User login
Official news magazine of the Society of Hospital Medicine
Copyright by Society of Hospital Medicine or related companies. All rights reserved. ISSN 1553-085X
nav[contains(@class, 'nav-ce-stack nav-ce-stack__large-screen')]
header[@id='header']
div[contains(@class, 'header__large-screen')]
div[contains(@class, 'read-next-article')]
div[contains(@class, 'main-prefix')]
div[contains(@class, 'nav-primary')]
nav[contains(@class, 'nav-primary')]
section[contains(@class, 'footer-nav-section-wrapper')]
footer[@id='footer']
section[contains(@class, 'nav-hidden')]
div[contains(@class, 'ce-card-content')]
nav[contains(@class, 'nav-ce-stack')]
div[contains(@class, 'view-medstat-quiz-listing-panes')]
div[contains(@class, 'pane-article-sidebar-latest-news')]
div[contains(@class, 'pane-pub-article-hospitalist')]
Dr. Geeta Arora Brings Her Passion for Locum Tenens Work to TH’s Editorial Board
If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.
As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.
Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.
Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:
Question: Why did you choose a career in medicine?
Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.
Q: How/when did you decide to become a hospitalist?
A: I decided to become a hospitalist as soon as I graduated residency.
Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?
A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.
Q: What do you like most about working as a hospitalist?
A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.
Q: What do you dislike most?
A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.
Q: What’s the best advice you ever received?
A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.
Q: What’s the worst advice you ever received?
A: Always practice defensive medicine because, if you don’t, you will get sued.
Q: Have you tried to mentor others? Why or why not?
A: I have mentored several medical students because I feel it is important to give back to the next generation.
Q: What’s the biggest change you’ve seen in HM in your career?
A: More paperwork.
Q: What’s the biggest change you would like to see in HM?
A: Decreasing paperwork.
Q: What aspect of patient care is most rewarding?
A: Connecting with patients.
Q: What is your biggest professional challenge?
A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.
Q: What is your biggest professional reward?
A: Being able to work with and learn from other hospitalists.
Q: Outside of patient care, tell us about your career interests.
A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: What’s next professionally?
A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.
Q: What’s the best book you’ve read recently? Why?
A: Fortify Your Life, a book about supplements.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: iPhone and MacBook on a daily basis.
Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?
A: I use them for electronic health records.
Q: What’s your favorite social network? Do you use it at all for work or professional development?
A: Instagram, but not for work.
Richard Quinn is a freelance writer in New Jersey.
If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.
As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.
Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.
Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:
Question: Why did you choose a career in medicine?
Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.
Q: How/when did you decide to become a hospitalist?
A: I decided to become a hospitalist as soon as I graduated residency.
Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?
A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.
Q: What do you like most about working as a hospitalist?
A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.
Q: What do you dislike most?
A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.
Q: What’s the best advice you ever received?
A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.
Q: What’s the worst advice you ever received?
A: Always practice defensive medicine because, if you don’t, you will get sued.
Q: Have you tried to mentor others? Why or why not?
A: I have mentored several medical students because I feel it is important to give back to the next generation.
Q: What’s the biggest change you’ve seen in HM in your career?
A: More paperwork.
Q: What’s the biggest change you would like to see in HM?
A: Decreasing paperwork.
Q: What aspect of patient care is most rewarding?
A: Connecting with patients.
Q: What is your biggest professional challenge?
A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.
Q: What is your biggest professional reward?
A: Being able to work with and learn from other hospitalists.
Q: Outside of patient care, tell us about your career interests.
A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: What’s next professionally?
A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.
Q: What’s the best book you’ve read recently? Why?
A: Fortify Your Life, a book about supplements.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: iPhone and MacBook on a daily basis.
Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?
A: I use them for electronic health records.
Q: What’s your favorite social network? Do you use it at all for work or professional development?
A: Instagram, but not for work.
Richard Quinn is a freelance writer in New Jersey.
If Geeta Arora, MD, were to purchase a personalized license plate, it probably would say something like “B3ACHNUT” or “SURF5UP.” Like many in the profession, she enjoys traveling and helping others. She’s a surfer girl, with a love of the beach and a heart for global medicine. And if given the chance, she says she’d rather be “selling coconuts on a beach” in the Caribbean, Costa Rica, or some other island paradise.
As a locum tenens hospitalist, Dr. Arora is based in New York City, but is licensed to practice in six states. In addition to her board certification in internal medicine, she also is board certified in integrative holistic medicine, something she hopes to expand on in coming years. She’s also active in telemedicine, providing outpatient consulting via phone or video chat with MDLive since 2014.
Dr. Arora, one of eight new members of Team Hospitalist, the volunteer editorial advisory board for The Hospitalist, had published a number of “Letters to the Editor” in SHM’s official newsmagazine prior to her application. The article topics were close to her heart, of course, with headlines reading “How Locums Tenens Can Help Avoid Burnout” and “5 Tips to Finding a Good Locum Tenens Company.” In fact, she recently was one of the interviewees for a TH video focused on working as a locum tenens hospitalist.
Dr. Arora recently stepped away from her busy schedule to chat with The Hospitalist:
Question: Why did you choose a career in medicine?
Answer: I wanted the opportunity to be present with people in some of the most vulnerable times in their lives and be able to help them when they are most vulnerable.
Q: How/when did you decide to become a hospitalist?
A: I decided to become a hospitalist as soon as I graduated residency.
Q: I see you completed undergrad at University of Guelph in Ontario, Canada. Tell us about your medical training. Was there a single moment you knew “I can do this”?
A: I went to medical school [at the Medical University of the Americas] in the Caribbean on an island called Nevis. My residency was at Albany Medical Center in Albany, N.Y. I disliked the politics of residency. I remember thinking, “I can do this,” in my third year of residency when I had just run two codes and was placing lines in a patient in the middle of the night on my own. I was surprised to find myself without any feeling of doubt in my mind as I placed the lines.
Q: What do you like most about working as a hospitalist?
A: I really enjoy the flexibility of my schedule and the large range of disease processes I see in a single day.
Q: What do you dislike most?
A: The immense amount of paperwork and the constant feeling of having administration trying to tell hospitalists how to do their job.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: The most challenging part of patient care, for me, is changing the plan of the previous provider. For example, if the physician that had been seeing the patient prior to me had promised that a CT scan would be repeated, but there is no indication, that often turns into a lengthy discussion with the patient and the patient’s family. And that can sometimes be challenging.
Q: What’s the best advice you ever received?
A: As long as you are doing everything in the best interest of your patient, you are doing the right thing.
Q: What’s the worst advice you ever received?
A: Always practice defensive medicine because, if you don’t, you will get sued.
Q: Have you tried to mentor others? Why or why not?
A: I have mentored several medical students because I feel it is important to give back to the next generation.
Q: What’s the biggest change you’ve seen in HM in your career?
A: More paperwork.
Q: What’s the biggest change you would like to see in HM?
A: Decreasing paperwork.
Q: What aspect of patient care is most rewarding?
A: Connecting with patients.
Q: What is your biggest professional challenge?
A: Leaving a hospital because of poor administrative processes, especially when the hospitalist group is excellent to work with.
Q: What is your biggest professional reward?
A: Being able to work with and learn from other hospitalists.
Q: Outside of patient care, tell us about your career interests.
A: I have a passion for locum tenens hospitalist medicine. I enjoy practicing in different types of communities across the country, and I enjoy teaching others to do the same. I also enjoy consulting hospitals about how to improve their hospitalist systems. Telemedicine platform consultation has also become one of my interests.
Q: Where do you see yourself in 10 years?
A: Retired.
Q: What’s next professionally?
A: I enjoy practicing global medicine. My next destination is Cambodia in October. I’d like to increase the number of global medicine trips I do per year. I also have a very strong interest in integrative holistic medicine and am excited about expanding my practice in the coming year.
Q: What’s the best book you’ve read recently? Why?
A: Fortify Your Life, a book about supplements.
Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?
A: iPhone and MacBook on a daily basis.
Q: What impact do you feel devices like those just mentioned have had on HM? And medicine in a broader sense?
A: I use them for electronic health records.
Q: What’s your favorite social network? Do you use it at all for work or professional development?
A: Instagram, but not for work.
Richard Quinn is a freelance writer in New Jersey.
Make Your Nominations for SHM Designations Now
- Awards of Excellence: www.hospitalmedicine.org/awards
- Board of Directors: www.hospitalmedicine.org/boardelection
- Committee nominations: www.hospitalmedicine.org/committee
- Masters of Hospital Medicine: www.hospitalmedicine.org/masters
- Awards of Excellence: www.hospitalmedicine.org/awards
- Board of Directors: www.hospitalmedicine.org/boardelection
- Committee nominations: www.hospitalmedicine.org/committee
- Masters of Hospital Medicine: www.hospitalmedicine.org/masters
- Awards of Excellence: www.hospitalmedicine.org/awards
- Board of Directors: www.hospitalmedicine.org/boardelection
- Committee nominations: www.hospitalmedicine.org/committee
- Masters of Hospital Medicine: www.hospitalmedicine.org/masters
Earn Fellow in Hospital Medicine Designation
If you applied for early decision on or before September 15, you’ll hear back on or before October 28, 2016. The regular decision application will remain open through November 30, with a decision on or before December 31, 2016. Apply now and learn how you can join other hospitalists who have earned this exclusive designation and recognition at www.hospitalmedicine.org/fellows.
If you applied for early decision on or before September 15, you’ll hear back on or before October 28, 2016. The regular decision application will remain open through November 30, with a decision on or before December 31, 2016. Apply now and learn how you can join other hospitalists who have earned this exclusive designation and recognition at www.hospitalmedicine.org/fellows.
If you applied for early decision on or before September 15, you’ll hear back on or before October 28, 2016. The regular decision application will remain open through November 30, with a decision on or before December 31, 2016. Apply now and learn how you can join other hospitalists who have earned this exclusive designation and recognition at www.hospitalmedicine.org/fellows.
Authors Needed for SHM Clinical Quick Talks
Busy clinical services and multiple demands on hospitalists’ time make it difficult to prepare brief talks to give to residents and students. The SHM Education Committee has created SHM Clinical Quick Talks, a bank of short prepared lectures on the SHM website. SHM Clinical Quick Talks are designed to be given in fewer than 10 minutes and are intended for use during teaching rounds, for a brief sit-down, or whenever time allows.
SHM is looking for additional authors for this series of micro-lectures. Read more and learn how to submit at connect.hospitalmedicine.org/clinicalquicktalks.
Busy clinical services and multiple demands on hospitalists’ time make it difficult to prepare brief talks to give to residents and students. The SHM Education Committee has created SHM Clinical Quick Talks, a bank of short prepared lectures on the SHM website. SHM Clinical Quick Talks are designed to be given in fewer than 10 minutes and are intended for use during teaching rounds, for a brief sit-down, or whenever time allows.
SHM is looking for additional authors for this series of micro-lectures. Read more and learn how to submit at connect.hospitalmedicine.org/clinicalquicktalks.
Busy clinical services and multiple demands on hospitalists’ time make it difficult to prepare brief talks to give to residents and students. The SHM Education Committee has created SHM Clinical Quick Talks, a bank of short prepared lectures on the SHM website. SHM Clinical Quick Talks are designed to be given in fewer than 10 minutes and are intended for use during teaching rounds, for a brief sit-down, or whenever time allows.
SHM is looking for additional authors for this series of micro-lectures. Read more and learn how to submit at connect.hospitalmedicine.org/clinicalquicktalks.
Opioids, Obesity among Topics in Newly Released AAP Clinical Reports
NEW YORK (Reuters Health) - The American Academy of Pediatrics (AAP) today released six clinical reports and one policy statement covering a range of timely topics relevant to the health and care of children. Here is a snapshot.
1) Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies.
This report focuses on the issues relevant to children and adolescents presenting to the emergency department (ED) or primary care clinic with a mental health condition or emergency and covers the following topics: medical clearance of pediatric psychiatric patients; suicidal ideation and suicide attempts; involuntary hospitalization; restraint of the agitated patient (verbal restraint, chemical restraint and physical restraint); coordination with the medical home.
2) Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms.
This clinical report focuses on the challenges a pediatrician may face when evaluating patients with a mental health condition, which may be contributing to or complicating a medical or indeterminate clinical presentation. Topics include somatic symptom and related disorders; adverse effects of psychiatric medications (antipsychotic adverse effects, neuroleptic malignant syndrome, serotonin syndrome); children with special needs in the ED (autism spectrum and developmental disorders); mental health screening in the ED.
Both reports are from the AAP Committee on Pediatric Emergency Medicine and the American College of Emergency Physicians Pediatric Emergency Medicine Committee and include an executive summary.
3) Mind-Body Therapies in Children and Youth
From the AAP Section on Integrative Medicine, this report notes that a "growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety."
4) Preventing Obesity and Eating Disorders in Adolescents
This report, from the AAP Committee on Nutrition, Committee on Adolescence, Section on Obesity, notes that "messages from pediatricians addressing obesity and reviewing constructive ways to manage weight can be safely and supportively incorporated into health care visits. Avoiding certain weight-based language and using motivational interviewing (MI) techniques may improve communication and promote successful outcomes when providing weight-management counseling. This clinical report addresses the interaction between obesity prevention and eating disorders (EDs) in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs."
5) Parental Presence During Treatment of Ebola or Other Highly Consequential Infection
From the AAP Committee on Infectious Diseases, this report offers "guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations."
6) Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns
This report, from the Committee on Fetus and Newborn, Task Force on Sudden Infant Death Syndrome, notes that skin-to-skin care (SSC) and rooming-in are now common in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as outlined in the World Health Organization's "Ten Steps to Successful Breastfeeding." The evidence indicates that implementation of these practices "increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies."
The policy statement - Medication-Assisted Treatment of Adolescents With Opioid Use Disorders - is from the Committee on Substance Use and Prevention. It notes that opioid use disorder is "a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction."
"The AAP recommends that pediatricians consider offering medication-assisted treatment to their adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service," the statement advises.
The six clinical reports and one policy statement are published in the September issue of Pediatrics and were released online August 22.
SOURCE: http://bit.ly/2bfNEj8
Pediatrics 2016.
(c) Copyright Thomson Reuters 2016.
NEW YORK (Reuters Health) - The American Academy of Pediatrics (AAP) today released six clinical reports and one policy statement covering a range of timely topics relevant to the health and care of children. Here is a snapshot.
1) Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies.
This report focuses on the issues relevant to children and adolescents presenting to the emergency department (ED) or primary care clinic with a mental health condition or emergency and covers the following topics: medical clearance of pediatric psychiatric patients; suicidal ideation and suicide attempts; involuntary hospitalization; restraint of the agitated patient (verbal restraint, chemical restraint and physical restraint); coordination with the medical home.
2) Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms.
This clinical report focuses on the challenges a pediatrician may face when evaluating patients with a mental health condition, which may be contributing to or complicating a medical or indeterminate clinical presentation. Topics include somatic symptom and related disorders; adverse effects of psychiatric medications (antipsychotic adverse effects, neuroleptic malignant syndrome, serotonin syndrome); children with special needs in the ED (autism spectrum and developmental disorders); mental health screening in the ED.
Both reports are from the AAP Committee on Pediatric Emergency Medicine and the American College of Emergency Physicians Pediatric Emergency Medicine Committee and include an executive summary.
3) Mind-Body Therapies in Children and Youth
From the AAP Section on Integrative Medicine, this report notes that a "growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety."
4) Preventing Obesity and Eating Disorders in Adolescents
This report, from the AAP Committee on Nutrition, Committee on Adolescence, Section on Obesity, notes that "messages from pediatricians addressing obesity and reviewing constructive ways to manage weight can be safely and supportively incorporated into health care visits. Avoiding certain weight-based language and using motivational interviewing (MI) techniques may improve communication and promote successful outcomes when providing weight-management counseling. This clinical report addresses the interaction between obesity prevention and eating disorders (EDs) in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs."
5) Parental Presence During Treatment of Ebola or Other Highly Consequential Infection
From the AAP Committee on Infectious Diseases, this report offers "guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations."
6) Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns
This report, from the Committee on Fetus and Newborn, Task Force on Sudden Infant Death Syndrome, notes that skin-to-skin care (SSC) and rooming-in are now common in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as outlined in the World Health Organization's "Ten Steps to Successful Breastfeeding." The evidence indicates that implementation of these practices "increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies."
The policy statement - Medication-Assisted Treatment of Adolescents With Opioid Use Disorders - is from the Committee on Substance Use and Prevention. It notes that opioid use disorder is "a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction."
"The AAP recommends that pediatricians consider offering medication-assisted treatment to their adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service," the statement advises.
The six clinical reports and one policy statement are published in the September issue of Pediatrics and were released online August 22.
SOURCE: http://bit.ly/2bfNEj8
Pediatrics 2016.
(c) Copyright Thomson Reuters 2016.
NEW YORK (Reuters Health) - The American Academy of Pediatrics (AAP) today released six clinical reports and one policy statement covering a range of timely topics relevant to the health and care of children. Here is a snapshot.
1) Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies.
This report focuses on the issues relevant to children and adolescents presenting to the emergency department (ED) or primary care clinic with a mental health condition or emergency and covers the following topics: medical clearance of pediatric psychiatric patients; suicidal ideation and suicide attempts; involuntary hospitalization; restraint of the agitated patient (verbal restraint, chemical restraint and physical restraint); coordination with the medical home.
2) Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms.
This clinical report focuses on the challenges a pediatrician may face when evaluating patients with a mental health condition, which may be contributing to or complicating a medical or indeterminate clinical presentation. Topics include somatic symptom and related disorders; adverse effects of psychiatric medications (antipsychotic adverse effects, neuroleptic malignant syndrome, serotonin syndrome); children with special needs in the ED (autism spectrum and developmental disorders); mental health screening in the ED.
Both reports are from the AAP Committee on Pediatric Emergency Medicine and the American College of Emergency Physicians Pediatric Emergency Medicine Committee and include an executive summary.
3) Mind-Body Therapies in Children and Youth
From the AAP Section on Integrative Medicine, this report notes that a "growing body of evidence supports the effectiveness and safety of mind-body therapies in pediatrics. This clinical report outlines popular mind-body therapies for children and youth and examines the best-available evidence for a variety of mind-body therapies and practices, including biofeedback, clinical hypnosis, guided imagery, meditation, and yoga. The report is intended to help health care professionals guide their patients to nonpharmacologic approaches to improve concentration, help decrease pain, control discomfort, or ease anxiety."
4) Preventing Obesity and Eating Disorders in Adolescents
This report, from the AAP Committee on Nutrition, Committee on Adolescence, Section on Obesity, notes that "messages from pediatricians addressing obesity and reviewing constructive ways to manage weight can be safely and supportively incorporated into health care visits. Avoiding certain weight-based language and using motivational interviewing (MI) techniques may improve communication and promote successful outcomes when providing weight-management counseling. This clinical report addresses the interaction between obesity prevention and eating disorders (EDs) in teenagers, provides the pediatrician with evidence-informed tools to identify behaviors that predispose to both obesity and EDs, and provides guidance about obesity and ED prevention messages. The focus should be on a healthy lifestyle rather than on weight. Evidence suggests that obesity prevention and treatment, if conducted correctly, do not predispose to EDs."
5) Parental Presence During Treatment of Ebola or Other Highly Consequential Infection
From the AAP Committee on Infectious Diseases, this report offers "guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations."
6) Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns
This report, from the Committee on Fetus and Newborn, Task Force on Sudden Infant Death Syndrome, notes that skin-to-skin care (SSC) and rooming-in are now common in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as outlined in the World Health Organization's "Ten Steps to Successful Breastfeeding." The evidence indicates that implementation of these practices "increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies."
The policy statement - Medication-Assisted Treatment of Adolescents With Opioid Use Disorders - is from the Committee on Substance Use and Prevention. It notes that opioid use disorder is "a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction."
"The AAP recommends that pediatricians consider offering medication-assisted treatment to their adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service," the statement advises.
The six clinical reports and one policy statement are published in the September issue of Pediatrics and were released online August 22.
SOURCE: http://bit.ly/2bfNEj8
Pediatrics 2016.
(c) Copyright Thomson Reuters 2016.
Using Brochures, Business Cards to Make Personal Connection with Patients
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
View a chart outlining key communication tactics
What I Say and Do
I sit down at patients’ eye level during patient visits and use a team brochure/personal business card for all new patients.
Why I Do It
One of the major concerns expressed by patients is the time spent with them by their provider. Sitting down at patients’ eye level lets them know that you are not in a hurry and you are there to give them whatever time they need. Sitting also causes your patients to perceive that you spent more time with them than if you spent the same amount of time while standing. This practice is not only advocated by patient-care consultants but is something I had reinforced during my firsthand experience as a patient several years ago when I had a surgical procedure. Every time the surgeon came into my hospital room, he sat in the chair, leisurely crossed his legs, and spoke to me from that position while writing in the chart. I knew exactly what he was doing, and it still made a difference to me! It put me more at ease and made me feel that he was there for me, ready to give me whatever time I needed and answer any questions that I had (and I had them). Sitting also puts you on an even level with your patients so they feel that you are talking with them, not down to them. This eases tension, adds comfort and trust to the situation, and is much more engaging.
How I Do It
After I greet patients, I look for a place to sit. If there is a chair, I pull it over to the bedside, sit in a relaxed manner, and continue the visit. If there is no chair in the room, I will sit on the windowsill, the bedside table (I have even been known to lower the bedside tray table and sit on the end with the support post if there is room on it), or whatever I can utilize to physically put myself on patients’ level. As a last resort, as long as there is not an isolatable infection, I will ask permission to sit on the edge of the bed. I make a point of telling them during this process that I am looking for a place to sit and talk so that they know this is my goal.
After the initial conversation and exam, if the patients are new to the service, I walk them through our team brochure and reiterate how we act as their PCP in the hospital and how we communicate with their PCP. I also make a point to show the team photo roster, which personalizes our team to patients, and say, “I also want you to have one of my baseball cards. We call our business cards ‘baseball cards’ because they have our pictures and a lot of ‘stats’ on them: our training, personal interests. That way, you know more about the person who is helping to take care of you.” I almost always see these cards out on patients’ trays or bedside tables on subsequent visits. Patients seem appreciative of the cards and the information. If I see another provider’s baseball card, I will ask patients a question about that provider as a way to continue to foster relations between our patients and our team. The more our patients can relate to us, the more they will trust us and the better their experience will be. TH
Dr. Sharp is a chief hospitalist with Sound Physicians at UF Health in Jacksonville, Fla.
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
View a chart outlining key communication tactics
What I Say and Do
I sit down at patients’ eye level during patient visits and use a team brochure/personal business card for all new patients.
Why I Do It
One of the major concerns expressed by patients is the time spent with them by their provider. Sitting down at patients’ eye level lets them know that you are not in a hurry and you are there to give them whatever time they need. Sitting also causes your patients to perceive that you spent more time with them than if you spent the same amount of time while standing. This practice is not only advocated by patient-care consultants but is something I had reinforced during my firsthand experience as a patient several years ago when I had a surgical procedure. Every time the surgeon came into my hospital room, he sat in the chair, leisurely crossed his legs, and spoke to me from that position while writing in the chart. I knew exactly what he was doing, and it still made a difference to me! It put me more at ease and made me feel that he was there for me, ready to give me whatever time I needed and answer any questions that I had (and I had them). Sitting also puts you on an even level with your patients so they feel that you are talking with them, not down to them. This eases tension, adds comfort and trust to the situation, and is much more engaging.
How I Do It
After I greet patients, I look for a place to sit. If there is a chair, I pull it over to the bedside, sit in a relaxed manner, and continue the visit. If there is no chair in the room, I will sit on the windowsill, the bedside table (I have even been known to lower the bedside tray table and sit on the end with the support post if there is room on it), or whatever I can utilize to physically put myself on patients’ level. As a last resort, as long as there is not an isolatable infection, I will ask permission to sit on the edge of the bed. I make a point of telling them during this process that I am looking for a place to sit and talk so that they know this is my goal.
After the initial conversation and exam, if the patients are new to the service, I walk them through our team brochure and reiterate how we act as their PCP in the hospital and how we communicate with their PCP. I also make a point to show the team photo roster, which personalizes our team to patients, and say, “I also want you to have one of my baseball cards. We call our business cards ‘baseball cards’ because they have our pictures and a lot of ‘stats’ on them: our training, personal interests. That way, you know more about the person who is helping to take care of you.” I almost always see these cards out on patients’ trays or bedside tables on subsequent visits. Patients seem appreciative of the cards and the information. If I see another provider’s baseball card, I will ask patients a question about that provider as a way to continue to foster relations between our patients and our team. The more our patients can relate to us, the more they will trust us and the better their experience will be. TH
Dr. Sharp is a chief hospitalist with Sound Physicians at UF Health in Jacksonville, Fla.
Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one or more of the “key communication” tactics in practice to maintain provider accountability for “everything we say and do that affects our patients’ thoughts, feelings, and well-being.”
View a chart outlining key communication tactics
What I Say and Do
I sit down at patients’ eye level during patient visits and use a team brochure/personal business card for all new patients.
Why I Do It
One of the major concerns expressed by patients is the time spent with them by their provider. Sitting down at patients’ eye level lets them know that you are not in a hurry and you are there to give them whatever time they need. Sitting also causes your patients to perceive that you spent more time with them than if you spent the same amount of time while standing. This practice is not only advocated by patient-care consultants but is something I had reinforced during my firsthand experience as a patient several years ago when I had a surgical procedure. Every time the surgeon came into my hospital room, he sat in the chair, leisurely crossed his legs, and spoke to me from that position while writing in the chart. I knew exactly what he was doing, and it still made a difference to me! It put me more at ease and made me feel that he was there for me, ready to give me whatever time I needed and answer any questions that I had (and I had them). Sitting also puts you on an even level with your patients so they feel that you are talking with them, not down to them. This eases tension, adds comfort and trust to the situation, and is much more engaging.
How I Do It
After I greet patients, I look for a place to sit. If there is a chair, I pull it over to the bedside, sit in a relaxed manner, and continue the visit. If there is no chair in the room, I will sit on the windowsill, the bedside table (I have even been known to lower the bedside tray table and sit on the end with the support post if there is room on it), or whatever I can utilize to physically put myself on patients’ level. As a last resort, as long as there is not an isolatable infection, I will ask permission to sit on the edge of the bed. I make a point of telling them during this process that I am looking for a place to sit and talk so that they know this is my goal.
After the initial conversation and exam, if the patients are new to the service, I walk them through our team brochure and reiterate how we act as their PCP in the hospital and how we communicate with their PCP. I also make a point to show the team photo roster, which personalizes our team to patients, and say, “I also want you to have one of my baseball cards. We call our business cards ‘baseball cards’ because they have our pictures and a lot of ‘stats’ on them: our training, personal interests. That way, you know more about the person who is helping to take care of you.” I almost always see these cards out on patients’ trays or bedside tables on subsequent visits. Patients seem appreciative of the cards and the information. If I see another provider’s baseball card, I will ask patients a question about that provider as a way to continue to foster relations between our patients and our team. The more our patients can relate to us, the more they will trust us and the better their experience will be. TH
Dr. Sharp is a chief hospitalist with Sound Physicians at UF Health in Jacksonville, Fla.
Pediatric Hospital Medicine 2016 Wrap Up
Pediatric Hospital Medicine 2016, cosponsored by the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), and the Society of Hospital Medicine (SHM), took place July 28–31 in Chicago. Didn’t make it? Here are all the news, research, and talking points you need to know.
Shape Your Brain to Avoid Burnout
Presenter: Lisa Zaoutis, MD, FHM
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, composed of hospitalists, PHM program leaders, and advanced-care practitioners, gathered to educate and inspire one another in the care of hospitalized children.
Lisa Zaoutis, MD, FHM, director of the pediatric residency program at The Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into pediatric hospital medicine and negative experiences that often drive behavior, she started with the beginning: the evolution of our brains.
“We are wired toward the negative,” Dr. Zaoutis said. “We are Teflon for positive experiences and Velcro for negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists leads to anxiety responses that are faster, more robust, and more easily triggered.
But all is not lost, Dr. Zaoutis noted, as our brains are more plastic than previously known. The “neural Darwinism” of our brains, she said, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience-dependent neuroplasticity. For example, London taxi drivers have thicker white matter in their hippocampus as a result of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways
The lesson for pediatric hospitalists, according Dr. Zaoutis, is that you can shape your brain for greater joy.
“Consciously choose activities” that counter our evolutionary negativity bias, Dr. Zaoutis said.
Here’s how to do it:
- Have a positive experience. (You can create one or retrieve a prior one.)
- Enrich it and install it by dwelling on it for at least 15–30 seconds.
- Absorb it into your body, which may require somatizing it. (Dr. Zaoutis presses her hand into her chest to aid in this.)
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your sign-out with the best thing that happened to you in the week. Most important, start with observing yourself.
Weijen Chang, MD, SFHM, is pediatric editor of The Hospitalist. He is associate clinical professor of medicine and pediatrics at the University of California, San Diego (UCSD) School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. Send comments and questions to [email protected].
New AAP Guideline on Evaluating, Managing Febrile Infants
Presenter: Kenneth Roberts, MD
One of PHM16’s most highly attended sessions was an update on the anticipated AAP guidelines for febrile infants ages 7–90 days. The updated guidelines stress the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C.
Exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.
The updated guideline will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk.
Key Takeaway
An updated AAP guideline algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days, and 60–90 days will be coming in the near future. It will help standardize care in this population but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
Promoting, Teaching Pediatric High-Value Care
Presenters: Lauren L. Walker, MD, FAAP; Alan Schroeder, MD, FAAP; Michael
Tchou, MD, FAAP; Jimmy Beck, MD, MEd; Lisa Herrmann, MD; Ricardo Quinonez, MD, FAAP
Pediatric hospitalists gathered to attend a fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high-value care are plenty and essentially universal to academic and community sites: We have had no formal teaching, there is cultural resistance, and there is lack of transparency on costs and charges.
The questions we perhaps should be asking ourselves, our trainees, and our families are:
- “What matters?” instead of “What’s the matter?”
- “Does that test benefit the patient? What are the harms of the test?” instead of “Will that test change our management?”
There is still a long way to go to move the pendulum to the side of value-based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary value; family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
Key Takeaway
This serves as an exciting time to unite and better our understanding about why we do what we do and deliberately think about downstream effects. High-value care curriculum for medical students, residents, fellows, and even faculty is an area ripe for further research.
Akshata Hopkins, MD, FAAP, is an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.
How to Design, Improve Educational Programs at Community Hospitals
Presenters: Christopher Russo, MD, FAAP; Laura Hodo, MD, and Lauren Wilson, MD
One session at PHM16 focused on ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session, a general background of the importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy,” “exposure to different career paths,” and “transfer decision making.”
Some of the challenges discussed in regard to developing an educational structure in community settings included:
1. Logistics
- Making the case for education
- Legal framework (e.g., affiliation agreements, liability)
- Finances (e.g., GME funding)
- Paperwork burden (e.g., licensing, credentialing)
2. Learning environment
- Complementing clinical work with materials
- Autonomy/supervision balancing
- Developing clinical teachers
The didactic session also reviewed the six steps for curriculum development: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation/feedback. Each of these was described in further detail with relevant examples.
Groups were broken into small groups based on four learner types: medical students, family medicine residents, pediatric residents, and PHM fellows. Within each group, a “program development matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “curriculum development matrix” was used during breakout groups that focused on curriculum development. This matrix was broken into three areas: educational strategies, implementation, and evaluation/feedback. These were further broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short- and long-term goals with action steps for both of these matrix subgroups.
Key Takeaway
Overall, the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools for sites that wish to develop or improve their current educational framework.
Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children’s National Health System Community Hospital Services in Washington, D.C.
Tips on Meeting Needs of Children with a Medical Complexity
Presenters: Mary L. Ehlenbach, MD, FAAP; Megan Z. Cardoso, MD, FAAP, and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex-care program. Presenters opened with a discussion on how to define children with medical complexity. This involved reviewing different methods, including using research-based aggregation of ICD-10 codes, relying on referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about one-third of healthcare spending. Because of advances in technology and medicine, this group of children is growing in numbers. It currently makes up about 10% of all pediatric admissions.
Key Takeaways
1. Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
2. When working to initiate a complex-care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are nonclinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children’s National Medical Center in Washington, D.C.
A Picture Is Worth a Thousand Words
Presenter: Kenneth Roberts, MD
PHM16’s “Visual Diagnosis: Signs and Why They Matter” session was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses or overdiagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as with Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis was necessary to help guide management and future treatment, including subspecialty evaluation.
Key Takeaway
Many diseases with visual presentations will have a benign course and require no treatment. Acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs not only with rare medical conditions but also in common illnesses such as Kawasaki disease and scarlet fever that may present similarly.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
Pediatric Hospital Medicine 2016, cosponsored by the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), and the Society of Hospital Medicine (SHM), took place July 28–31 in Chicago. Didn’t make it? Here are all the news, research, and talking points you need to know.
Shape Your Brain to Avoid Burnout
Presenter: Lisa Zaoutis, MD, FHM
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, composed of hospitalists, PHM program leaders, and advanced-care practitioners, gathered to educate and inspire one another in the care of hospitalized children.
Lisa Zaoutis, MD, FHM, director of the pediatric residency program at The Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into pediatric hospital medicine and negative experiences that often drive behavior, she started with the beginning: the evolution of our brains.
“We are wired toward the negative,” Dr. Zaoutis said. “We are Teflon for positive experiences and Velcro for negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists leads to anxiety responses that are faster, more robust, and more easily triggered.
But all is not lost, Dr. Zaoutis noted, as our brains are more plastic than previously known. The “neural Darwinism” of our brains, she said, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience-dependent neuroplasticity. For example, London taxi drivers have thicker white matter in their hippocampus as a result of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways
The lesson for pediatric hospitalists, according Dr. Zaoutis, is that you can shape your brain for greater joy.
“Consciously choose activities” that counter our evolutionary negativity bias, Dr. Zaoutis said.
Here’s how to do it:
- Have a positive experience. (You can create one or retrieve a prior one.)
- Enrich it and install it by dwelling on it for at least 15–30 seconds.
- Absorb it into your body, which may require somatizing it. (Dr. Zaoutis presses her hand into her chest to aid in this.)
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your sign-out with the best thing that happened to you in the week. Most important, start with observing yourself.
Weijen Chang, MD, SFHM, is pediatric editor of The Hospitalist. He is associate clinical professor of medicine and pediatrics at the University of California, San Diego (UCSD) School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. Send comments and questions to [email protected].
New AAP Guideline on Evaluating, Managing Febrile Infants
Presenter: Kenneth Roberts, MD
One of PHM16’s most highly attended sessions was an update on the anticipated AAP guidelines for febrile infants ages 7–90 days. The updated guidelines stress the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C.
Exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.
The updated guideline will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk.
Key Takeaway
An updated AAP guideline algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days, and 60–90 days will be coming in the near future. It will help standardize care in this population but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
Promoting, Teaching Pediatric High-Value Care
Presenters: Lauren L. Walker, MD, FAAP; Alan Schroeder, MD, FAAP; Michael
Tchou, MD, FAAP; Jimmy Beck, MD, MEd; Lisa Herrmann, MD; Ricardo Quinonez, MD, FAAP
Pediatric hospitalists gathered to attend a fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high-value care are plenty and essentially universal to academic and community sites: We have had no formal teaching, there is cultural resistance, and there is lack of transparency on costs and charges.
The questions we perhaps should be asking ourselves, our trainees, and our families are:
- “What matters?” instead of “What’s the matter?”
- “Does that test benefit the patient? What are the harms of the test?” instead of “Will that test change our management?”
There is still a long way to go to move the pendulum to the side of value-based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary value; family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
Key Takeaway
This serves as an exciting time to unite and better our understanding about why we do what we do and deliberately think about downstream effects. High-value care curriculum for medical students, residents, fellows, and even faculty is an area ripe for further research.
Akshata Hopkins, MD, FAAP, is an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.
How to Design, Improve Educational Programs at Community Hospitals
Presenters: Christopher Russo, MD, FAAP; Laura Hodo, MD, and Lauren Wilson, MD
One session at PHM16 focused on ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session, a general background of the importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy,” “exposure to different career paths,” and “transfer decision making.”
Some of the challenges discussed in regard to developing an educational structure in community settings included:
1. Logistics
- Making the case for education
- Legal framework (e.g., affiliation agreements, liability)
- Finances (e.g., GME funding)
- Paperwork burden (e.g., licensing, credentialing)
2. Learning environment
- Complementing clinical work with materials
- Autonomy/supervision balancing
- Developing clinical teachers
The didactic session also reviewed the six steps for curriculum development: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation/feedback. Each of these was described in further detail with relevant examples.
Groups were broken into small groups based on four learner types: medical students, family medicine residents, pediatric residents, and PHM fellows. Within each group, a “program development matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “curriculum development matrix” was used during breakout groups that focused on curriculum development. This matrix was broken into three areas: educational strategies, implementation, and evaluation/feedback. These were further broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short- and long-term goals with action steps for both of these matrix subgroups.
Key Takeaway
Overall, the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools for sites that wish to develop or improve their current educational framework.
Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children’s National Health System Community Hospital Services in Washington, D.C.
Tips on Meeting Needs of Children with a Medical Complexity
Presenters: Mary L. Ehlenbach, MD, FAAP; Megan Z. Cardoso, MD, FAAP, and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex-care program. Presenters opened with a discussion on how to define children with medical complexity. This involved reviewing different methods, including using research-based aggregation of ICD-10 codes, relying on referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about one-third of healthcare spending. Because of advances in technology and medicine, this group of children is growing in numbers. It currently makes up about 10% of all pediatric admissions.
Key Takeaways
1. Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
2. When working to initiate a complex-care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are nonclinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children’s National Medical Center in Washington, D.C.
A Picture Is Worth a Thousand Words
Presenter: Kenneth Roberts, MD
PHM16’s “Visual Diagnosis: Signs and Why They Matter” session was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses or overdiagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as with Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis was necessary to help guide management and future treatment, including subspecialty evaluation.
Key Takeaway
Many diseases with visual presentations will have a benign course and require no treatment. Acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs not only with rare medical conditions but also in common illnesses such as Kawasaki disease and scarlet fever that may present similarly.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
Pediatric Hospital Medicine 2016, cosponsored by the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), and the Society of Hospital Medicine (SHM), took place July 28–31 in Chicago. Didn’t make it? Here are all the news, research, and talking points you need to know.
Shape Your Brain to Avoid Burnout
Presenter: Lisa Zaoutis, MD, FHM
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, composed of hospitalists, PHM program leaders, and advanced-care practitioners, gathered to educate and inspire one another in the care of hospitalized children.
Lisa Zaoutis, MD, FHM, director of the pediatric residency program at The Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into pediatric hospital medicine and negative experiences that often drive behavior, she started with the beginning: the evolution of our brains.
“We are wired toward the negative,” Dr. Zaoutis said. “We are Teflon for positive experiences and Velcro for negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists leads to anxiety responses that are faster, more robust, and more easily triggered.
But all is not lost, Dr. Zaoutis noted, as our brains are more plastic than previously known. The “neural Darwinism” of our brains, she said, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience-dependent neuroplasticity. For example, London taxi drivers have thicker white matter in their hippocampus as a result of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways
The lesson for pediatric hospitalists, according Dr. Zaoutis, is that you can shape your brain for greater joy.
“Consciously choose activities” that counter our evolutionary negativity bias, Dr. Zaoutis said.
Here’s how to do it:
- Have a positive experience. (You can create one or retrieve a prior one.)
- Enrich it and install it by dwelling on it for at least 15–30 seconds.
- Absorb it into your body, which may require somatizing it. (Dr. Zaoutis presses her hand into her chest to aid in this.)
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your sign-out with the best thing that happened to you in the week. Most important, start with observing yourself.
Weijen Chang, MD, SFHM, is pediatric editor of The Hospitalist. He is associate clinical professor of medicine and pediatrics at the University of California, San Diego (UCSD) School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. Send comments and questions to [email protected].
New AAP Guideline on Evaluating, Managing Febrile Infants
Presenter: Kenneth Roberts, MD
One of PHM16’s most highly attended sessions was an update on the anticipated AAP guidelines for febrile infants ages 7–90 days. The updated guidelines stress the need to separate individual components of serious bacterial infections (UTI, bacteremia, and meningitis) as the incidence and clinical course can vary greatly in this population.
The inclusion criteria for infants for this upcoming algorithm require an infant to be full-term (37–43 weeks’ gestation), aged 7–90 days, well-appearing, and presenting with a temperature of 38°C.
Exclusion criteria include perinatal/prenatal/neonatal maternal fever, infection, or antimicrobial treatment; the presence of any evident infection; being technology-dependent; and the presence of congenital anomalies.
The updated guideline will aim to stratify management by ages 7–28 days, 29–60 days, and 61–90 days to provide the most appropriate and directed treatment.
It will also include a role for inflammatory markers and allow for a “kinder, gentler” approach, including withholding certain treatments and procedures if infants are at low risk of infection. An active need for observation may be appropriate for certain infants as well. These guidelines should be tailored for individual patients to provide the best care possible while minimizing risk.
Key Takeaway
An updated AAP guideline algorithm for the management of well-appearing febrile infants ages 7–28 days, 29–60 days, and 60–90 days will be coming in the near future. It will help standardize care in this population but should not be used as a substitute for clinical judgment.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
Promoting, Teaching Pediatric High-Value Care
Presenters: Lauren L. Walker, MD, FAAP; Alan Schroeder, MD, FAAP; Michael
Tchou, MD, FAAP; Jimmy Beck, MD, MEd; Lisa Herrmann, MD; Ricardo Quinonez, MD, FAAP
Pediatric hospitalists gathered to attend a fruitful discussion on not only how to change our way of thinking but also how to feed it forward to our trainees. The barriers to promoting and teaching high-value care are plenty and essentially universal to academic and community sites: We have had no formal teaching, there is cultural resistance, and there is lack of transparency on costs and charges.
The questions we perhaps should be asking ourselves, our trainees, and our families are:
- “What matters?” instead of “What’s the matter?”
- “Does that test benefit the patient? What are the harms of the test?” instead of “Will that test change our management?”
There is still a long way to go to move the pendulum to the side of value-based practice and teaching. There is still controversy on how and whether cost should be discussed with the family. Cost is more than just monetary value; family anxiety and patient harm may resonate more with families as we perfect our skills in shared decision making.
Key Takeaway
This serves as an exciting time to unite and better our understanding about why we do what we do and deliberately think about downstream effects. High-value care curriculum for medical students, residents, fellows, and even faculty is an area ripe for further research.
Akshata Hopkins, MD, FAAP, is an academic hospitalist at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla.
How to Design, Improve Educational Programs at Community Hospitals
Presenters: Christopher Russo, MD, FAAP; Laura Hodo, MD, and Lauren Wilson, MD
One session at PHM16 focused on ways to design and improve education within community hospital settings. It was done via a didactic session, breakout groups, and an electronic assessment tool. Facilitators included the workshop leaders and co-leaders along with current PHM fellows and educators from community and academic settings.
During the didactic session, a general background of the importance of education during times of increasing academic and community site affiliations was discussed. This included the strengths of community hospitals for learners such as “appropriate learner autonomy,” “exposure to different career paths,” and “transfer decision making.”
Some of the challenges discussed in regard to developing an educational structure in community settings included:
1. Logistics
- Making the case for education
- Legal framework (e.g., affiliation agreements, liability)
- Finances (e.g., GME funding)
- Paperwork burden (e.g., licensing, credentialing)
2. Learning environment
- Complementing clinical work with materials
- Autonomy/supervision balancing
- Developing clinical teachers
The didactic session also reviewed the six steps for curriculum development: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation/feedback. Each of these was described in further detail with relevant examples.
Groups were broken into small groups based on four learner types: medical students, family medicine residents, pediatric residents, and PHM fellows. Within each group, a “program development matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.
A separate “curriculum development matrix” was used during breakout groups that focused on curriculum development. This matrix was broken into three areas: educational strategies, implementation, and evaluation/feedback. These were further broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short- and long-term goals with action steps for both of these matrix subgroups.
Key Takeaway
Overall, the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools for sites that wish to develop or improve their current educational framework.
Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children’s National Health System Community Hospital Services in Washington, D.C.
Tips on Meeting Needs of Children with a Medical Complexity
Presenters: Mary L. Ehlenbach, MD, FAAP; Megan Z. Cardoso, MD, FAAP, and Christina Kleier, ARNP, PNP
This session at PHM16 was focused on logistical tips on how to build a pediatric complex-care program. Presenters opened with a discussion on how to define children with medical complexity. This involved reviewing different methods, including using research-based aggregation of ICD-10 codes, relying on referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about one-third of healthcare spending. Because of advances in technology and medicine, this group of children is growing in numbers. It currently makes up about 10% of all pediatric admissions.
Key Takeaways
1. Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.
2. When working to initiate a complex-care program:
- Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
- Ensure the team composition is sustainable and meets the needs of the patients.
- Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
- Include team members who are nonclinical to aid in improving hospital revenue and highlighting program benefits to the institution.
Margaret Rush, MD, is a hospitalist fellow at Children’s National Medical Center in Washington, D.C.
A Picture Is Worth a Thousand Words
Presenter: Kenneth Roberts, MD
PHM16’s “Visual Diagnosis: Signs and Why They Matter” session was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses or overdiagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.
Many of the presented cases highlighted examples in which there was extensive workup, hospitalization, subspecialty evaluation, and even incorrect treatment of patients.
In other instances, such as with Henoch-Schonlein purpura, Waardenburg syndrome, or McCune-Albright syndrome, the correct diagnosis was necessary to help guide management and future treatment, including subspecialty evaluation.
Key Takeaway
Many diseases with visual presentations will have a benign course and require no treatment. Acknowledging this is important in providing reassurance to a family that may be very anxious over the physical appearance of their child.
This session underscores the need for experience and exposure to various signs not only with rare medical conditions but also in common illnesses such as Kawasaki disease and scarlet fever that may present similarly.
Chandani DeZure, MD, FAAP, is a pediatric hospitalist at Children’s National Health System and instructor of pediatrics at George Washington University School of Medicine & Health Sciences in Washington, D.C.
After a Fracture, Patients Often Continue Meds that Boost Fracture Risk
(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.
"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."
The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.
About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.
"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.
Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.
"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.
"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.
However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."
Which drugs can be stopped will vary from case to case, Munson noted.
"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."
SOURCE: http://bit.ly/2bc6PIN
JAMA Intern Med 2016.
(c) Copyright Thomson Reuters 2016.
(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.
"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."
The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.
About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.
"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.
Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.
"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.
"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.
However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."
Which drugs can be stopped will vary from case to case, Munson noted.
"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."
SOURCE: http://bit.ly/2bc6PIN
JAMA Intern Med 2016.
(c) Copyright Thomson Reuters 2016.
(Reuters Health) - Older people who break a bone are often receiving medications that can increase the risk of a fracture - and even after a fracture, less than 10 percent of them stop taking those drugs, according to a new study.
"One would expect that a significant health event like a fracture would result in some change in the use of prescription drugs that might have contributed to that event," said lead author Dr. Jeffrey C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire. "In contrast to this expectation, we observed that for the overwhelming majority of patients we studied, a fragility fracture did not lead to any change in medications that have been linked to fracture risk."
The authors used data on 168,000 Medicare beneficiaries, more than 80 percent of whom were women, on average age 80, who had experienced a hip, shoulder or wrist fracture. They compared these records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.
About 75 percent of fracture patients had been taking one of these medications. While seven percent of people stopped taking the medication after their fracture, a similar number started to take a new medication also tied to fracture risk, the authors reported in JAMA Internal Medicine, online August 22.
"Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall," said Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, who coauthored a linked editorial.
Blood pressure medications cause changes in blood pressure that could lead to a fall. Other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture, Berry told Reuters Health by email.
"Fractures are the leading cause of death from injury and one of the main reasons for nursing home placement in persons over the age of 65," she said.
"When a patient has a hip, shoulder or wrist fracture, it is important for healthcare providers to examine all the prescription medications he or she is taking, and carefully assess whether there is an opportunity to eliminate those that might cause a future fracture," Munson told Reuters Health by email.
However, he said, "In many cases, the benefits of a drug may outweigh its risks, even when those risks are significant."
Which drugs can be stopped will vary from case to case, Munson noted.
"For many of the drugs we studied, there are alternative drugs that treat the same conditions but with a lower risk of fracture," he said. "In other cases, it may be possible to eliminate a drug altogether."
SOURCE: http://bit.ly/2bc6PIN
JAMA Intern Med 2016.
(c) Copyright Thomson Reuters 2016.
Spreading Innovation among Hospitalists
“Increasingly, we are not having faculty who are going up for promotion and reliably running into challenges around mentorship, national reputation, and having a network outside of their local hospital that is critical for advancement,” says lead author Ethan Cumbler, MD, FHM, FACP, of the Department of Medicine at the University of Colorado School of Medicine. “Hospital medicine as a movement is built on a foundation of innovation, and so as a specialty, we have a mandate to not only innovate but to disseminate those innovations.”
The model of the visiting professorship described in the paper takes midcareer academic hospitalists and provides an infrastructure for reciprocal faculty exchanges. This provides a forum to increase professional networks.
“We found that both junior faculty and our visiting professors saw value in advancing those goals,” Dr. Cumbler says. “We also saw evidence of the spread of ideas and new shared scholarship derived from having these reciprocal visits.”
This has model relevance for nonacademic hospitals, too. For example, it’d be useful for hospital medicine groups to share ideas with one another, Dr. Cumbler says.
“This is a simple structure, but it’s just like a small pebble thrown into a large body of water can create ripples which affect distant shores—sometimes it’s very simple concepts that are worth pursuing,” he says.
Reference
- Cumbler E, Herzke C, Smalligan R, Glasheen JJ, O’Malley C, Pierce JR Jr. Visiting professorship in hospital medicine: an innovative twist for a growing specialty [published online ahead of print June 23, 2016]. J Hosp Med. doi:10.1002/jhm.2625.
“Increasingly, we are not having faculty who are going up for promotion and reliably running into challenges around mentorship, national reputation, and having a network outside of their local hospital that is critical for advancement,” says lead author Ethan Cumbler, MD, FHM, FACP, of the Department of Medicine at the University of Colorado School of Medicine. “Hospital medicine as a movement is built on a foundation of innovation, and so as a specialty, we have a mandate to not only innovate but to disseminate those innovations.”
The model of the visiting professorship described in the paper takes midcareer academic hospitalists and provides an infrastructure for reciprocal faculty exchanges. This provides a forum to increase professional networks.
“We found that both junior faculty and our visiting professors saw value in advancing those goals,” Dr. Cumbler says. “We also saw evidence of the spread of ideas and new shared scholarship derived from having these reciprocal visits.”
This has model relevance for nonacademic hospitals, too. For example, it’d be useful for hospital medicine groups to share ideas with one another, Dr. Cumbler says.
“This is a simple structure, but it’s just like a small pebble thrown into a large body of water can create ripples which affect distant shores—sometimes it’s very simple concepts that are worth pursuing,” he says.
Reference
- Cumbler E, Herzke C, Smalligan R, Glasheen JJ, O’Malley C, Pierce JR Jr. Visiting professorship in hospital medicine: an innovative twist for a growing specialty [published online ahead of print June 23, 2016]. J Hosp Med. doi:10.1002/jhm.2625.
“Increasingly, we are not having faculty who are going up for promotion and reliably running into challenges around mentorship, national reputation, and having a network outside of their local hospital that is critical for advancement,” says lead author Ethan Cumbler, MD, FHM, FACP, of the Department of Medicine at the University of Colorado School of Medicine. “Hospital medicine as a movement is built on a foundation of innovation, and so as a specialty, we have a mandate to not only innovate but to disseminate those innovations.”
The model of the visiting professorship described in the paper takes midcareer academic hospitalists and provides an infrastructure for reciprocal faculty exchanges. This provides a forum to increase professional networks.
“We found that both junior faculty and our visiting professors saw value in advancing those goals,” Dr. Cumbler says. “We also saw evidence of the spread of ideas and new shared scholarship derived from having these reciprocal visits.”
This has model relevance for nonacademic hospitals, too. For example, it’d be useful for hospital medicine groups to share ideas with one another, Dr. Cumbler says.
“This is a simple structure, but it’s just like a small pebble thrown into a large body of water can create ripples which affect distant shores—sometimes it’s very simple concepts that are worth pursuing,” he says.
Reference
- Cumbler E, Herzke C, Smalligan R, Glasheen JJ, O’Malley C, Pierce JR Jr. Visiting professorship in hospital medicine: an innovative twist for a growing specialty [published online ahead of print June 23, 2016]. J Hosp Med. doi:10.1002/jhm.2625.
Dr. Benjamin Frizner Brings Post-Acute-Care Expertise to TH’s Editorial Board
Going to medical school at Universidad Autónoma de Guadalajara in Guadalajara, Mexico, could have been too much for Benjamin Frizner, MD, FHM.
Medicine is its own new language, as any first-year can tell you. Throw in learning Spanish? And a new culture? One could be forgiven for not excelling.
Dr. Frizner isn’t one of those people.
“The experience changed my life,” he says. “After I survived the first year, I knew I loved medicine.”
After medical school, Dr. Frizner had to complete a Fifth Pathway program, which formerly allowed students who completed four years at a foreign medical school to finish supervised clinical work at a U.S. medical school and become eligible as a U.S. resident.
He learned of hospital medicine during his residency at York Hospital in York, Pa., and, despite others suggesting hospital medicine was “something to do before you really figure out your career,” he enjoyed both working within the hospital walls and having a schedule that allowed 15 shifts a month and commensurate time off.
But as with his shift from undergraduate school in suburban Maryland to medical school in Mexico, Dr. Frizner likes a new challenge. So after a four-year stint as director of the hospitalist program at Saint Agnes Hospital in Baltimore, he took a job in August 2015 as director of the Ventilator Unit at FutureCare Irvington, a post-acute-care center in Baltimore staffed by CEP America.
“Post-acute care has become a new passion and chapter in my career,” he says, adding, “Skilled nursing facilities are extensions of the acute-care hospital and are just as challenging and fulfilling as hospitalist work.”
It’s a perspective Dr. Frizner will bring as one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: Why did you choose a career in medicine?
Answer: I enjoyed math and biology in college. I started out thinking I would be an engineer but fell in love with anatomy. I like solving problems and working with people. Internal medicine/hospital medicine is a perfect match, working to solve a patient’s diagnosis and helping families make difficult decisions about placement and palliative care.
Q: What do you like most about working as a hospitalist?
A: Interacting with all the different specialties, social work, case management, residents, ED docs. I really enjoy the camaraderie.
Q: What do you dislike most?
A: Hospital groups contribute immensely to patient flow, care, quality, process improvement, throughput, but hospitals always advertise the new specialist and never the excellent hospitalist group.
Q: What’s the best advice you ever received?
A: No matter what, do what is best for the patient. Everything else will take care of itself.
Q: What’s the worst advice you ever received?
A: Don’t worry about the contract; you don’t need to really look it over.
Q: What’s the biggest change you’ve seen in HM in your career?
A: The pace of medicine continues to speed up. Residents have to hit the ground running with baseline case-management knowledge.
Q: What’s the biggest change you would like to see in HM?
A: I would like to see more hospitalists ascend into senior leadership in hospitals and healthcare systems.
Q: Why should group leaders continue to see patients?
A: It is important to maintain trust and respect with docs you are leading and managing. When I was a hospitalist director, I made sure I worked nights and weekends so I could understand the workload during those shifts and my team felt I was not just dumping on them.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust with the patient and their family. But it has become second nature to me at this point. The secret is to introduce yourself, tell the patient and family you will take care of them in the hospital, communicate with their outpatient physician and that you are part of a 24-7 team of docs there to take care of the patient.
Q: What aspect of patient care is most rewarding?
A: Helping families navigate end-of-life decisions. It is the most stressful time in a family’s life, and I think it is the most rewarding and honorable part of practicing medicine.
Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: I lead teaching rounds a few months a year when I was a hospitalist director, and I think the most difficult part is getting the residents to understand the workload will be a lot tougher when they get out into the real world. During their third year, residents need to practice efficiency and gauge their work ethic—not the kind of work ethic needed to pass the boards but the kind needed to stay in the ED and help your teammate out until the admissions are caught up or round on a few extra patients when there is a surge in the census.
Q: What is your biggest professional challenge?
A: [Getting others to] stop underestimating my skills and experience as a hospitalist and physician leader. I will complete an MBA through ACPE UMass this December. Learning basic accounting, business law, and finance has helped round out blind spots and build my confidence.
Q: What is your biggest professional reward?
A: Completing quality improvement projects such as increasing DVT prophylaxis, reducing CAUTI, and decreasing throughput times, which all help make the hospital course safer and efficient for the patient.
Q: What SHM event made the most lasting impression on you?
A: Seven years ago, I attended the Level I leadership academy at the Aria hotel in Las Vegas. The meeting opened my eyes to the world of leadership, management, and healthcare economics, which sparked my drive to eventually become a hospitalist director.
Q: What’s the best book you’ve read recently? Why?
A: David and Goliath by Malcolm Gladwell. As a foreign medical graduate, I was told there would be limits to what I could achieve in my career. Mr. Gladwell’s book is filled with stories of people who overcame difficult situations and went on to rise to the top of their fields.
Richard Quinn is a freelance writer in New Jersey.
Going to medical school at Universidad Autónoma de Guadalajara in Guadalajara, Mexico, could have been too much for Benjamin Frizner, MD, FHM.
Medicine is its own new language, as any first-year can tell you. Throw in learning Spanish? And a new culture? One could be forgiven for not excelling.
Dr. Frizner isn’t one of those people.
“The experience changed my life,” he says. “After I survived the first year, I knew I loved medicine.”
After medical school, Dr. Frizner had to complete a Fifth Pathway program, which formerly allowed students who completed four years at a foreign medical school to finish supervised clinical work at a U.S. medical school and become eligible as a U.S. resident.
He learned of hospital medicine during his residency at York Hospital in York, Pa., and, despite others suggesting hospital medicine was “something to do before you really figure out your career,” he enjoyed both working within the hospital walls and having a schedule that allowed 15 shifts a month and commensurate time off.
But as with his shift from undergraduate school in suburban Maryland to medical school in Mexico, Dr. Frizner likes a new challenge. So after a four-year stint as director of the hospitalist program at Saint Agnes Hospital in Baltimore, he took a job in August 2015 as director of the Ventilator Unit at FutureCare Irvington, a post-acute-care center in Baltimore staffed by CEP America.
“Post-acute care has become a new passion and chapter in my career,” he says, adding, “Skilled nursing facilities are extensions of the acute-care hospital and are just as challenging and fulfilling as hospitalist work.”
It’s a perspective Dr. Frizner will bring as one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: Why did you choose a career in medicine?
Answer: I enjoyed math and biology in college. I started out thinking I would be an engineer but fell in love with anatomy. I like solving problems and working with people. Internal medicine/hospital medicine is a perfect match, working to solve a patient’s diagnosis and helping families make difficult decisions about placement and palliative care.
Q: What do you like most about working as a hospitalist?
A: Interacting with all the different specialties, social work, case management, residents, ED docs. I really enjoy the camaraderie.
Q: What do you dislike most?
A: Hospital groups contribute immensely to patient flow, care, quality, process improvement, throughput, but hospitals always advertise the new specialist and never the excellent hospitalist group.
Q: What’s the best advice you ever received?
A: No matter what, do what is best for the patient. Everything else will take care of itself.
Q: What’s the worst advice you ever received?
A: Don’t worry about the contract; you don’t need to really look it over.
Q: What’s the biggest change you’ve seen in HM in your career?
A: The pace of medicine continues to speed up. Residents have to hit the ground running with baseline case-management knowledge.
Q: What’s the biggest change you would like to see in HM?
A: I would like to see more hospitalists ascend into senior leadership in hospitals and healthcare systems.
Q: Why should group leaders continue to see patients?
A: It is important to maintain trust and respect with docs you are leading and managing. When I was a hospitalist director, I made sure I worked nights and weekends so I could understand the workload during those shifts and my team felt I was not just dumping on them.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust with the patient and their family. But it has become second nature to me at this point. The secret is to introduce yourself, tell the patient and family you will take care of them in the hospital, communicate with their outpatient physician and that you are part of a 24-7 team of docs there to take care of the patient.
Q: What aspect of patient care is most rewarding?
A: Helping families navigate end-of-life decisions. It is the most stressful time in a family’s life, and I think it is the most rewarding and honorable part of practicing medicine.
Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: I lead teaching rounds a few months a year when I was a hospitalist director, and I think the most difficult part is getting the residents to understand the workload will be a lot tougher when they get out into the real world. During their third year, residents need to practice efficiency and gauge their work ethic—not the kind of work ethic needed to pass the boards but the kind needed to stay in the ED and help your teammate out until the admissions are caught up or round on a few extra patients when there is a surge in the census.
Q: What is your biggest professional challenge?
A: [Getting others to] stop underestimating my skills and experience as a hospitalist and physician leader. I will complete an MBA through ACPE UMass this December. Learning basic accounting, business law, and finance has helped round out blind spots and build my confidence.
Q: What is your biggest professional reward?
A: Completing quality improvement projects such as increasing DVT prophylaxis, reducing CAUTI, and decreasing throughput times, which all help make the hospital course safer and efficient for the patient.
Q: What SHM event made the most lasting impression on you?
A: Seven years ago, I attended the Level I leadership academy at the Aria hotel in Las Vegas. The meeting opened my eyes to the world of leadership, management, and healthcare economics, which sparked my drive to eventually become a hospitalist director.
Q: What’s the best book you’ve read recently? Why?
A: David and Goliath by Malcolm Gladwell. As a foreign medical graduate, I was told there would be limits to what I could achieve in my career. Mr. Gladwell’s book is filled with stories of people who overcame difficult situations and went on to rise to the top of their fields.
Richard Quinn is a freelance writer in New Jersey.
Going to medical school at Universidad Autónoma de Guadalajara in Guadalajara, Mexico, could have been too much for Benjamin Frizner, MD, FHM.
Medicine is its own new language, as any first-year can tell you. Throw in learning Spanish? And a new culture? One could be forgiven for not excelling.
Dr. Frizner isn’t one of those people.
“The experience changed my life,” he says. “After I survived the first year, I knew I loved medicine.”
After medical school, Dr. Frizner had to complete a Fifth Pathway program, which formerly allowed students who completed four years at a foreign medical school to finish supervised clinical work at a U.S. medical school and become eligible as a U.S. resident.
He learned of hospital medicine during his residency at York Hospital in York, Pa., and, despite others suggesting hospital medicine was “something to do before you really figure out your career,” he enjoyed both working within the hospital walls and having a schedule that allowed 15 shifts a month and commensurate time off.
But as with his shift from undergraduate school in suburban Maryland to medical school in Mexico, Dr. Frizner likes a new challenge. So after a four-year stint as director of the hospitalist program at Saint Agnes Hospital in Baltimore, he took a job in August 2015 as director of the Ventilator Unit at FutureCare Irvington, a post-acute-care center in Baltimore staffed by CEP America.
“Post-acute care has become a new passion and chapter in my career,” he says, adding, “Skilled nursing facilities are extensions of the acute-care hospital and are just as challenging and fulfilling as hospitalist work.”
It’s a perspective Dr. Frizner will bring as one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: Why did you choose a career in medicine?
Answer: I enjoyed math and biology in college. I started out thinking I would be an engineer but fell in love with anatomy. I like solving problems and working with people. Internal medicine/hospital medicine is a perfect match, working to solve a patient’s diagnosis and helping families make difficult decisions about placement and palliative care.
Q: What do you like most about working as a hospitalist?
A: Interacting with all the different specialties, social work, case management, residents, ED docs. I really enjoy the camaraderie.
Q: What do you dislike most?
A: Hospital groups contribute immensely to patient flow, care, quality, process improvement, throughput, but hospitals always advertise the new specialist and never the excellent hospitalist group.
Q: What’s the best advice you ever received?
A: No matter what, do what is best for the patient. Everything else will take care of itself.
Q: What’s the worst advice you ever received?
A: Don’t worry about the contract; you don’t need to really look it over.
Q: What’s the biggest change you’ve seen in HM in your career?
A: The pace of medicine continues to speed up. Residents have to hit the ground running with baseline case-management knowledge.
Q: What’s the biggest change you would like to see in HM?
A: I would like to see more hospitalists ascend into senior leadership in hospitals and healthcare systems.
Q: Why should group leaders continue to see patients?
A: It is important to maintain trust and respect with docs you are leading and managing. When I was a hospitalist director, I made sure I worked nights and weekends so I could understand the workload during those shifts and my team felt I was not just dumping on them.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust with the patient and their family. But it has become second nature to me at this point. The secret is to introduce yourself, tell the patient and family you will take care of them in the hospital, communicate with their outpatient physician and that you are part of a 24-7 team of docs there to take care of the patient.
Q: What aspect of patient care is most rewarding?
A: Helping families navigate end-of-life decisions. It is the most stressful time in a family’s life, and I think it is the most rewarding and honorable part of practicing medicine.
Q: Are you on teaching service? If so, what aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: I lead teaching rounds a few months a year when I was a hospitalist director, and I think the most difficult part is getting the residents to understand the workload will be a lot tougher when they get out into the real world. During their third year, residents need to practice efficiency and gauge their work ethic—not the kind of work ethic needed to pass the boards but the kind needed to stay in the ED and help your teammate out until the admissions are caught up or round on a few extra patients when there is a surge in the census.
Q: What is your biggest professional challenge?
A: [Getting others to] stop underestimating my skills and experience as a hospitalist and physician leader. I will complete an MBA through ACPE UMass this December. Learning basic accounting, business law, and finance has helped round out blind spots and build my confidence.
Q: What is your biggest professional reward?
A: Completing quality improvement projects such as increasing DVT prophylaxis, reducing CAUTI, and decreasing throughput times, which all help make the hospital course safer and efficient for the patient.
Q: What SHM event made the most lasting impression on you?
A: Seven years ago, I attended the Level I leadership academy at the Aria hotel in Las Vegas. The meeting opened my eyes to the world of leadership, management, and healthcare economics, which sparked my drive to eventually become a hospitalist director.
Q: What’s the best book you’ve read recently? Why?
A: David and Goliath by Malcolm Gladwell. As a foreign medical graduate, I was told there would be limits to what I could achieve in my career. Mr. Gladwell’s book is filled with stories of people who overcame difficult situations and went on to rise to the top of their fields.
Richard Quinn is a freelance writer in New Jersey.