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New SHM Members – February/March 2017

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Brett Radler

The Society of Hospital Medicine welcomes its newest members:

Kwie-Hoa Siem, MD, Alaska

Frank Abene, Alabama

Kayla Maldonado, Alabama

Kenny Murray, MD, Alabama

Shanthan Ramidi, MD, Alabama

Lauren Hancock, APRN, Arkansas

William Hawkins, MD, Arkansas

Matthew Law, Arkansas

Emily Smith, MD, Arkansas

Firas Abbas, MBchB, Arizona

Shahid Ahmad, MD, MBBS, Arizona

Praveen Bheemanathini, Arizona

Atoosa Hosseini, Arizona

William McGrade, DO, Arizona

Konstantin Mazursky, DO, Arizona

Ibrahim Taweel, MD, Arizona

Kevin Virk, MD, FACP, Arizona

Kevin Virk, MD, FACP, Arizona

Mohemmedd Khalid Abbas, Arizona

Hasan Chaudhry, MD, Arizona

Kelly Kelleher, FAAP, Arizona

Priyanka Sultania Dudani, MBBS, Arizona

Krishna Kasireddy, MD, Arizona

Melanie Meguro, Arizona

Puneet Tuli, MD, Arizona

Jonathan Byrdy, DO, Arizona

Sarah Corral, DO, Arizona

Edward Maharam, MD, Arizona

Arvind Satyanarayan, DO, Arizona

Mayank Aggarwal, MD, Arizona

Syed Jafri, Arizona

Bujji Ainapurapu, MD, Arizona

Aaron Fernandes, MD, Arizona

Sonal Gandhi, Arizona

Sudhir Tutiki, Arizona

Navaneeth Kumar, MD, Arizona

Brian T. Courtney, MD, California

Won Jin Jeon, California

Veena Panduranga, MD, California

Jennifer Tinloy, DO, California

Debra Buckland Coffey, MCUSN, MD, California

Kathleen Teves, MD, California

Paul Goebel, MD, ACMPE, California

Shainy Hegde, California

Summaiya Muhammad, California

Desmond Wah, California

Chonn Khristin Ng, California

Almira Yang, DO, California

Salimah Boghani, MD, California

Stella Abhyankar, California

Cherie Ginwalla, MD, California

Armond Esmaili, California

Sarah Schaeffer, MD, MPH, California

Sophia Virani, MD, California

Dipti Munshi, MD, California

Judy Nguyen, DO, California

Daniel Owyang, DO, California

Christian Chiavetta, DO, California

David Reinert, DO, California

Joseph Pawlowski, MD, California

Eleanor Yang, California

Adrian Campo, MD, California

Emerson De Jesus, MD, California

Zachary Edmonds, MD, California

Trit Garg, California

Alexandra G. Ianculescu, MD, PhD, California

Felix Karp, MD, California

Cara Lai, California

Kristen Lew, MD, California

John Mogannam, California

Ameer Moussa, California

Neil Parikh, MD, MBA, California

Priya Reddy, California

Adam Simons, California

Sanjay Vadgama, MD, California

Kristofer Wills, DO, California

Michael Yang, MD, MS, California

Victor Ekuta, California,

Donna Colobong, PA-C, Colorado

Janna B. Dreason, FNP-C, Colorado

Cheryl English, NP-C, Colorado

Melanie Gerrior, MD, Colorado

Marciann Harris, NP, Colorado

Marsha Henke, MD, Colorado

Brett Hesse, Colorado

Naomi J Hipp, MD, Colorado

Aurell Horing, Colorado

Rachel Koch, DO, Colorado

Ed Marino, PA-C, Colorado

Marcus Reinhardt, MD, Colorado

Carol Runge, Colorado

Harshal Shah, Colorado

Leo Soehnlen, DO, Colorado

Anna Villalobos, MD, Colorado

Kathryn Whitfield, PA-C, Colorado

Jonathan Bei-Shing Young, MD, Colorado

Leah Damiani, MD, Colorado

Kathy Lynch, MD, Colorado

Micah Friedman, Colorado

Rachael Hilton, MD, Colorado

Madeline Koerner, Colorado

Chi Zheng, MD, Colorado

Chin-Kun Baw, MD, Connecticut

Alexandra Hawkins, NP, Connecticut

Vasundhara Singh, MD, MBBS, Connecticut

Ryan Quarles, MD, Connecticut

Debra Hernandez, APRN, BC, Connecticut

Karine Karapetyan, MD, Delaware

Choosak Burr, ARNP, Florida

Nelsi Mora, Florida

Mary Quillinan, Florida

Thuntanat Rachanakul, Florida

Samual W. Sauer, MD, MPH, Florida

Jennifer Tibangin, Florida

Keith Williams, MD, Florida

Eric Penedo, MD, Florida

Margaret Webb, Florida

Mark Bender, Florida

Brett Waress, MD, MHA, Florida

Giselle Racho, Florida

Bryan Thiel, Florida

Juan Loor Tuarez, MD, Florida

Christine Stopyra, Florida

Betsy Screws, ARNP, Florida

Jaimie Weber, MD, Florida

Priti Amin, MHA, Georgia

Naga Doddapaneni, Georgia

Stephanie Fletcher, Georgia

Disha Spath, MD, Georgia

Rafaela Wesley, DO, Georgia

Nikky Keer, DO, Georgia

James Kim, Georgia

Todd Martin, Georgia

Eli Mlaver, Georgia

Andrew Ritter, Georgia

Ali Al-Zubaidi, MBchB, Georgia

Deann Bing, MD, Georgia

Tushar Shah, Georgia

Cameron Straughn, DO, Georgia

Nobuhiro Ariyoshi, MEd, Hawaii

Prerna Kumar, Iowa

Jonathan Sebolt, MD, Iowa

Amy Tesar, DO, Iowa

Houng Chea, NP, Idaho

Finnegan Greer, PA-C, Idaho

Thao Nelson, PA, Idaho

Malatesha Gangappa, Idaho

Gloria Alumona, ACNP, Illinois

Ram Sanjeev Alur, Illinois

James Antoon, MD, FAAP, PhD, Illinois

Stefania Bailuc, MD, Illinois

Richard Huh, Illinois

Bhakti Patel, MD, Illinois

Frances Uy, ACNP, Illinois

Fernando Velazquez Vazquez, MD, Illinois

Tiffany White, MD, Illinois

Bryan P. Tully, MD, Illinois

Swati Gobhil, MBBS, Illinois

Lianghe Gao, Illinois

Gopi Astik, MD, Illinois

Marina Kovacevic, MD, Illinois

Abbie Raymond, DO, Illinois

Timothy Yung, Illinois

Ahmed Zahid, MD, Illinois

Cristina Corsini, MEd, Illinois

Faisal Rashid, MD, FACP, Illinois

Mansoor Ahmad, MD, Illinois

Matthew A. Strauch, DO, Illinois

Purshotham Reddy Grinne, Illinois

Nadia Nasreen, MD, Illinois

Maham Ashraf, MD, Indiana

Jennifer Gross, Indiana

Debasmita Mohapatra, MBBS, Indiana

Eric Scheper, Indiana

Katherine Gray, APRNBC, FNP, Indiana

Venkata Kureti, Indiana

Omer Al-Buoshkor, MD, Indiana

David Johnson, FNP, MSN, Indiana

Jonathan Salisbury, MD, Indiana

Debra Shapert, MSN, RN, Iowa

Lisa Carter, ARNP, Iowa

Matthew Woodham, Iowa

Tomoharu Suzuki, MD, Pharm, Japan

Khaldoun Haj, Kansas

Will Rogers, ACMPE, MA, MBA, Kansas

Karen Shumate, Kansas

Lisa Unruh, MD, Kansas

Matthew George, Kansas

Katie Washburn, DO, Kansas

Edwin Avallone, DO, Kentucky

Matthew Morris, Kentucky

Samantha Cappetto, MD, Kentucky

Jaison John, Kentucky

Ammar Al Jajeh, Kentucky

Joseph Bolger, MD, PhD, Louisiana

Clairissa Mulloy, Louisiana

Harish Talla, MD, Louisiana

John Amadon, Louisiana

Karthik Krishnareddy, Louisiana

Cheryl DeGrandpre, PA-C, Maine

Katherine Liu, MD, Maine

Sarah Sedney, MD, Maine

Aksana Afanasenka, MD, Maryland

Syed Nazeer Mahmood, MBBS, Maryland

Joseph Apata, MD, Maryland

Russom Ghebrai, MD, Maryland

Musa Momoh, MD, Maryland

Antanina Voit, Maryland

Dejene Kassaye, MD, MSC, Maryland

Shams Quazi, MD, FACP, MS, Maryland

Dawn Roelofs, FNP, MSN, Maryland

Kirsten Austad, MD, Massachusetts

Yoel Carrasquillo Vega, MD, Massachusetts

Michele Gaudet, NP, Massachusetts

Karina Mejias, Massachusetts

Peter Rohloff, MD, PhD, Massachusetts

Jennifer Schaeffer, Massachusetts

James Shaw, MD, Massachusetts

Renee Wheeler, Massachusetts

Angela Freeman, PA, PA-C, Massachusetts

Supriya Parvatini, MD, Massachusetts

Karen Jiang, MD, Massachusetts

Roula E. Abou-Nader, MD, Massachusetts

Shreekant Vasudhev, MD, Massachusetts

Nivedita Adabala, MD, MBBS, Michigan

Robert Behrendt, RN, BSN, Michigan

Molly Belisle, Michigan

Christine Dugan, MD, Michigan

Baljinder Gill, Michigan

Kellie Herringa, PA-C, Michigan

Christine Klingert, Michigan

Kathy Mitchell, Michigan

Aimee Vos, Michigan

Alyssa Churchill, DO, Michigan

Mailvaganam Sridharan, MD, Michigan

Atul Kapoor, MD, MBBS, Michigan

Anitha Kompally, MD, MBBS, Michigan

Nicole Webb, PA-C, Michigan

Abdulqadir Ahmad, MD, Minnesota

John Patrick Eikens, Minnesota

Bobbi Jo Jensen, PA-C, Minnesota

Rachel Keuseman, Minnesota

Stephen Palmquist, Minnesota

Manit Singla, MD, Minnesota

Douglas Berg, Minnesota

Nathan Palmolea, Minnesota

Molly Tureson, PAC, Minnesota

Mehdi Dastrange, MD, MHA, Minnesota

Kent Svee, Minnesota

Ashley Viere, PA-C, Minnesota

Molly Yang, MD, Minnesota

Paige Sams, DO, Minnesota

Amit Reddy, MBBS, Mississippi

Jacqueline Brooke Banks, FNP-C, Mississippi

Lori Foxworth, CFNP, Mississippi

Nicki Lawson, FNP-C, Mississippi

Bikash Acharya, Missouri

Zafar Ahmad, PA-C, Missouri

Harleen Chela, MD, Missouri

Jeffrey Chung, MD, Missouri

Daniel Kornfeld, Missouri

Erika Leung, MD, MSc, Missouri

Lisa Moser, PA, Missouri

Mark Stiffler, Missouri

Tushar Tarun, MBBS, Missouri

Nicole McLaughlin, Missouri

Katy Lohmann, PA-C, Missouri

Jayasree Bodagala, MD, Missouri

Ravi Kiran Morumuru, ACMPE, Missouri

Matthew Brown, MD, FAAFP, Missouri

Ravikanth Tadi, Missouri

Bazgha Ahmad, DO, Missouri

Monica Hawkins, RN, Missouri

Karri Vesey, BSN, Montana

Madison Vertin, PA-C, Montana

Urmila Mukherjee, MD, Nebraska

Noah Wiedel, MD, Nebraska

Sidrah Sheikh, MD, MBBS, Nebraska

Mohammad Esmadi, MBBS, Nebraska

Jill Zabih, MD, Nebraska

Jody Frey-Burns, RN, Nevada

Adnan Akbar, MD, Nevada

Peter Gayed, MRCP, New Hampshire

Jonathan T. Huntington, MD, New Hampshire

Meghan Meehan, ACNP, New Hampshire

Saurabh Mehta, MD, New Jersey

Hanaa Benchekroun Belabbes, MD, MHA, New Jersey

Hwan Kim, MD, New Jersey

Mary Tobiasson, USA, New Jersey

Muhammad Khakwani, MD, New Jersey

Amita Maibam, MD, MPH, New Jersey

Kumar Rohit, MBBS, New Jersey

Crystal Benjamin, MD, New Jersey

Rafael Garabis, New Mexico

Sam MacBride, MD, New Mexico

Indra Peram, MD, New Mexico

Sarah Vertrees, DO, New Mexico

Aswani Kumar Alavala, MD, New Mexico

Christopher Anstine, New Mexico

Prathima Guruguri, MD, New Mexico

Diedre Hofinger, MD, FACP, New Mexico

Katharine Juarez, New Mexico

Amtul Mahavesh, MD, New Mexico

Francisco Marquez, New Mexico

Payal Sen, MD, New Mexico

Morgan Wong, DO, New Mexico

Kelly Berchou, New York

Ronald Cho, New York

Nishil Dalsania, New York

Carolyn Drake, MD, MPH, New York

Leanne Forman, New York

Valerie Gausman, New York

Laurie Jacobs, New York

Janice Jang, MD, New York

Sonia Kohli, MD, New York

Nancy Lee, PA, New York

Allen Lee, MD, New York

Matthew McCarthy, FACP, New York

Akram Mohammed, MD, New York

Jennifer Nead, New York

Kristal Persaud, PA, New York

Mariya Rozenblit, MD, New York

Christian Torres, MD, New York

Sasha De Jesus, MD, New York

Gabriella Polyak, New York

Nataliya Yuklyaeva, MD, New York

Riyaz Kamadoli, MD, New York

Ramanuj Chakravarty, New York

Adil Zaidi, MD, New York

Allison Walker, MD, New York

Himali Gandhi, New York

Alexey Yanilshtein, MD, New York

Ramsey Al-Khalil, New York

Latoya Codougan, MD, New York

Khan Najmi, MD, New York

Sara Stream, MD, New York

Bhuwan Poudyal, MD, New York

Khalil Anchouche, New York

Sarah Azarchi, New York

Susana Bejar, New York

Brian Chang, New York

Jonathan Chen, New York

Hailey Gupta, MD, New York

Medhavi Gupta, New York

Ali Khan, New York

Benjamin Kwok, MD, New York

Billy Lin, New York

Katherine Ni, New York

Jina Park, New York

Gabriel Perreault, New York

Luis Alberto Romero, New York

Payal Shah, New York

Punita Shroff, New York

Scott Statman, New York

Maria Sunseri, New York

Benjamin Verplanke, New York

Audrey Zhang, New York

Gaby Razzouk, MD, New York

Pranitha Mantrala, MD, New York

Marsha Antoine, New York

Kanica Yashi, New York

Navid Ahmed, New York

Tasha Richards, PA, New York

Connor Tryon, MD, New York

Naveen Yarlagadda, MD, New York

Alex Hogan, New York

Andrew Donohoe, CCM, MD, North Carolina

Brittany Forshay, MD, North Carolina

Kelly Hammerbeck, FNP, North Carolina

Jennifer Hausman, North Carolina

Babajide Obisesan, North Carolina

Kwadwo Ofori, MD, North Carolina

Eric Ofosu, MD, North Carolina

Kale Roth, North Carolina

Robert Soma, PA-C, North Carolina

Sommany Weber, North Carolina

Ronnie Jacobs, North Carolina

Muhammad Ghani, MD, MACP, MBBS, North Carolina

Madeline Treasure, North Carolina

Andrew McWilliams, MD, North Carolina

Karen Payne, ACNP, MPH, North Carolina

Rafal Poplawski, MD, North Carolina

James Seal, PA-C, North Carolina

Farheen Qureshi, DO, North Carolina

Basavatti Sowmya, MD, MBBS, North Carolina

Eshwar Lal, MD, North Carolina

Catherine Hathaway, MD, North Carolina

Sherif Naguib, FAAFP, North Carolina

Sara Skavroneck, North Carolina

Charles Ofosu, North Carolina

Alex Alburquerque, MD, Ohio

Isha Butler, DO, Ohio

Anne Carrol, MD, Ohio

Scott Childers, MD, Ohio

Philip Jonas, MD, Ohio

Ahmadreza Karimianpour, Ohio

Rahul Kumar, MD, Ohio

George Maidaa, MD, Ohio

Kevin McAninch, Ohio

Jill Mccourt, FNP, Ohio

Roxanne Oliver, Ohio

Farah Hussain, Ohio

Natasha Axton, PA-C, Ohio

Brooke Harris, ACNP, Ohio

Vidhya Murukesan, MD, Ohio

Sara Dong, Ohio

Christie Astor, FNP, Ohio

Sunita Mall, MD, Ohio

Sunita Mall, MD, Ohio

Fouzia Tariq, MD, Ohio

Kaveri Sivaruban, MD, Ohio

Eunice Quicho, Ohio

Smitha Achuthankutty, MD, Ohio

Harmanpreet Shinh, MD, Ohio

Maereg Tesfaye, Ohio

Kalyn Jolivette, MD, Ohio

Richelle Voth, PA-C, Oklahoma

Samuel J. Ratermann, MD, FAAFP, Oklahoma

Richelle Voth, PA-C, Oklahoma

Alden Forrester, MD, Oregon

Nicholas Brown, DO, Oregon

Ian Pennell-Walklin, MD, Oregon

Bruce Ramsey, Oregon

Kyle Brekke, DO, Oregon

Sarah Webber, MD, Oregon

Brian Beaudoin, MD, Pennsylvania

Glenn Bedell, MHSA, Pennsylvania

Cristina Green, AGACNP-DNP, Pennsylvania

Andrew Groff, Pennsylvania

Sulman Masood Hashmi, MBBS, Pennsylvania

Eric Kasprowicz, MD, MPH, Pennsylvania

Laura Leuenberger, Pennsylvania

James Liszewski, MD, Pennsylvania

Caitlyn Moss, Pennsylvania

Paul Seunghyun Nho, Pennsylvania

Rishan Patel, MD, Pennsylvania

Dilli R. Poudel, MBBS, Pennsylvania

Naveen Yellappa, MBBS, Pennsylvania

Usman Zulfiqar, Pennsylvania

Nina Jain, Pennsylvania

Bhumika Patel, DO, Pennsylvania

Jenna M. Diasio, PA-C, Pennsylvania

Malachi Courtney, MD, Pennsylvania

Sonia Arneja, MD, Pennsylvania

Ross Ellis, MD, Pennsylvania

Samreen Siddiqui, Pennsylvania

Jillian Zavodnick, Pennsylvania

Kinan Kassar, MD, Pennsylvania

Maritsa M. Scoulos-Hanson, Pennsylvania

Jennifer Taylor, PA-C, Pennsylvania

Steven Delaveris, DO, Pennsylvania

Danica Buzniak, DO, Rhode Island

Paul Browning, MD, South Carolina

Matt Coones, MD, South Carolina

Cedric Fisher, MD, South Carolina

Aloysius Jackson, MD, South Carolina

Katharine DuPont, MD, South Carolina

Michael Jenkins, MD, South Carolina

Jessica Hamilton, APRN, BC, FNP, South Carolina

Pamela Pyle, DO, South Carolina

Shakeel Ahmed, MBBS, MD, South Dakota

D. Bruce Eaton, MD, South Dakota

Drew Jorgensen, MD, South Dakota

Shelly Turbak, MSN, RN, South Dakota

Tamera Sturm, DO, South Dakota

Peggy Brooks, Tennessee

Joseph Garrido, MD, Tennessee

Lisa Grimes, FNP, Tennessee

Chennakesava Kummathi, MBBS, Tennessee

Victoria Okafor, Tennessee

Ashley Smith, Tennessee

Monisha Bhatia, Tennessee

Belinda Jenkins, APRN-BC, Tennessee

Kim Zahnke, MD, Tennessee

Robert Arias, Texas

Nicolas Batterton, MD, Texas

Scott DePaul, MD, Texas

Nancy Foster, Texas

Larry Hughes, Texas

Erin Koval, Texas

Femi Layiwola, MD, Texas

Krysta Lin, Texas

James J. Onorato, MD, PhD, Texas

Allison Stephenson, PA-C, Texas

Brandon Stormes, Texas

Rubin Simon, MD, Texas

Brian Anderson, DO, Texas

Hatim Chhatriwala, MD, Texas

Aziz Hammoud, Texas

Haru Yamamoto, MD, Texas

Lauren Schiegg, Texas

Victoria Grasso, DO, Texas

Victor Salcedo, MD, Texas

Rajiv Bhattarai, Texas

Iram Qureshi, DO, Texas

Lisa Hafemeister, FACHE, MHA, Texas

Helena Kurian, MD, Texas

Jessica Lin, Texas

Nathan Nowalk, MD, Texas

Keely Smith, MD, Texas

Jonathan Weiser, MD, Texas

Roland Prezas, DO, FAAFP, Texas

Allan Recto, AHIP, Texas

Regina Dimbo, Texas

Venkata Ghanta, Texas

Richmond Hunt, Texas

Vishal Patel, MD, Texas

Zain Sharif, MD, Texas

Rommel Del Rosario, MD, Texas

Khawer Khadimally, DO, Texas

Diogenes Valderrama, MD, Texas

Charles Ewoh, MD, Texas

Deepika Kilaru, Texas

Tilahun Belay, MD, Texas

Chandra S Reddy Navuluri, MD, Texas

Bradley Goad, DO, FACP, Virginia

Patrick Higdon, MD, Virginia

Gabriella Miller, MD, HMDC, Virginia

Miklos Szentirmai, MD, Virginia

Hyder Tamton, Virginia

Andra Mirescu, MD, Virginia

Olukayode Ojo, Virginia

Robert Szeles, MD, Virginia

Anya Cope, DO, Virginia

OsCiriah Press, MD, Virginia

Rikin Kadakia, MD, Virginia

Bryant Self, DO, Virginia

Sarah Sabo, ACNP, Virginia

Pedro A. Gonzales Alvarez, MD, Virginia

William Best, Virginia

Pushpanjali Basnyat, MD, Washington

Nikki Hartley-Jonason, Washington

Helen Johnsonwall, MD, Washington

Eric LaMotte, MD, Washington

Maher Muraywid, Washington

Evan Neal Paul, MD, Washington

Sarah Rogers, MD, Washington

Lindee Strizich, Washington

Maryam Tariq, MBBS, Washington

Meghaan Walsh, MD, Washington

Oleg Zbirun, MD, Washington

Meeta Sabnis, MD, Washington

James Kuo, MD, Washington

Liang Du, Washington

Syed Farhan Tabraiz Hashmi, MD, Washington

Jessica Jung, MD, Washington

Joshua Pelley, MD, Washington

Alex Yu, MD, Washington

Alfred Curnow, MD, Washington

Duhwan Kang, Washington

Gilbert Daniel, MD, Washington, D.C.

Eleanor Fitall, Washington, D.C.

Vinay Srinivasan, Washington, D.C.

Scott Wine, West Virginia

Trevor Miller, MBA, PA-C, West Virginia

Audrey Hiltunen, Wisconsin

Elina Litinskaya, Wisconsin

John M. Murphy, MD, Wisconsin

Tanya Pedretti, PA, Wisconsin

Adine Rodemeyer, MD, Wisconsin

Oghomwen Sule, MBBS, Wisconsin

Terrence Witt, MD, Wisconsin

Mayank Arora, Wisconsin

John D. MacDonald, MD, Wisconsin

Abigail Cook, Wisconsin

Mohamed Ibrahim, MD, Wisconsin

Aymen Khogali, MD, Wisconsin

Nicholas Haun, Wisconsin

Sandra Brown, Victoria, Australia

Alessandra Gessner, Alberta, Canada

Courtney Carlucci, British Columbia, Canada

Muhanad Y. Al Habash, Canada

Karen Tong, MD, Canada

Taku Yabuki, Japan

Liza van Loon, the Netherlands

Edward Gebuis, MD, the Netherlands

Abdisalan Afrah, MD, Qatar

Akhnuwkh Jones, Qatar

Mashuk Uddin, MBBS, MRCP, FRCP, Qatar

Ibrahim Yusuf Abubeker, MRCP, Qatar

Chih-Wei Tseng, Taiwan

Sawsan Abdel-Razig, MD, FACP, United Arab Emirates

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Noninvasive therapy cut COPD readmissions

Comment by Dr. Vera A. De Palo, MD, MBA, FCCP,

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American Thoracic Society (ATS): International Conference 2017

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Fri, 01/18/2019 - 16:48

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Eli Zimmerman

WASHINGTON – The addition of noninvasive ventilation to home oxygen therapy regimens correlated with increased time to readmission or death among patients with exacerbated chronic obstructive pulmonary diseases (COPD), according to a study presented at an international conference of the American Thoracic Society.

Among 116 patients observed with COPD, the 57 patients given home oxygen and noninvasive ventilation reported an average time to readmission of 4.3 months, compared with 1.4 months among the 59 patients given only home oxygen, according to Patrick B. Murphy, PhD, of St. Thomas’ Hospital, London (JAMA. 2017 May 21. doi: 10.1001/jama.2017.4451), who presented this research on the same day it was published in JAMA.

Intervention patients also reported a decrease in annual COPD exacerbations, with an average 3.8 per year compared with 5.1 per year among patients in the control group.In 2013, the reported readmission rate of patients with hypercapnia was one in five, according to Dr. Murphy and his coinvestigators.

Dr. Murphy said the findings are encouraging for patients with COPD suffering from exacerbations from the disease.

“Patients with established chronic respiratory failure secondary to COPD have poor outcomes with limited treatment options available,” the investigators noted. “The results of the current trial are reassuring, suggesting that home noninvasive ventilation added to home oxygen therapy in this population improved the overall clinical outcome without adding to the health burden of the patient.”

In this 12-month, phase III, multicenter, randomized clinical trial, the average age of the patients was 67 years, and the average body mass index was 21.6 mg/k². The patients had an average partial pressure of carbon dioxide (PaCo₂) level of 59, indicating persistent hypercapnia.

The investigators gave those in the intervention group one of three noninvasive home ventilators – nasal, oronasal, or total face mask – to use for a minimum of 6 hours nightly. Patients in both groups received 15 hours of oxygen therapy daily.

Doctors gathered data from patients after 6 weeks, 3 months, 6 months, and 12 months.

After 12 months, risk of readmission or death in the intervention group was 63.4%, while those in the oxygen-only group reported a risk of 80.4%. Despite a 17% risk reduction, a similar number of patients died during the experiment in both groups: five in the noninvasive intervention group and four in the control group, according to the investigators.

At the end of the trial, 16 patients (28%) in the intervention group and 19 (32%) in the control group died.

Dr. Murphy and his peers asserted that these deaths do not take away from the success of the treatment, as the focus of the study was to find a way to reduce readmissions, not necessarily mortality.

“The driver of the clinical improvement in the home oxygen therapy plus home noninvasive ventilation group was readmission avoidance with no significant difference in mortality,” they wrote. “This study has major clinical relevance because readmission avoidance is beneficial to the patient in terms of preservation of lung function and health-related quality of life, as well as providing a direct and indirect cost saving.”

The study was limited by the lack of a double-blind design; however, investigators said that a sham device may have made patients’ respiratory failure worse.

Some patients in the control group were later given ventilation treatment for safety reasons. Eighteen patients were given noninvasive ventilation, although reportedly after the primary endpoint was reached.

Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.

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Vera A. De Palo, MD, FCCP, MBA, comments: A goal for any patient with a chronic disease is the best possible quality of life. Increasing hospital-free and exacerbation-free days helps to improve that quality of life. The authors report that the addition of noninvasive ventilation therapy increased the time to readmission due to COPD exacerbation. This adds another tool to the armamentarium to help improve outcomes for our COPD patients.

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Comment by Dr. Vera A. De Palo, MD, MBA, FCCP,

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Vitals

Key clinical point: Noninvasive ventilation coupled with oxygen therapy correlated with longer time between discharge and rehospitalization among chronic obstructive pulmonary disease (COPD) patients.

Major finding: The average time until readmission or death was 4.3 months for patients using both oxygen therapy and ventilation, compared with an average of 1.4 months for patients using only oxygen therapy.

Data source: Phase III, multicenter, randomized clinical trial of 116 COPD patients gathered from 13 U.K. medical centers between February, 2010, and April, 2015.

Disclosures: Philips Respironics, ResMed, the ResMed Foundation, and the Guy’s and St. Thomas’ Charity funded the study. Dr. Patrick B. Murphy and his coinvestigators reported receiving some manner of financial support from ResMed, Philips Respironics, and B&D Electromedical.

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Committee and chapter involvement allows SHM member to give back

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Paul Grant, MD, SFHM, contributes to SHM growth on both a local and national level

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Felicia Steele

Editor’s note: Each month, SHM puts the spotlight on some of our most active members who are making substantial contributions to hospital medicine. Log on to www.hospitalmedicine.org/getinvolved for more information on how you can lend your expertise to help SHM improve the care of hospitalized patients.

This month, The Hospitalist spotlights Paul Grant, MD, SFHM, assistant professor of medicine at the University of Michigan Medical School, Ann Arbor. Dr. Grant is the chair of SHM’s Membership Committee and an active member of SHM’s Michigan Chapter.

Why did you choose a career in hospital medicine, and how did you become an SHM member?

During my internal medicine residency, I tried hard to find a subspecialty I could see myself doing for the rest of my career. But I couldn’t. What I loved about general medicine was the variety of patients I saw on a daily basis. My next decision was whether to do hospital medicine or ambulatory medicine. This was a tough choice for me, but choosing hospital medicine was one of the best career decisions I’ve ever made.

After residency, I completed a hospital medicine fellowship at the Cleveland Clinic. During my fellowship, I joined SHM. At that time, I knew nothing about the society, but that soon changed. My fellowship required me to attend the annual meeting and submit an abstract in the RIV competition, which was an extremely valuable experience for me. Not only was I blown away by the meeting, but my poster won the clinical vignette competition, as well! Needless to say, I’ve been an SHM member ever since.

What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?

Because SHM has done so much for my career as a hospitalist, I’ve tried to give back by volunteering on committees. After spending several years on the Early Career Hospitalist Committee, I felt the transition to the Membership Committee was a natural fit. Because SHM membership had been growing every year, our committee felt some pressure to keep this trend going. Thankfully, we have continued to see growth each year in every membership category.

Our committee has been working on several projects. One of the key demographics we have been targeting is the resident member. Residents play a significant role in the future of hospital medicine, as well as SHM membership. We are developing ways to reach out to residency program directors – particularly those running a hospital medicine track – to find ways they can benefit from SHM’s educational offerings. Additionally, our committee has been discussing ways to attract international members to SHM. Because hospital medicine is quite developed in the United States, we believe we have much to offer to hospitalists around the world.

Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?

A few years ago, at the end of SHM’s annual meeting, several of my hospital medicine colleagues in southeast Michigan happened to be on the same flight home. At the departure gate in the airport, we all agreed we should start an SHM chapter. After drawing straws, it was decided that I would be chapter president for our inaugural year. In a few short years, our chapter has grown into one of the largest in the country.

As for a typical meeting, each starts with a cocktail hour to encourage our members to network. We have a guest speaker, who presents on a hospital medicine topic, and then, we end the evening with a business meeting. We encourage students and residents to attend. More recently, we’ve been using interactive technology to broadcast our meetings to large hospital medicine groups in the western and northern parts of the state. Our chapter was thrilled to learn that we’d won the Outstanding Chapter award this year!

What value do you find in connecting with hospital medicine professionals at the local level?

Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.

As a chapter, we can pull together our resources to address these issues. Furthermore, we have the ability to reach out to more trainees and show them what hospital medicine is all about. Our chapter has been able to partially fund both medical students and residents so they could attend SHM’s annual meeting. I’m always amazed at what I can learn from other hospitalists – in the state of Michigan and beyond.

Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .

Felicia Steele is SHM’s communications coordinator.

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Paul Grant, MD, SFHM, contributes to SHM growth on both a local and national level

Why did you choose a career in hospital medicine, and how did you become an SHM member?

What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?

Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?

What value do you find in connecting with hospital medicine professionals at the local level?

Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.

Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .

Felicia Steele is SHM’s communications coordinator.

Why did you choose a career in hospital medicine, and how did you become an SHM member?

What prompted you to join the Membership Committee? Can you discuss some of the projects the committee is currently working on?

Tell TH about your involvement with SHM’s Michigan Chapter. What does a typical chapter meeting entail?

What value do you find in connecting with hospital medicine professionals at the local level?

Whether it’s a hospitalist working at a large, tertiary care center or one working in a small rural setting, it seems we all face similar challenges.

Find a chapter near you and get involved at the local level at hospitalmedicine.org/chapters .

Felicia Steele is SHM’s communications coordinator.

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Scheduling patterns: Time for a change?

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Bob Wachter, MD, created buzz in March 2016 when, at the SHM annual meeting in San Diego, he displayed a slide titled “What did we get wrong?” The slide contained the copy, “Hospitalist shifts run 7 a.m.-7 p.m.; 10 a.m.-10 p.m. 7on/7off” circled in bold red.

Over the last several years, thought leaders in the hospital medicine field have expressed concern that this one-size-fits-all schedule model is a threat to the well-being of many physicians and, by extension, the sustainability of their hospital medicine groups. Despite this, the 2016 State of Hospital Medicine Report reveals relatively little change in the way hospital medicine groups schedule their physicians.

Most groups (69.2%), report the duration of scheduled day shifts to be between 12 and 13.9 hours, similar to the 65.4% reported in the 2014 survey for this same metric. Likely, most of these shifts are the traditional 12-hour shift displayed on Dr. Wachter’s slide. Groups reporting shorter shifts tended to be either very large, with the number of bodies needed to develop flexible scheduling, or in academic settings where they could utilize house-staff coverage.

Night shifts echo this trend. There is an even greater number of groups utilizing the 12- to 13.9-hour shift length (79%), which has also varied less at just approximately 5% in either direction over the last two surveys. It is likely very hard to be creative with the shift length for your night physicians when the group is structured predominately around a 12-hour day position.

The 12-hour shift scheduled in long blocks is straightforward to employ for the scheduler, limits hand offs of care, and maximizes number of days off. So, why are Wachter et al. calling for change? Seven day stretches off may seem attractive when you are just starting out, but, as physicians mature, the very long day competes with family time that cannot be made up on weekday mornings when others are at school and work. Furthermore, the very long hours for 7 days straight lead to burn out and eventually retention issues as well. Some argue that this design promotes disengagement. It sets the expectation that, during “off” weeks, physicians might be unavailable for email responses, committee meetings, or participation in quality improvement initiatives, which disrupts integration into the larger hospital community and perhaps even our own career advancement.

Some groups are trying to address these concerns with innovative approaches to block scheduling. While the hallmark hospital medicine schedule of 7on/7off blocks remains the predominant model – 38.1% of all groups – this represents a drop of approximately 15%, compared with the prior survey. A new large contingent of groups entering the survey this year utilize a Monday-Friday model with rotating moonlighter/weekend coverage. This lifestyle and family-friendly model predominates in the Midwest. It is also found more in smaller groups, which may employ this model to keep the most system-knowledgeable worker around during high volume times, as well as to preserve the well-being and retention of their limited physician work force.

Of note, reconfiguring the 7on/7off model does not necessarily translate into more time off. The median number of shifts per year is also relatively stable at 182 which is the exact number of shifts per year in a strict 7on/7off schedule. This number does not vary by region of the country, group size, or teaching status. Some might argue that working 182 annual shifts is ideal, giving hospitalists a “vacation” every other week. However, this line of thought does not take into account the very long workdays, nor the 52 weekend days spent in the hospital – far more than most specialty peers who serve fewer weekend calls often with more limited in-house hours. In addition, one might argue that defining ourselves as available only during our 182 clinical “on” days is not in our own best interest, as it is the important nonclinical quality and committee service activities that are likely to lead to professional recognition and advancement.

Our hospital medicine group has deviated from this scheduling mainstay and requires only 160 shifts per year. We have set this number based on removal of the number of shifts equivalent to the vacation hours received by our medical group peers. The model poses a challenge in terms of matching our productivity up to benchmarks when talking to system leaders. This challenge pales in comparison to the increased buy-in from our physicians, as they feel equitable vacation time signifies respect from the medical group leadership.

In addition, our group has had success in being flexible around the number of days worked in a continuity stretch. We utilize everything from a 3-day block over holidays to a 7-day block. In general, we allow physicians to select their desired block length. The scheduler then works to accommodate that stretch as much as is feasible. The upfront work in this system is significant, but the downstream effect is decreased turnover costs. Even our own entrenched standard of 7on/7off schedules for house staff services (designed to protect continuity for the learner) have been the target of change. A pilot of alternating 4 and 5 day runs in a 4-week stretch has been implemented over the last few months. The number of days the residents are exposed to a given attending is the same in this model, but there is one additional switch day. The additional switch day puts the residents at risk of managing a change in care plan related to change in attending, but this was mitigated by paring attendings with very similar teaching and patient management styles. For our group, the extra administrative effort needed to work around the 7on/7off model has always paid off in terms of provider satisfaction and retention.

On the other hand, although I lead a large academic group, we have not yet developed flexibility around the shift length. Only one of the 29 roles our providers fill each 24-hour period is not a 12-hour shift. Over the years, I have tried to offer alternate models with shorter shifts to improve flow, reduce burn out, and increase family time. No matter how eloquent the reasoning, the response from the group was always the same: a resounding “no.” Most providers felt that they would wind up with a very similar work load and not actually leave the hospital earlier. Other reasons included not wanting to come in more days per month and concerns about increased handoffs/cross coverage.

There is some reason to think change may actually come. For one, burnout is high and may lead physicians to try a new model even with fear of the unknown. Our practice may be reconsidering this one-size-fits-all shift length in the very near future as an increasing percentage of candidates seeking to join our group express a strong interest in finding more accommodating hours.

Overall, I am hopeful that, in the coming years, my hospital medicine group, as well as many others, will heed the thoughts expressed by Dr. Wachter. Finding the flexibility to break out of these rigid scheduling models will be a first step in promoting both physician and system well being.

Dr. Eisenstock, MD, FHM, is clinical chief, division of hospital medicine, at the University of Massachusetts Memorial Health Care, Worcester.

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Kimberly Eisenstock, MD, FHM

Dr. Eisenstock, MD, FHM, is clinical chief, division of hospital medicine, at the University of Massachusetts Memorial Health Care, Worcester.

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A prescription for heart failure success: Change the name

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Mitchel L. Zoler, PhD

PARIS – Does heart failure’s name doom any progress against the disease?

That was the provocative premise advanced by Lynne Warner Stevenson, MD, who suggested that efforts to prevent, diagnose, and treat the disease would go better if it could only jettison that unfortunate word “failure,” its hard-wired albatross.

Dr. Stevenson offered several potentially superior alternatives, including cardiac insufficiency, heart dysfunction, and her favorite, cardiomyopathy.

“I used to be a purist and felt you couldn’t call it cardiomyopathy if the patient also had coronary or valve disease, but now we see it all the time – ischemic cardiomyopathy or valvular cardiomyopathy,” she said at a meeting held by the Heart Failure Association of the ESC.

“Is heart failure still the best diagnosis” for the entire spectrum of disease that most patients progress through ,including the many patients in earlier stages of the disease who do not have a truly failing heart? “Perhaps cardiomyopathy is the condition and heart failure is the transition,” she proposed.

To Dr. Stevenson, it’s more than just semantics.

“Words are hugely powerful,” she explained in an interview following her talk. “I think patients do not want to be seen as having heart failure. They don’t want to think of themselves as having heart failure. I think it can make them delay getting care, and it makes them ignore the disease. I worry about that a lot. I also worry that patients don’t provide support to each other that they could. Patients tend to hide that they have heart failure. We need to come up with a term that does not make patients ashamed of their disease.”

Part of the problem, Dr. Stevenson said, is that the name heart failure can be very misleading depending on the stage of the disease that patients have. Patients with stage B (presymptomatic) disease and those with mild stage C disease “don’t see themselves as having heart failure,” as having a heart that has failed them. “We need to be able to convince these patients that they have a disease that we need to treat carefully and aggressively.”

Additionally, labeling tens of millions of people as having stage A heart failure, which is presymptomatic and occurs before the heart shows any sign of damage or dysfunction, is also counterproductive, maintained Dr. Stevenson, professor of medicine at Harvard Medical School and director of the Cardiomyopathy and Heart Failure Program at Brigham and Women’s Hospital in Boston.

“So many people are at risk of developing heart failure,” she noted, including patients with hypertension, diabetes, or coronary artery disease. To label them all as already also having heart failure at that stage “tends to make them ignore the disease that we are trying to get them to pay attention to. Telling patients they have the disease that we are trying to prevent doesn’t help.”

Calling the whole range of the disease heart failure also confuses patients and others. “Patients ask me, ‘How can I have heart failure without any symptoms?’ ‘My ejection fraction improved to almost normal; do I still have heart failure?’ and ‘I don’t understand how my heart muscle is strong but my heart is failing,’ ” she said

For Dr. Stevenson, perhaps the biggest problem is the stigma of failure and the way that word ties a huge weight to the disease that prompts patients and caregivers alike to relegate it to a hidden and neglected place.

“It’s failure. Who is proud to have heart failure? Where are the marches for heart failure? Where are the celebrity champions for heart failure? We have celebrities who are happy to admit that they have Parkinson’s disease, ALS [amyotrophic lateral sclerosis], drug addiction, and even erectile dysfunction, but no one wants to say they have heart failure. We can’t get any traction behind heart failure. It doesn’t sound very inspiring,” an issue that even percolates down to dissuading clinicians from pursuing a career in heart failure care. Young people do not aspire to go into failure, she said.

“We need to call it something else.”

[email protected]

On Twitter @mitchelzoler

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PARIS – Does heart failure’s name doom any progress against the disease?

[email protected]

On Twitter @mitchelzoler

PARIS – Does heart failure’s name doom any progress against the disease?

[email protected]

On Twitter @mitchelzoler

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EXPERT ANALYSIS FROM HEART FAILURE 2017

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Community-based palliative care reduces emergency department visits

By Bryan J. Huang, MD, FHM

Retrospective cohort study showed that patients receiving community-based palliative care were less likely to seek ED care. The reduction was greater for older patients and for patients living in areas of higher socioeconomic status.

Reference: Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The association of community-based palliative care with reduced emergency department visits in the last year of life varies by patient factors. Ann Emerg Med 2017;69(4):416-25.

Time to intubation after cardiac arrest: Earlier may not be better

By Sarah Horman, MD

In a retrospective, observational, cohort study of 86,628 adults with in-hospital cardiac arrest, intubation during the first 15 minutes was associated with decreased survival, compared with no intubation.

Reference: Andersen, LW, Granfeldt, A, Callaway, CW, et al. Association between Tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA. 2017;317(5):494-506.

DNR orders often not transferred to ED from outside care facilities

By Leslie M. Martin, MD

Prospective chart review of patients presenting from extended care facilities to an urban trauma center found hospital staff did a poor job of noting do not resuscitate preferences, and extended care facilities were inconsistent in providing their patients’ DNR forms.

Reference: McQuown CM, Frey JA, Amireh A, Chaudhary A. Transfer of do not resuscitate orders to the emergency department from extended care facilities. Am J Emerg Med. Published on 4 Feb 2017. doi: 10.1016/j.ajem.2017.02.007.

A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

By William James Frederick III, MD, PhD

A single center, quasi-experimental, before-after trial shows a lung-protective mechanical ventilation protocol for emergency department and intensive care patients with Acute Respiratory Distress Syndrome reduced mortality and increased ventilator-free days.

Reference: Fuller BM, Ferguson IT, Mohr NM, et al. A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome. Crit Care Med. 2017;45(4);645-52.

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By Bryan J. Huang, MD, FHM

Time to intubation after cardiac arrest: Earlier may not be better

By Sarah Horman, MD

DNR orders often not transferred to ED from outside care facilities

By Leslie M. Martin, MD

A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

By William James Frederick III, MD, PhD

Community-based palliative care reduces emergency department visits

By Bryan J. Huang, MD, FHM

Time to intubation after cardiac arrest: Earlier may not be better

By Sarah Horman, MD

DNR orders often not transferred to ED from outside care facilities

By Leslie M. Martin, MD

A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

By William James Frederick III, MD, PhD

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Will artificial intelligence make us better doctors?

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Gating factors: Data availability, signal, noise.

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Win Whitcomb, MD

MHM

Given the amount of time physicians spend entering data, clicking through screens, navigating pages, and logging in to computers, one would have hoped that substantial near-term payback for such efforts would have materialized.

Many of us believed this would take the form of health information exchange – the ability to easily access clinical information from hospitals or clinics other than our own, creating a more complete picture of the patient before us. To our disappointment, true information exchange has yet to materialize. (We won’t debate here whether politics or technology is culpable.) We are left to look elsewhere for the benefits of the digitization of the medical records and other sources of health care knowledge.

Lately, there has been a lot of talk about the promise of machine learning and artificial intelligence (AI) in health care. Much of the resurgence of interest in AI can be traced to IBM Watson’s appearance as a contestant on Jeopardy in 2011. Watson, a natural language supercomputer with enough power to process the equivalent of a million books per second, had access to 200 million pages of content, including the full text of Wikipedia, for Jeopardy.¹ Watson handily outperformed its human opponents – two Jeopardy savants who were also the most successful contestants in game show history – taking the $1 million first prize but struggling in categories with clues containing only a few words.

MD Anderson and Watson: Dashed hopes follow initial promise

As a result of growing recognition of AI’s potential in health care, IBM began collaborations with a number of health care organizations to deploy Watson.

In 2013, MD Anderson Cancer Center and IBM began a pilot to develop an oncology clinical decision support technology tool powered by Watson to aid MD Anderson “in its mission to eradicate cancer.” Recently, it was announced that the project – which cost the cancer center $62 million – has been put on hold, and MD Anderson is looking for other contractors to replace IBM.

While administrative problems are at least partly responsible for the project’s challenges, the undertaking has raised issues with the quality and quantity of data in health care that call into question the ability of AI to work as well in health care as it did on Jeopardy, at least in the short term.

Health care: Not as data rich as you might think

“We are not ‘Big Data’ in health care, yet.” – Dale Sanders, Health Catalyst.²

In its quest for Jeopardy victory, Watson accessed a massive data storehouse subsuming a vast array of knowledge assembled over the course of human history. Conversely, for health care, Watson is limited to a few decades of scientific journals (that may not contribute to diagnosis and treatment as much as one might think), claims data geared to billing without much clinical information like outcomes, and clinical data from progress notes (plagued by inaccuracies, serial “copy and paste,” and nonstandardized language and numeric representations), and variable-format reports from lab, radiology, pathology, and other disciplines.

To articulate how data-poor health care is, Dale Sanders, executive vice president for software at Health Catalyst, notes that a Boeing 787 generates 500GB of data in a six hour flight while one patient may generate just 100MB of data in an entire year.² He pointed out that, in the near term, AI platforms like Watson simply do not have enough data substrate to impact health care as many hoped it would. Over the longer term, he says, if health care can develop a coherent, standard approach to data content, AI may fulfill its promise.

SKapi/Thinkstock

What can AI and related technologies achieve in the near-term?

“AI seems to have replaced Uber as the most overused word or phrase in digital health.” – Reporter Stephanie Baum, paraphrasing from an interview with Bob Kocher, Venrock Partners.³

My observations tell me that we have already made some progress and are likely to make more strides in the coming years, thanks to AI, machine learning, and natural language processing. A few areas of potential gain are:

Clinical documentation

Technology that can derive meaning from words or groups of words can help with more accurate clinical documentation. For example, if a patient has a documented UTI but also has in the record an 11 on the Glasgow Coma Scale, a systolic BP of 90, and a respiratory rate of 24, technology can alert the physician to document sepsis.

Quality measurement and reporting

Similarly, if technology can recognize words and numbers, it may be able to extract and report quality measures (for example, an ejection fraction of 35% in a heart failure patient) from progress notes without having a nurse-abstractor manually enter such data into structured fields for reporting, as is currently the case.

Predicting readmissions, mortality, other events

While machine learning has had mixed results in predicting future clinical events, this is likely to change as data integrity and algorithms improve. Best-of-breed technology will probably use both clinical and machine learning tools for predictive purposes in the future.

In 2015, I had the privilege of meeting Vinod Khosla, cofounder of SUN Microsystems and venture capitalist, who predicts that computers will largely supplant physicians in the future, at least in domains relying on access to data. As he puts it, “the core functions necessary for complex diagnoses, treatments, and monitoring will be driven by machine judgment instead of human judgment.”⁴

While the benefits of technology, especially in health care, are often oversold, I believe AI and related technologies will some day play a large role alongside physicians in the care of patients. However, for AI to deliver, we must first figure out how to collect and organize health care data so that computers are able to ingest, digest and use it in a purposeful way.

Note: Dr. Whitcomb is founder and advisor to Zato Health, which uses natural language processing and discovery technology in health care.

He is chief medical officer at Remedy Partners in Darien, Conn., and a cofounder and past president of SHM.

References

1. Zimmer, Ben. Is It Time to Welcome Our New Computer Overlords?. The Atlantic. https://www.theatlantic.com/technology/archive/2011/02/is-it-time-to-welcome-our-new-computer-overlords/71388/. Accessed 23 Apr 2017.

2. Sanders, Dale. The MD Anderson / IBM Watson Announcement: What does it mean for machine learning in healthcare? Webinar. https://www.slideshare.net/healthcatalyst1/the-md-anderson-ibm-watson-announcement-what-does-it-mean-for-machine-learning-in-healthcare. Accessed 23 Apr 2017.

3. Baum, Stephanie. Venrock survey predicts a flight to quality for digital health investments. MedCity News. 12 Apr 2017. http://medcitynews.com/2017/04/venrock-survey-predicts-flight-quality-digital-health-investment/. Accessed 22 Apr 2017.

4. Khosla, Vinod. The Reinvention Of Medicine: Dr. Algorithm V0-7 And Beyond. TechCrunch. 22 Sept 2014. https://techcrunch.com/2014/09/22/the-reinvention-of-medicine-dr-algorithm-version-0-7-and-beyond/. Accessed 22 Apr 2017.

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Gating factors: Data availability, signal, noise.

MD Anderson and Watson: Dashed hopes follow initial promise

As a result of growing recognition of AI’s potential in health care, IBM began collaborations with a number of health care organizations to deploy Watson.

Health care: Not as data rich as you might think

“We are not ‘Big Data’ in health care, yet.” – Dale Sanders, Health Catalyst.²

SKapi/Thinkstock

What can AI and related technologies achieve in the near-term?

“AI seems to have replaced Uber as the most overused word or phrase in digital health.” – Reporter Stephanie Baum, paraphrasing from an interview with Bob Kocher, Venrock Partners.³

Clinical documentation

Quality measurement and reporting

Predicting readmissions, mortality, other events

Note: Dr. Whitcomb is founder and advisor to Zato Health, which uses natural language processing and discovery technology in health care.

He is chief medical officer at Remedy Partners in Darien, Conn., and a cofounder and past president of SHM.

References

MD Anderson and Watson: Dashed hopes follow initial promise

As a result of growing recognition of AI’s potential in health care, IBM began collaborations with a number of health care organizations to deploy Watson.

Health care: Not as data rich as you might think

“We are not ‘Big Data’ in health care, yet.” – Dale Sanders, Health Catalyst.²

SKapi/Thinkstock

What can AI and related technologies achieve in the near-term?

“AI seems to have replaced Uber as the most overused word or phrase in digital health.” – Reporter Stephanie Baum, paraphrasing from an interview with Bob Kocher, Venrock Partners.³

Clinical documentation

Quality measurement and reporting

Predicting readmissions, mortality, other events

Note: Dr. Whitcomb is founder and advisor to Zato Health, which uses natural language processing and discovery technology in health care.

He is chief medical officer at Remedy Partners in Darien, Conn., and a cofounder and past president of SHM.

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Lactulose plus albumin is more effective than lactulose alone for treatment of hepatic encephalopathy

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Clinical Question: Is the combination of lactulose plus albumin more effective than lactulose alone for treatment of hepatic encephalopathy?

Background: Hepatic encephalopathy is caused by the effect of toxins that build up in the bloodstream when the liver is not able to perform its normal functions. Lactulose is primarily directed at the reduction of blood ammonia levels. Albumin is thought to minimize oxidative injury and improve circulatory dysfunction present in cirrhosis.

Study Design: Prospective, open-label, randomized controlled trial.

Setting: Tertiary care centers in India.

Synopsis: 120 patients with overt hepatic encephalopathy were randomized to treatment with lactulose plus albumin (1.5 gm/kg/day; n = 60), versus lactulose alone (n = 60). Patients with serum creatinine greater than 1.5 mg/dL on admission, active alcohol intake less than 4 weeks prior to presentation, other metabolic encephalopathies, or hepatocellular carcinoma were excluded. Treatment was continued up to a maximum of 10 days until complete resolution of hepatic encephalopathy as assessed independently by two expert hepatologists.

Of patients receiving lactulose plus albumin, 75% had complete reversal of hepatic encephalopathy within 10 days, compared with 53% of patients receiving lactulose alone (P = .03). Patients in lactulose plus albumin group had shorter hospital length-of-stay (6.4 vs. 8.6 days; P = .01). There was lower mortality at 10 days in the lactulose plus albumin group (18.3% vs. 31.6%; P = .04).

Limitations of the study include the noted exclusion factors, including presence of alcohol intake, limitation to a single country (India), and a relatively high mortality rate in both groups.

Bottom Line: Combination of lactulose plus albumin is more effective than lactulose alone at reversing hepatic encephalopathy and is also associated with decreased length-of-stay and mortality.

Reference: Sharma BC, Singh J, Srivastava S, et al. A randomized controlled trial comparing lactulose plus albumin with lactulose alone for treatment of hepatic encephalopathy. J Gastroenterol Hepatol. Published online Nov 25, 2016. doi: 10.1111/jgh.13666.

Dr. Huang is associate clinical professor in the division of hospital medicine, department of medicine, University of California, San Diego.

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Dr. Huang is associate clinical professor in the division of hospital medicine, department of medicine, University of California, San Diego.

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A case for building our leadership skills

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Nasim Afsar, MD, SFHM

Let me ask you a question: When was the last time you used the Krebs cycle in the hospital?

Now another question: When did you last have to persuade your boss to give you additional resources?

My guess is that your need for additional resources comes up more frequently than the Krebs cycle. It’s interesting that we spent so much time in our training focused on biochemical pathways and next to nothing on leadership skills, such as ways to motivate our health care teams or the most effective way to provide feedback – skills that we use on a regular basis. Yet, these skills are just as critical as understanding the science behind our daily work.

I’ll give you an example. I’ve been involved in quality improvement and operational work for a decade, so I often find myself in front of groups of health care professionals convincing them to implement new pathways and protocols.

In the past, I would present my case in the following way:

1. Highlight the importance of the ask.

2. Leverage data to prove the point.

3. Illustrate large-scale implications of the ask.

4. Make the ask.

I’ll use a project to increase DVT prophylaxis rates to illustrate this point:

1. Highlight the importance of DVT prophylaxis: I would focus on statistics that would surprise the audience, such as “Hospital acquired venous thromboembolism leads to significant morbidity and mortality, including more than 100,000 deaths.”¹

2. Leverage data to prove the point: “Worldwide, only 40%-60% of patients who require DVT prophylaxis actually receive it in the hospital.² Our performance leaves tremendous room for improvement – we’re currently at 68%.”

3. Illustrate large-scale implications of the ask: “If we do this, it enhances our reputation as a group, and it will improve hospital revenues.”

4. Make the ask: “I have an evidence-based protocol that we need to implement to achieve results.”

Through leadership courses over the past couple of years, I’ve changed my approach significantly. By leveraging concepts from behavioral economics, we can significantly improve the effect of our work. Here’s how I would conduct that same meeting:

1. Connect with the audience in a genuine way: Start off with “You are quality-minded providers who have taken on major challenges in the past and successfully delivered results, like the time you reduced the rates of catheter associated urinary tract infections.”

2. Make the ask: “I’m here to talk to you about improving our DVT prophylaxis rates. Here’s the protocol we need to implement.”

3. Leverage data to prove the point: “DVT prophylaxis rates at the hospital across town (or at another unit in the hospital) are at 82%. What do you think our numbers are? We’re actually at 68%!”

4. Illustrate large-scale implications of the ask: “We all know this. Patients under our care will die or be seriously harmed if we don’t improve our practice. The hospital will also lose money, which will ultimately impact us. So, we have two options: a) We can continue what we’ve been doing – work as hard as we can and our practice will not improve. b) Or we can decide today to pilot this new protocol and change our practice and performance.”

Let’s look at the changes above in greater detail:

Connect with the audience in a genuine way: Instead of highlighting the importance of the ask with statistics, use an attention getter to connect with the group. Highlighting the fact that the group is “quality-minded” and has surmounted challenging obstacles in the past reinforces the providers’ sense of identity.³ This helps the group think more openly about the proposal.

Make the ask: Now that you’ve captured their attention, make your ask, clearly and concisely, upfront. Remember, in today’s health care settings, we have short attention spans. You’re minutes away from someone getting paged away from the meeting or people checking their emails or the latest Facebook post. Don’t schedule the protocol review as the last item on the agenda.

Leverage data to prove your point: Data are powerful, but only if presented in the right way. Use questions to keep your audience engaged (“What do you think our numbers are?”), particularly around data, where most people decide to switch their attention to their smartphones. Based on your access to data sources, find another unit or institution with a higher performance than yours. State that upfront. It anchors,the group to a higher number, so, when you reveal your current performance, the gap is highlighted. ^3,4 In the first case, when the lower national average of 40-60% is presented initially, the group will be happy that their performance is in fact better at 68%.

Illustrate large-scale implications of the ask: There are two concepts at work here: First, loss aversion.^3,4 We tend to experience greater psychological burden with losses versus gains. Changing the framing from the fact that the hospital will lose money, versus making money in the first case, changes how we perceive the information. Second, active choice.³ Emphasizing that a decision has to be made today and giving the group a choice around it increases the likelihood of walking out of the meeting with a decision.

With some simple, yet thoughtful, modifications, the message takes on a more effective tone, and, based on my experience, it is significantly more impactful.

So, while I’m a fan of biochemical pathways that enable us to generate energy, I also hope we can integrate leadership lessons into our day-to-day learning and life.

Dr. Afsar is an assistant clinical professor in the departments of medicine and neurosurgery and the associate chief medical officer at UCLA Hospitals.

References

1. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US). Office of the Surgeon General (US). 2008.

2. Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet. 2008;371(9610):387-94.

3. Soman D. The Last Mile. 2015.

4. Thaler RH, Sunstein CR. Nudge. 2009.

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Nasim Afsar, MD, SFHM

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Let me ask you a question: When was the last time you used the Krebs cycle in the hospital?

1. Highlight the importance of the ask.

2. Leverage data to prove the point.

3. Illustrate large-scale implications of the ask.

4. Make the ask.

I’ll use a project to increase DVT prophylaxis rates to illustrate this point:

Dr. Afsar is an assistant clinical professor in the departments of medicine and neurosurgery and the associate chief medical officer at UCLA Hospitals.

References

Let me ask you a question: When was the last time you used the Krebs cycle in the hospital?

1. Highlight the importance of the ask.

2. Leverage data to prove the point.

3. Illustrate large-scale implications of the ask.

4. Make the ask.

I’ll use a project to increase DVT prophylaxis rates to illustrate this point:

Dr. Afsar is an assistant clinical professor in the departments of medicine and neurosurgery and the associate chief medical officer at UCLA Hospitals.

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Family reports provide additional information regarding adverse events

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Clinical Question: Do family reports of adverse events improve incident detection, compared with clinician reports and hospital incident reports?

Background: Hospital incident reports, which are voluntary and suffer from underreporting, capture only a fraction of errors and adverse events (defined as errors resulting in harm). Systematic, prospective surveillance by researchers is the gold standard but is time consuming and expensive. The authors hypothesized that family reports would improve error and adverse event detection.

Study Design: Prospective cohort study.

Setting: Four U.S. pediatric hospitals.

Synopsis: The authors developed a Family Safety Interview, administered weekly and on discharge, and compared reporting of errors and adverse events to clinician reports, hospital incident reports, and systematic review of records by researchers. Of 989 hospitalized pediatric patients, 746 parents/caregivers completed interviews between December 2014 and July 2015. From all sources, the authors found a total of 179 errors and 113 adverse events. Families reported a total of 39 of these 179 errors (including 19 unique errors not reported elsewhere) and 33 of 113 adverse events (8 unique).

Overall, error rates with family-reported errors were 15.5% higher (95% confidence interval, 9.0%-22.3%) than without. Adverse event rates with family reporting were 9.8% higher (95% CI, 3.1%-16.9%) than without. Family-reported error rates were 5 times higher (95% CI, 1.9-13.0) than hospital incident report rates.

The study showed that family-reported error and adverse event rates were significantly higher than voluntary, clinician-only hospital incident report rates. The study was limited to pediatric hospitals on general pediatric and subspecialty services, though findings potentially may be applicable more broadly (for example, adult and surgical services).

Bottom Line: Using a structured interview, families report significantly higher rates of errors and adverse events, compared with other sources.

Reference: Khan A, Coffey M, Litterer KP, et al. Families as partners in hospital error and adverse event surveillance. JAMA Pediatrics. Published online Feb 27, 2017. doi: 10.1001/jamapediatrics.2016.4812.

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