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In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

In their landmark decision in the Whole Woman’s Health v. Hellerstedt case that challenged abortion restrictions put into place in the state of Texas, U.S. Supreme Court justices specifically cited an amicus brief submitted by the Society of Hospital Medicine.

Getting cited is a pretty big deal! It means that justices not only used what SHM wrote to inform their opinion, but also shows they gave it particular weight.

On June 27 in a 5-3 vote, the Court struck down both the admitting privileges and ambulatory surgical center requirements of the Texas law, finding that neither of these requirements provided sufficient medical benefits to justify the burdens imposed.

The brief, submitted by SHM in conjunction with the Society of OB/GYN Hospitalists last January, provided the Court with material to clarify obsolete impressions about how inpatient care currently transpires, how provider-to-provider transitions occur, and how admitting privileges work in real life.

Texas partially justified their law on views about site-to-site patient handoffs as unsafe and not in keeping with current care standards. However, as geographically based providers (hospitalists) know, care no longer arises in that manner and handoffs are not just the norm, but customary and safe.

SHM, however, did not weigh in on Constitutional questions, and did not take any stance on moral or ethical matters. SHM’s membership has diverse beliefs, and a position on this topic would be inappropriate.

In part, the SHM brief noted that:

“Admitting privileges are appropriate for physicians who regularly admit patients. But requiring physicians who specialize in outpatient procedures with low incidence of post-procedure complications, whether that specialty is podiatry or gynecology, to maintain privileges serves no medical purpose, is inconsistent with modern medicine, and is unnecessary to ensure continuity of care. Having a hospitalist serve as the admitting or attending physician does not deprive patients of quality inpatient or outpatient services.”

SHM’s amicus brief provides procedural clarification and informs the Court of how hospitalists function, but SHM emphasizes that it has not taken an ideological or ethical stance regarding the issue. SHM applauds the diversity of its membership, in background and in belief.

Regardless of procedure, modern medicine now has a presence in multiple locations with varied disciplines coordinating care. Hospitalists and other providers know handoffs are safe with outcomes equivalent to, or exceeding, prior norms. SHM felt duty-bound to correct the record for future reference and the purpose of precedent.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.

Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.

"For so long we've been talking about five to seven attempts to quit," said lead author Dr. Michael Chaiton of the School of Public Health at the University of Toronto in Canada. "For us (the numbers) were a lot higher."

The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn't include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open, June 9.

For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.

A quit attempt was deemed a success when a participant went at least one year without a cigarette.

The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.

That's much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.

"People are very bad at remembering over their whole lifetimes," Chaiton told Reuters Health. "The second problem is we were only asking people who have been successful at quitting."

The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.

"This doesn't mean you hit a magic number and then you can quit," Chaiton said. "There are many people who are able to and do quit on their first attempt or in the first few.

"There are people who are good at many things, some are good at quitting smoking," he added.

Quitting smoking is often a long-term process with many attempts, he said.

"When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we're not going to be very successful," Chaiton said.

A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.

"The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit," said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.

"However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it's not only important to quit but it's important to quit while you are younger," said Hughes, who was not part of the new study.

"So it's important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work," Hughes told Reuters Health by email.

SOURCE: http://bit.ly/28LH9ED

BMJ Open 2016.

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

S. Godfrey, Alabama

A. Velayati, MD, Alabama

M. Neyman, MD, Arizona

S. StimsonRiahi, FACP, Arizona

D. Testa, Arizona

S. Thomas, MD, Arizona

A. Babaki, California

K. Blanton, BSN, California

K. Chan, DO, California

J. Cipa-Tatum, MD, California

M. Essig, California

R. Garcia, MPH, PA-C, California

C. Ho, California

J. Hoppe, California

M. Hudock, PA-C, California

V. Huynh, California

N. Lakhera, California

P. Lin, California

G. Martinez, California

R. Mistry, PA-C, California

A. Murphy, California

V. Reddy, California

S. Sharif, DO, California

J. Smith Jonas, RN, MSN, California

A. Williams, DO, California

H. Crossman, Colorado

L. Donigan, Colorado

F. Merritt, MD, Colorado

B. Clark, Connecticut

A. Kimowicz Ely, Delaware

V. Ramdoss, Delaware

B. Bhimji, MD, Florida

J. Dyer, Florida

S. Hussain, MD, Florida

J. Rodemeyer, Florida

R. A. Adene-Peter, MD, Georgia

M. Burnett, PA-C, Georgia

C. Gordon, MD, FACP, Georgia

M. Morris, Georgia

A. Roberson, PA-C, Georgia

A. Gorham, Idaho

M. Ashraf, Illinois

A. Kovalsky, DO, MPH, Illinois

G. Patel, USA, Illinois

A. Brown, ACNP, Indiana

A. Brown, ANP-BC, Indiana

R. De Los Santos, MD, Indiana

C. Frame, ACNP, Indiana

J. Myers, FNP, Indiana

A. Greif, MD, Iowa

M. Jones, DO, Kansas

S. Suman, MD, MPH, Kentucky

S. Davuluri, MD, Louisiana

A. LaComb, FAAFP, Louisiana

E. Von Felten, FAAFP, Maine

K. Anwar, Maryland

R. Sedighi Manesh, MD, Maryland

K. Islam, Massachusetts

V. Kandimalla, MD, Massachusetts

K. Ntiforo, Massachusetts

S. Paudel, MD, Massachusetts

O. Enaohwo, MD, Michigan

N. Wisniewski, MEd, MPAS, PA-C, Michigan

M. Buchner-Mehling, Minnesota

T. Mukonje, Minnesota

T. Perttula, Minnesota

C. Plooster, MPAS, PA-C, Minnesota

S. Reichl, Minnesota

J. Sundberg, MD, Minnesota

D. Wolbrink, MD, Minnesota

D. Haddad, MD, Mississippi

K. Bleisch, AGNP, Missouri

V. Kenguva, MD, Missouri

R. Kroeger, MD, Missouri

H. McKeever, ACAGNP, Missouri

A. Pickrell, MD, Missouri

P. Podaralla, MD, Missouri

C. Robertson, FNP, Missouri

E. Robinson-Mitchell, MD, Missouri

K. Schaefermeier, AGNP, Missouri

A. Shah, MD, Missouri

S. V. Yew, MBBS, Missouri

T. Hylland, FNP, Montana

R. Goodwin, Nebraska

M. Hofreiter, FACP, New Hampshire

G. Looser, PA-C, New Hampshire

V. Verma, MD, New Jersey

M. Behl, MD, New Mexico

P. Boehringer, MD, FACP, New Mexico

L. Fatemi, DO, New Mexico

L. Flores, New Mexico

B. Khan, MD, New Mexico

M. Knof, New Mexico

H. McKnight, MD, New Mexico

B. Murguia, MD, New Mexico

R. Pierce, MD, New Mexico

A. Belman, MD, New York

W. Dissanayake, MD, New York

M. Fabisevich, MD, New York

S. Madderla, MD, New York

M. Maynard, DO, New York

P. Park, MD, New York

V. Subramanian, MD, New York

M. Wolfe, New York

A. Chatterjee, MD, North Carolina

G. Gilson, MHA, North Carolina

C. Nashatizadeh, MD, North Carolina

J. Perez Coste, North Carolina

K. Gupta, North Dakota

M. Sampson, CCFP, MD, Nova Scotia

M. J. Belderol, MD, Ohio

K. Crouser, MD, Ohio

C. Lambert, MD, Ohio

J. Muriithi, MD, Ohio

Y. Omran, USA, Ohio

T. Scheufler, DO, Ohio

J. Springer, Ohio

H. Szugye, DO, Ohio

J. Zang, MS, Ohio

J. Zimmerman, FACEP, Ohio

D. Beeson, MD, Oklahoma

E. Mathias, LPN, Oklahoma

M. Salehidobakhshari, Ontario

J. Hull, DO, Oregon

R. Asaad, Pennsylvania

N. Desai, MD, Pennsylvania

N. Ezeife, MD, Pennsylvania

M. Mazich, PA, Pennsylvania

K. Mezue, MSC, Pennsylvania

V. Shah, MD, MBBS, Pennsylvania

W. Sherman, DO, MBA, MS, Pennsylvania

S. Tripp, Pennsylvania

M. Weidner, CRNP, Pennsylvania

B. Weinbaum, MD, Pennsylvania

A. Gupta, MD, Rhode Island

S. El-Ibiary, South Carolina

C. Obi, South Carolina

J. Reed, MD, South Dakota

R. Mahboob, MD, Tennessee

L. Ackerman, MD, Texas

K. Chung, Texas

N. Jayaswal, MBBS, Texas

R. Kessel, MD, Texas

A. Khatoon, Texas

C. Renner, Texas

H. Smith, PA-C, Texas

R. Trien, Texas

J. Anderson, ACNP, Utah

C. Mitchell, MD, Vermont

L. Lawson, Virginia

S. Glass, MD, Washington

J. Joy, MHA, Washington

D. Farmer, BS, DO, MS, West Virginia

D. Nunev, MD, West Virginia

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

The State of Hospital Medicine (SoHM) report is the most comprehensive survey of hospital medicine in the country and provides current data on hospitalist compensation and productivity and also covers practice demographics, staffing levels, staff growth, and compensation models.

“The SoHM report is an indispensable tool for hospital medicine group directors,” says Andrew White, MD, SFHM. “I really appreciate the breakdown by characteristics, such as region of the country, academic practice, pediatrics, family medicine, and the involvement of NP and PA providers. The SoHM represents an excellent value. It has a ton of information in an easy-to-read format.”

Don’t miss out on getting your copy when it becomes available. Order now and be notified directly when the report is released in September at www.hospitalmedicine.org/Survey.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

NEW YORK - A new protein-based risk score outperforms the Framingham model for predicting cardiovascular outcomes in patients with stable coronary heart disease.

"Patients who carry the diagnosis of stable coronary heart disease have been viewed traditionally as a homogeneous population within which all individuals tend to be treated similarly," Dr. Peter Ganz, from the University of California, San Francisco, told Reuters Health by email.

"Instead, we found that individuals who all carried the same clinical diagnosis of stable coronary heart disease had a risk of adverse events (heart attacks, strokes, heart failure, and death) that varied by as much as 10-fold, as revealed by analysis of the levels of nine proteins in their blood," he said.

Dr. Ganz and colleagues sought to derive and validate a score to predict the risk of cardiovascular outcomes among patients with coronary heart disease, using modified aptamers to measure 1,130 proteins in plasma samples.

Aptamers are small nucleic acids that can form secondary and tertiary structures capable of specifically binding proteins and thus can be considered the chemical equivalent of antibodies.

The researchers' unbiased statistical approach identified nine proteins, from which they derived a risk score that reflects the probability of a cardiovascular event occurring within four years.

In both the derivation and validation cohorts, participants had four-year cumulative event rates of 60% to 80% in the highest risk score decile and less than 10% in the lowest risk score decile, according to the June 21 JAMA report.

Compared with the Framingham model, the protein-based risk score showed an absolute increase of 12% in average risk for participants with events compared with participants without events.

The protein-based risk score was within two percentage points of the observed event rate in the external validation cohort.

Moreover, the protein-based risk score changed more than the Framingham model among participants approaching new events, and the protein-based risk score at follow-up was a stronger predictor of subsequent outcomes than the preceding baseline risk score.

"We may now be able to tell individual patients with coronary heart disease, 'You are at a very high risk, medium risk, or a very low risk,' and they may opt to be treated differently from other patients with the same diagnosis," Dr. Ganz said.

"In addition to the results described in the JAMA paper that apply to patients with coronary heart disease, we have an ongoing discovery program to identify proteins that can predict the risk of cardiovascular disease in additional patient populations, including lower-risk individuals who appear healthy but may actually be at high risk of coronary heart disease due to high cholesterol, high blood pressure, diabetes, or smoking, or among individuals who may be at high risk due to kidney disease or HIV infection," Dr. Ganz said.

"Although more accurate risk prediction is always welcome, clinicians more readily embrace measuring a prognostic biomarker or calculating a risk score if the results could alter therapeutic decision making," writes Dr. Marc S. Sabatine from Brigham and Women's Hospital, Boston, in an accompanying editorial.

"To that end, it would be interesting to apply these arrays to samples from patients in randomized clinical trials of therapies," he said. "If a gradient of treatment benefit existed, such data would make measurement of the relevant proteins in clinical practice more compelling (which, for the current list, is impractical). Furthermore, part of the long-term value of this sort of proteomics work may come from exploring the basic pathways that underline some of the novel associations described."

Dr. Matthew Sherwood, from Duke University Medical Center, Durham, North Carolina, who recently described multimarker risk stratification in patients with acute myocardial infarction, told Reuters Health by email, "While the results are impressive, their scope is limited. Since the population studied is already at high risk for further cardiovascular events, more refined risk stratification may not have significant clinical import. These patients have indications for treatment of CAD at present, thus changes in medical management are unlikely."

"Our ability to use proteomic signatures to predict cardiovascular risk continues to expand, and may become available to a broad cohort of patients in the future," Dr. Sherwood said. "The clinical utility of these platforms remains uncertain, and further investigation is needed to determine if proteomic based risk scores could help to modify therapeutic management in lower risk populations."

SomaLogic provided funding for protein assays and employed two coauthors. Four coauthors and the editorialist reported disclosures.

SOURCE: http://bit.ly/28L6oEy and http://bit.ly/28NgaJg

JAMA 2016.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

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: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

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: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.

Jill Slater Waldman, MD, SFHM, loved math and science and working with people, so a career in medicine was always the logical choice. She just didn’t want to leave a hospital, literally. So when she was finishing her internal medicine residency in 1994 at Westchester Medical Center in Valhalla, N.Y., internal medicine (IM) suddenly appealed.

“I started seeking any job that would be ‘all in house,’ with no outpatient or clinic time,” Dr. Waldman says. “I was informed those jobs did not exist, so I joined the faculty of Albert Einstein College of Medicine with a dual appointment in emergency and internal medicine.”

Fast-forward through a few IM positions at New York State hospitals, and she landed the directorship of the adult hospitalist program at Nyack (N.Y.) Hospital. Two years later, she left for her current post, director of the adult hospital service at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y.

A crowded résumé got an extra line this year as Dr. Waldman is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.

Question: Tell us about your training years.

Answer: I initially matched in anesthesia but within two weeks realized the pre-ops and post-ops were my favorite visits. I went back to complete my IM residency, doing multiple extra months of ICU night float to avoid having to go to continuity of care clinic.

Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?

A: My mentor was undoubtedly my internship coordinator, who allowed me back to complete my IM training when I realized anesthesia was not for me. He is a special man, incredibly brilliant, and committed to the art and science of medicine. He taught his staff to always act like a physician, always have respect for yourself and the patients, and to take no shortcuts. He is the brightest physician I likely have ever met, and I am lucky to have been hired by him to run his hospital medicine program as a senior attending.

Q: Have you tried to mentor others?

A: I enjoy mentoring junior faculty, house staff, and students. I just returned from a medical mission during which I supervised three fantastic medical students—one of whom was my own daughter.

Q: What do you like most about working as a hospitalist?

A: The variety of patients we get to interact with and the variety of pathology we see.

Q: What do you dislike most?

A: Raw beets and egotistical consultants who treat hospitalists like house staff.

Q: How many Apple products do you interface with in a given week?

A: Two.

Q: What impact do you feel those devices and ones similar to them have had on HM and medicine in a broader sense?

A: I believe they have enabled channels of communication and allowed the public to become more knowledgeable medically.

Q: What’s the best advice you ever received?

A: Do unto others as you wish others to do unto you.

Q: What’s the worst advice you ever received?

A: “There’s no way you can be both a mother and a doctor. Pick one.”

Q: What’s the biggest change you’ve seen in HM in your career?

A: The evolution of HM as a true specialty, requiring a skill set of its own to be a hospitalist.

Q: What’s the biggest change you would like to see in HM?

A: More respect for the field and understanding of our skill set and knowledge base.

Q: As a group leader, why is it important for you to continue seeing patients?

A: As a director, I believe keeping my skill set current is important for myself as well as my partners. I have always said I would never ask them to do something I would not do, so I get to practice what I preach. I also think it enables me to keep perspective when discussing plans with administration or reviewing complaints.

Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?

A: You are meeting a person on what is likely the worst day of their life. Trying to find the best approach for each individual is still a challenge.

Q: What aspect of patient care is most rewarding?

A: Seeing the relief on a patient’s face when you tell them they will get better and explain their treatment plan.

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: Teaching in the 21st century is challenging with all the new regulations. We have a family physician residency at our hospital, and the blind dedication we had as residents is just not present in a group of physicians who have grown up with duty hour restrictions and protected time.

Q: What is your biggest professional reward?

A: Our group has virtually no attrition and has been intact for more than five years.

Q: You received your SFHM designation five years ago. What does that public recognition mean to you?

A: It was a mark of respect and recognition for expertise in this new field. A very proud moment.

Q: Where do you see yourself in 10 years?

A: Hopefully, working as a part-time nocturnist two nights per week and caring for some grandbabies and going on medical missions. TH

Richard Quinn is a freelance writer in New Jersey.

NEW YORK - Patients dependent on prescription opioids are likely to quit if they get individual drug counseling with their prescribed medications, according to long-term follow-up results.

"Medication-assisted treatment for opioid dependence benefited people who were dependent on prescription opioids. Good standard medical management, medically based counseling, can be effective for these people if given in conjunction with buprenorphine treatment," said lead author Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School in Boston and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts.

"Over time, with treatment, these patients have relatively optimistic outcomes, but there are a number of risks involved, including people shifting from prescription opioids to heroin who had never injected drugs, injecting them, and a higher death rate," he told Reuters Health by phone.

Dr. Weiss and colleagues examined the outcomes over a 42-month follow-up period among adult participants in POATS (the Prescription Opioid Addiction Treatment Study), the first long-term multisite randomized trial to investigate whether outcomes for patients dependent on prescription opioid analgesics can be improved with standard medical management by adding individual drug counseling to prescribed buprenorphine (combined with naloxone to prevent withdrawal symptoms).

The researchers enrolled 653 participants at 12 medical centers in nine states through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. They examined the results at four and 12 weeks and conducted follow-up assessments of opioid and other substance abuse through telephone interviews with 375 patients at 1.5 years, 2.5 years, and 3.5 years from study entry.

At 1.5 years, most follow-up participants no longer depended on opioids, and at 3.5 years, fewer than 10% of them were opioid dependent. Patients who reported a lifetime history of heroin use at study entry were more likely to be opioid dependent at 3.5 years (odds ratio 4.56, p<0.05).

At 2.5 years, 61% of patients reported that they had abstained from opioids for one month. The roughly one-third of the sample who received opioid agonist treatment during follow-up were more likely to be abstinent at month 42. Even so, 27 (8%) of 338 patients used heroin for the first time during follow-up and 10.1% reported that they had injected heroin for the first time.

The results were presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"Prior to this study, there had never been a study of treatment in people dependent on prescription opioids. There had been many opioid-dependence treatment studies, but they had all focused on people who exclusively or primarily used heroin, and most were done in methadone maintenance programs. This was the first study done with people receiving office-based buprenorphine treatment," Dr. Weiss told Reuters Health.

"A real strength of this study is that it was very large and included a mixture of urban, suburban, and rural sites. No other study has looked at even 100 people," he added.

Regarding future related research, Dr. Weiss told Reuters Health that it would be good to learn exactly which people do well over time and how to increase their success rate.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/28MTqd6 APA 2016.

NEW YORK - Patients dependent on prescription opioids are likely to quit if they get individual drug counseling with their prescribed medications, according to long-term follow-up results.

"Medication-assisted treatment for opioid dependence benefited people who were dependent on prescription opioids. Good standard medical management, medically based counseling, can be effective for these people if given in conjunction with buprenorphine treatment," said lead author Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School in Boston and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts.

"Over time, with treatment, these patients have relatively optimistic outcomes, but there are a number of risks involved, including people shifting from prescription opioids to heroin who had never injected drugs, injecting them, and a higher death rate," he told Reuters Health by phone.

Dr. Weiss and colleagues examined the outcomes over a 42-month follow-up period among adult participants in POATS (the Prescription Opioid Addiction Treatment Study), the first long-term multisite randomized trial to investigate whether outcomes for patients dependent on prescription opioid analgesics can be improved with standard medical management by adding individual drug counseling to prescribed buprenorphine (combined with naloxone to prevent withdrawal symptoms).

The researchers enrolled 653 participants at 12 medical centers in nine states through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. They examined the results at four and 12 weeks and conducted follow-up assessments of opioid and other substance abuse through telephone interviews with 375 patients at 1.5 years, 2.5 years, and 3.5 years from study entry.

At 1.5 years, most follow-up participants no longer depended on opioids, and at 3.5 years, fewer than 10% of them were opioid dependent. Patients who reported a lifetime history of heroin use at study entry were more likely to be opioid dependent at 3.5 years (odds ratio 4.56, p<0.05).

At 2.5 years, 61% of patients reported that they had abstained from opioids for one month. The roughly one-third of the sample who received opioid agonist treatment during follow-up were more likely to be abstinent at month 42. Even so, 27 (8%) of 338 patients used heroin for the first time during follow-up and 10.1% reported that they had injected heroin for the first time.

The results were presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"Prior to this study, there had never been a study of treatment in people dependent on prescription opioids. There had been many opioid-dependence treatment studies, but they had all focused on people who exclusively or primarily used heroin, and most were done in methadone maintenance programs. This was the first study done with people receiving office-based buprenorphine treatment," Dr. Weiss told Reuters Health.

"A real strength of this study is that it was very large and included a mixture of urban, suburban, and rural sites. No other study has looked at even 100 people," he added.

Regarding future related research, Dr. Weiss told Reuters Health that it would be good to learn exactly which people do well over time and how to increase their success rate.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/28MTqd6 APA 2016.

NEW YORK - Patients dependent on prescription opioids are likely to quit if they get individual drug counseling with their prescribed medications, according to long-term follow-up results.

"Medication-assisted treatment for opioid dependence benefited people who were dependent on prescription opioids. Good standard medical management, medically based counseling, can be effective for these people if given in conjunction with buprenorphine treatment," said lead author Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School in Boston and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts.

"Over time, with treatment, these patients have relatively optimistic outcomes, but there are a number of risks involved, including people shifting from prescription opioids to heroin who had never injected drugs, injecting them, and a higher death rate," he told Reuters Health by phone.

Dr. Weiss and colleagues examined the outcomes over a 42-month follow-up period among adult participants in POATS (the Prescription Opioid Addiction Treatment Study), the first long-term multisite randomized trial to investigate whether outcomes for patients dependent on prescription opioid analgesics can be improved with standard medical management by adding individual drug counseling to prescribed buprenorphine (combined with naloxone to prevent withdrawal symptoms).

The researchers enrolled 653 participants at 12 medical centers in nine states through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. They examined the results at four and 12 weeks and conducted follow-up assessments of opioid and other substance abuse through telephone interviews with 375 patients at 1.5 years, 2.5 years, and 3.5 years from study entry.

At 1.5 years, most follow-up participants no longer depended on opioids, and at 3.5 years, fewer than 10% of them were opioid dependent. Patients who reported a lifetime history of heroin use at study entry were more likely to be opioid dependent at 3.5 years (odds ratio 4.56, p<0.05).

At 2.5 years, 61% of patients reported that they had abstained from opioids for one month. The roughly one-third of the sample who received opioid agonist treatment during follow-up were more likely to be abstinent at month 42. Even so, 27 (8%) of 338 patients used heroin for the first time during follow-up and 10.1% reported that they had injected heroin for the first time.

The results were presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"Prior to this study, there had never been a study of treatment in people dependent on prescription opioids. There had been many opioid-dependence treatment studies, but they had all focused on people who exclusively or primarily used heroin, and most were done in methadone maintenance programs. This was the first study done with people receiving office-based buprenorphine treatment," Dr. Weiss told Reuters Health.

"A real strength of this study is that it was very large and included a mixture of urban, suburban, and rural sites. No other study has looked at even 100 people," he added.

Regarding future related research, Dr. Weiss told Reuters Health that it would be good to learn exactly which people do well over time and how to increase their success rate.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/28MTqd6 APA 2016.

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

Geeta Arora, MD, locum tenens hospitalist

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

Geeta Arora, MD, locum tenens hospitalist

In early 2014, I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then, I have worked with several telemedicine platforms. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider. Here are my top tips for deciding which telemedicine company to work with.

1. Technology support: Telemedicine is dependent on technology. If it is difficult to get help from tech support, do not credential with the company. Tech support is your lifeline to your patients. Make sure you can get help right away if you are having problems finishing or starting a consult. Companies that send automatic emails saying they will get back to you within 24 hours are the most difficult to work with.
2. Nursing support: All of the telemedicine companies that I have worked with have amazing nurses, but some are overwhelmed with work. Telemedicine nurses are able to connect to your patients via direct callback numbers in a way that you cannot connect. They are able to call in prescriptions to pharmacies if the platform is down or if the patient put in the wrong pharmacy information. Make sure that the company has a nurse that is able to call you back right away. A few telemedicine companies are understaffed with nurses, and it can take hours for a callback. If the key to telemedicine is volume, this is frustrating to deal with.
3. Chief complaints: Many telemedicine companies are moving away from making the “chief complaint” visible to providers before choosing to take the consult. For me, this is a big red flag. It can be as simple as, “I have a cold.” I like this because if I see a patient who says, “I have abdominal pain,” I know to triage them first.
4. Volume: Telemedicine is great for staying connected to outpatient medicine. If you are looking to work on a telemedicine platform for your main source of income, then volume is key. A lot of telemedicine companies will tell you how many calls they get per day; the key question is how many calls they get for the states that you are licensed in and how many providers they have licensed in those states. If you want higher volume, then ask if they will pay for your license in states with higher needs (some will). If you are willing to pay to be licensed in additional states, make sure the volume is high enough to make that extra out-of-pocket cost worth it.
5. Malpractice coverage: Many companies provide malpractice coverage as part of their credentialing package. If they do not, make sure your malpractice coverage covers you for telemedicine.
6. Documentation: Documentation during your telemedicine consult is arguably even more important than in an outpatient visit. Everything is on the phone or by video, so make sure, in the subjective area, that you are quoting what the patient is telling you. You are not able to do a physical exam, so your recommendations will be based on what the patient is saying.

Have fun! Telemedicine has been really enjoyable for me. I like being able to have the time to educate my patients about things like antibiotics. I enjoy the technological aspects and understanding all of the different platforms. Telemedicine gives you a unique opportunity to practice your skills from the comfort of your own home. TH

Geeta Arora, MD, locum tenens hospitalist

NEW YORK - Several hepatitis C virus core antigen (HCVcAg) tests accurately diagnose hepatitis C virus (HCV) infection and could replace nucleic acid testing (NAT) in settings where HCV is prevalent, according to a systematic review and meta-analysis.

"Overall, several of the tests perform very well and while they are not equal to NAT, the lower costs may improve diagnostic capacity in the appropriate setting," Dr. J. Morgan Freiman from Boston Medical Center in Massachusetts told Reuters Health by email.

The current two-step diagnostic procedure for diagnosing HCV infection -- screening for antibodies to HCV followed by NAT for those with anti-HCV antibodies -- is a major bottleneck for addressing the HCV elimination strategy proposed by the World Health Organization. Currently, there are five tests for HCVcAg commercially available.

Dr. Freiman and colleagues evaluated the accuracy of diagnosis of active HCV infection among adults and children for these five commercially available tests compared with NAT in their systematic review and meta-analysis of 44 published reports.

The pooled sensitivity and specificity were 93.4% and 98.8% for the Abbott ARCHITECT assay, 93.2% and 99.2% for the Ortho HCV Ag ELISA, and 59.5% and 82.9% for the Hunan Jynda HCV Ag ELISA. There was insufficient information for a pooled analysis of the Eiken Lumispot HCV Ag and the Fujirebio Lumipulse Ortho HCV Ag assays.

Three reports showed that the HCVcAg correlated well with RNA when levels were at least 3000 IU/mL when the Abbott ARCHITECT assay was used, according to the June 21 Annals of Internal Medicine report.

"Although even tests with the highest performance are not as sensitive as NAT, well-performing HCVcAg tests with an analytic sensitivity reaching into the femtomolar range (equal to 3000 IU/mL) could replace NAT for HCV detection, particularly if a lower cost per test allows more patients to be served," the researchers conclude. "Therefore, HCVcAg should be explored for point-of-care (POC) testing to increase the number of patients diagnosed and streamline the HCV cascade of care."

"There is much more work to be done to determine at what sensitivity threshold a POC test would be clinically useful," Dr. Freiman said. "In settings with reliable access to centralized laboratory processing and higher diagnostic capacity, a POC test may still prove to be useful as a screening tool, but would be less likely to replace confirmatory nucleic acid testing (NAT)."

"We have the technology to detect circulating HCV RNA down to 15 IU/mL - amazing -- but how clinically relevant is that threshold when access to testing is equally as important as accuracy in resource limited settings?" he wondered.

Dr. Jose-Manuel Echevarria, from Carlos III Health Institute, Madrid, Spain, who recently reported that HCV core-specific antibody may represent occult HCV infection among blood donors, told Reuters Health by email, "Physicians should conclude from the report that HCVcAg testing provides trustful diagnostic results for the characterization of their anti-HCV positive patients as viremic or non-viremic before deciding about antiviral treatment."

"I would add that HCVcAg testing is particularly useful for the purpose of transfusion centers," he said. "Chronically infected blood donors are detected by anti-HCV screening, and HCVcAg will detect efficiently almost every blood unit obtained from donors experiencing the window period of the acute HCV infection, who test negative for anti-HCV."

"At present, high-resource settings will for sure use NAT testing because of its higher sensitivity, and because automatic equipment has reduced the chance for false-positive results because sample-to-sample contamination (is kept) to a minimum," Dr. Echevarria concluded. "However, HCVcAg testing is extremely useful and convenient for low-resource settings, and also for emergency units everywhere."

The National Institutes of Health funded this research. Three coauthors reported disclosures.

SOURCE: http://bit.ly/28LpRcU Ann Intern Med 2016.

NEW YORK - Several hepatitis C virus core antigen (HCVcAg) tests accurately diagnose hepatitis C virus (HCV) infection and could replace nucleic acid testing (NAT) in settings where HCV is prevalent, according to a systematic review and meta-analysis.

"Overall, several of the tests perform very well and while they are not equal to NAT, the lower costs may improve diagnostic capacity in the appropriate setting," Dr. J. Morgan Freiman from Boston Medical Center in Massachusetts told Reuters Health by email.

The current two-step diagnostic procedure for diagnosing HCV infection -- screening for antibodies to HCV followed by NAT for those with anti-HCV antibodies -- is a major bottleneck for addressing the HCV elimination strategy proposed by the World Health Organization. Currently, there are five tests for HCVcAg commercially available.

Dr. Freiman and colleagues evaluated the accuracy of diagnosis of active HCV infection among adults and children for these five commercially available tests compared with NAT in their systematic review and meta-analysis of 44 published reports.

The pooled sensitivity and specificity were 93.4% and 98.8% for the Abbott ARCHITECT assay, 93.2% and 99.2% for the Ortho HCV Ag ELISA, and 59.5% and 82.9% for the Hunan Jynda HCV Ag ELISA. There was insufficient information for a pooled analysis of the Eiken Lumispot HCV Ag and the Fujirebio Lumipulse Ortho HCV Ag assays.

Three reports showed that the HCVcAg correlated well with RNA when levels were at least 3000 IU/mL when the Abbott ARCHITECT assay was used, according to the June 21 Annals of Internal Medicine report.

"Although even tests with the highest performance are not as sensitive as NAT, well-performing HCVcAg tests with an analytic sensitivity reaching into the femtomolar range (equal to 3000 IU/mL) could replace NAT for HCV detection, particularly if a lower cost per test allows more patients to be served," the researchers conclude. "Therefore, HCVcAg should be explored for point-of-care (POC) testing to increase the number of patients diagnosed and streamline the HCV cascade of care."

"There is much more work to be done to determine at what sensitivity threshold a POC test would be clinically useful," Dr. Freiman said. "In settings with reliable access to centralized laboratory processing and higher diagnostic capacity, a POC test may still prove to be useful as a screening tool, but would be less likely to replace confirmatory nucleic acid testing (NAT)."

"We have the technology to detect circulating HCV RNA down to 15 IU/mL - amazing -- but how clinically relevant is that threshold when access to testing is equally as important as accuracy in resource limited settings?" he wondered.

Dr. Jose-Manuel Echevarria, from Carlos III Health Institute, Madrid, Spain, who recently reported that HCV core-specific antibody may represent occult HCV infection among blood donors, told Reuters Health by email, "Physicians should conclude from the report that HCVcAg testing provides trustful diagnostic results for the characterization of their anti-HCV positive patients as viremic or non-viremic before deciding about antiviral treatment."

"I would add that HCVcAg testing is particularly useful for the purpose of transfusion centers," he said. "Chronically infected blood donors are detected by anti-HCV screening, and HCVcAg will detect efficiently almost every blood unit obtained from donors experiencing the window period of the acute HCV infection, who test negative for anti-HCV."

"At present, high-resource settings will for sure use NAT testing because of its higher sensitivity, and because automatic equipment has reduced the chance for false-positive results because sample-to-sample contamination (is kept) to a minimum," Dr. Echevarria concluded. "However, HCVcAg testing is extremely useful and convenient for low-resource settings, and also for emergency units everywhere."

The National Institutes of Health funded this research. Three coauthors reported disclosures.

SOURCE: http://bit.ly/28LpRcU Ann Intern Med 2016.

NEW YORK - Several hepatitis C virus core antigen (HCVcAg) tests accurately diagnose hepatitis C virus (HCV) infection and could replace nucleic acid testing (NAT) in settings where HCV is prevalent, according to a systematic review and meta-analysis.

"Overall, several of the tests perform very well and while they are not equal to NAT, the lower costs may improve diagnostic capacity in the appropriate setting," Dr. J. Morgan Freiman from Boston Medical Center in Massachusetts told Reuters Health by email.

The current two-step diagnostic procedure for diagnosing HCV infection -- screening for antibodies to HCV followed by NAT for those with anti-HCV antibodies -- is a major bottleneck for addressing the HCV elimination strategy proposed by the World Health Organization. Currently, there are five tests for HCVcAg commercially available.

Dr. Freiman and colleagues evaluated the accuracy of diagnosis of active HCV infection among adults and children for these five commercially available tests compared with NAT in their systematic review and meta-analysis of 44 published reports.

The pooled sensitivity and specificity were 93.4% and 98.8% for the Abbott ARCHITECT assay, 93.2% and 99.2% for the Ortho HCV Ag ELISA, and 59.5% and 82.9% for the Hunan Jynda HCV Ag ELISA. There was insufficient information for a pooled analysis of the Eiken Lumispot HCV Ag and the Fujirebio Lumipulse Ortho HCV Ag assays.

Three reports showed that the HCVcAg correlated well with RNA when levels were at least 3000 IU/mL when the Abbott ARCHITECT assay was used, according to the June 21 Annals of Internal Medicine report.

"Although even tests with the highest performance are not as sensitive as NAT, well-performing HCVcAg tests with an analytic sensitivity reaching into the femtomolar range (equal to 3000 IU/mL) could replace NAT for HCV detection, particularly if a lower cost per test allows more patients to be served," the researchers conclude. "Therefore, HCVcAg should be explored for point-of-care (POC) testing to increase the number of patients diagnosed and streamline the HCV cascade of care."

"There is much more work to be done to determine at what sensitivity threshold a POC test would be clinically useful," Dr. Freiman said. "In settings with reliable access to centralized laboratory processing and higher diagnostic capacity, a POC test may still prove to be useful as a screening tool, but would be less likely to replace confirmatory nucleic acid testing (NAT)."

"We have the technology to detect circulating HCV RNA down to 15 IU/mL - amazing -- but how clinically relevant is that threshold when access to testing is equally as important as accuracy in resource limited settings?" he wondered.

Dr. Jose-Manuel Echevarria, from Carlos III Health Institute, Madrid, Spain, who recently reported that HCV core-specific antibody may represent occult HCV infection among blood donors, told Reuters Health by email, "Physicians should conclude from the report that HCVcAg testing provides trustful diagnostic results for the characterization of their anti-HCV positive patients as viremic or non-viremic before deciding about antiviral treatment."

"I would add that HCVcAg testing is particularly useful for the purpose of transfusion centers," he said. "Chronically infected blood donors are detected by anti-HCV screening, and HCVcAg will detect efficiently almost every blood unit obtained from donors experiencing the window period of the acute HCV infection, who test negative for anti-HCV."

"At present, high-resource settings will for sure use NAT testing because of its higher sensitivity, and because automatic equipment has reduced the chance for false-positive results because sample-to-sample contamination (is kept) to a minimum," Dr. Echevarria concluded. "However, HCVcAg testing is extremely useful and convenient for low-resource settings, and also for emergency units everywhere."

The National Institutes of Health funded this research. Three coauthors reported disclosures.

SOURCE: http://bit.ly/28LpRcU Ann Intern Med 2016.

Clinical question: Is one dose of dexamethasone comparable to five days of prednisone for treating mild-to-moderate asthma exacerbations?

Background: Corticosteroids are the mainstay of initial treatment for asthma exacerbations. The National Heart, Lung, and Blood Institute recommends a minimum of five days of prednisone, though studies have shown incomplete adherence to prolonged therapies. Dexamethasone has a longer duration of action than prednisone.

Study design: Randomized, controlled, double-blinded trial.

Setting: Urban, safety-net, teaching hospital.

Synopsis: The study included 376 adults ages 18–55 presenting to the emergency department for a mild-to-moderate asthma exacerbation who were randomized to two treatment courses of corticosteroids: one 12 mg dose of oral dexamethasone followed by four days of placebo versus five days of 60 mg of oral prednisone. Two weeks later, a telephone survey asked if they had relapsed and had to seek medical attention. This study did not show noninferiority of the dexamethasone option compared to the standard of care. Specifically, it showed a 12.1% relapse rate in the dexamethasone group versus a 9.8% relapse rate for prednisone (95% CI, -4.1% to 8.6%).

This was a small study looking at adults without other chronic lung diseases or diabetes. The authors did not include those patients who were either lost to follow-up (20% of those initially randomized) or ultimately admitted after their emergency department course.

Hospitalists who care for patients with asthma should look to the current standards of corticosteroid selection and duration to minimize clinical relapses and possibly readmissions.

Bottom line: One large dose of dexamethasone is inferior to the standard five days of prednisone for treating acute asthma exacerbations in adults.

Citation: Rehrer MW, Liu B, Rodriguez M, Lam J, Alter HJ. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma [published online ahead of print April 14, 2016]. Ann Emerg Med. doi:10.1016/j.annemergmed.2016.03.017.

Short Take

Guideline Recommends ED Asthma Management Associated with Shorter Inpatient Stay

Observational study found ED treatment concordance with four guideline-based processes for acute asthma treatment (inhaled beta-agonists, inhaled anticholinergics, systemic corticosteroids, and avoidance of methylxanthines) is associated with a 17% shorter hospital length of stay.

Citation: Hasegawa K, Brenner BE, Nowak RM, et al. Association of guideline-concordant acute asthma care in the emergency department with shorter hospital length of stay: a multicenter observational study. Acad Emerg Med. 2016;23(5):616-622.

Clinical question: Is one dose of dexamethasone comparable to five days of prednisone for treating mild-to-moderate asthma exacerbations?

Background: Corticosteroids are the mainstay of initial treatment for asthma exacerbations. The National Heart, Lung, and Blood Institute recommends a minimum of five days of prednisone, though studies have shown incomplete adherence to prolonged therapies. Dexamethasone has a longer duration of action than prednisone.

Study design: Randomized, controlled, double-blinded trial.

Setting: Urban, safety-net, teaching hospital.

Synopsis: The study included 376 adults ages 18–55 presenting to the emergency department for a mild-to-moderate asthma exacerbation who were randomized to two treatment courses of corticosteroids: one 12 mg dose of oral dexamethasone followed by four days of placebo versus five days of 60 mg of oral prednisone. Two weeks later, a telephone survey asked if they had relapsed and had to seek medical attention. This study did not show noninferiority of the dexamethasone option compared to the standard of care. Specifically, it showed a 12.1% relapse rate in the dexamethasone group versus a 9.8% relapse rate for prednisone (95% CI, -4.1% to 8.6%).

This was a small study looking at adults without other chronic lung diseases or diabetes. The authors did not include those patients who were either lost to follow-up (20% of those initially randomized) or ultimately admitted after their emergency department course.

Hospitalists who care for patients with asthma should look to the current standards of corticosteroid selection and duration to minimize clinical relapses and possibly readmissions.

Bottom line: One large dose of dexamethasone is inferior to the standard five days of prednisone for treating acute asthma exacerbations in adults.

Citation: Rehrer MW, Liu B, Rodriguez M, Lam J, Alter HJ. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma [published online ahead of print April 14, 2016]. Ann Emerg Med. doi:10.1016/j.annemergmed.2016.03.017.

Short Take

Guideline Recommends ED Asthma Management Associated with Shorter Inpatient Stay

Observational study found ED treatment concordance with four guideline-based processes for acute asthma treatment (inhaled beta-agonists, inhaled anticholinergics, systemic corticosteroids, and avoidance of methylxanthines) is associated with a 17% shorter hospital length of stay.

Citation: Hasegawa K, Brenner BE, Nowak RM, et al. Association of guideline-concordant acute asthma care in the emergency department with shorter hospital length of stay: a multicenter observational study. Acad Emerg Med. 2016;23(5):616-622.

Clinical question: Is one dose of dexamethasone comparable to five days of prednisone for treating mild-to-moderate asthma exacerbations?

Background: Corticosteroids are the mainstay of initial treatment for asthma exacerbations. The National Heart, Lung, and Blood Institute recommends a minimum of five days of prednisone, though studies have shown incomplete adherence to prolonged therapies. Dexamethasone has a longer duration of action than prednisone.

Study design: Randomized, controlled, double-blinded trial.

Setting: Urban, safety-net, teaching hospital.

Synopsis: The study included 376 adults ages 18–55 presenting to the emergency department for a mild-to-moderate asthma exacerbation who were randomized to two treatment courses of corticosteroids: one 12 mg dose of oral dexamethasone followed by four days of placebo versus five days of 60 mg of oral prednisone. Two weeks later, a telephone survey asked if they had relapsed and had to seek medical attention. This study did not show noninferiority of the dexamethasone option compared to the standard of care. Specifically, it showed a 12.1% relapse rate in the dexamethasone group versus a 9.8% relapse rate for prednisone (95% CI, -4.1% to 8.6%).

This was a small study looking at adults without other chronic lung diseases or diabetes. The authors did not include those patients who were either lost to follow-up (20% of those initially randomized) or ultimately admitted after their emergency department course.

Hospitalists who care for patients with asthma should look to the current standards of corticosteroid selection and duration to minimize clinical relapses and possibly readmissions.

Bottom line: One large dose of dexamethasone is inferior to the standard five days of prednisone for treating acute asthma exacerbations in adults.

Citation: Rehrer MW, Liu B, Rodriguez M, Lam J, Alter HJ. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma [published online ahead of print April 14, 2016]. Ann Emerg Med. doi:10.1016/j.annemergmed.2016.03.017.

Short Take

Guideline Recommends ED Asthma Management Associated with Shorter Inpatient Stay

Observational study found ED treatment concordance with four guideline-based processes for acute asthma treatment (inhaled beta-agonists, inhaled anticholinergics, systemic corticosteroids, and avoidance of methylxanthines) is associated with a 17% shorter hospital length of stay.

Citation: Hasegawa K, Brenner BE, Nowak RM, et al. Association of guideline-concordant acute asthma care in the emergency department with shorter hospital length of stay: a multicenter observational study. Acad Emerg Med. 2016;23(5):616-622.