-volume, premixed, cranberry-flavored solution, making it easier to use and more palatable for patients.

The oral solution is approved with two dosing options: split dose, one dose the evening prior and one dose the morning of the procedure, or the day before dose, which involves taking both doses the day prior to the procedure. Day before dosing is an alternative and should be used when split dosing is not appropriate. After each dose of sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution, clear liquids should be consumed based on the dosing recommendation. The American College of Gastroenterology recommends the split-dose regimen because of its improved cleansing quality of the colon and better tolerability of the liquid volume by patients.

Patients with impaired renal function should exercise caution if using sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution as it may effect renal function. A more comprehensive list of safety information is available at www.clenpiq.com.
 

[email protected]

The Food and Drug Administration has approved a premixed sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution (Clenpiq) for cleansing of the colon in adults preparing to undergo colonoscopy, according to Ferring Pharmaceuticals.

The sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution is a relatively low-volume, premixed, cranberry-flavored solution, making it easier to use and more palatable for patients.

The oral solution is approved with two dosing options: split dose, one dose the evening prior and one dose the morning of the procedure, or the day before dose, which involves taking both doses the day prior to the procedure. Day before dosing is an alternative and should be used when split dosing is not appropriate. After each dose of sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution, clear liquids should be consumed based on the dosing recommendation. The American College of Gastroenterology recommends the split-dose regimen because of its improved cleansing quality of the colon and better tolerability of the liquid volume by patients.

Patients with impaired renal function should exercise caution if using sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution as it may effect renal function. A more comprehensive list of safety information is available at www.clenpiq.com.
 

[email protected]

The Food and Drug Administration has approved a premixed sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution (Clenpiq) for cleansing of the colon in adults preparing to undergo colonoscopy, according to Ferring Pharmaceuticals.

The sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution is a relatively low-volume, premixed, cranberry-flavored solution, making it easier to use and more palatable for patients.

The oral solution is approved with two dosing options: split dose, one dose the evening prior and one dose the morning of the procedure, or the day before dose, which involves taking both doses the day prior to the procedure. Day before dosing is an alternative and should be used when split dosing is not appropriate. After each dose of sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution, clear liquids should be consumed based on the dosing recommendation. The American College of Gastroenterology recommends the split-dose regimen because of its improved cleansing quality of the colon and better tolerability of the liquid volume by patients.

Patients with impaired renal function should exercise caution if using sodium picosulfate, magnesium oxide, and anhydrous citric acid oral solution as it may effect renal function. A more comprehensive list of safety information is available at www.clenpiq.com.
 

[email protected]

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.

For many patients, paying for medication presents a serious challenge. Studies show that up to 45% of Americans do not fill prescriptions secondary to cost, and medication nonadherence leads to morbidity and mortality, with costs from $100 billion to $300 billion annually.

One way to address the problem is by empowering clinicians to reduce patient outpatient medication costs – the goal described in a recent abstract.

Reference

Kubey A et al. Expensive free hospitalizations – A novel approach to reducing outpatient medication cost [abstract]. J Hosp Med. 2017; 12 (suppl 2). Accessed Aug. 7, 2017.