All Content

Clinical question: Can cardiac catheterization prolong survival in patients with stable ischemic heart disease?

Background: Previous results from the COURAGE trial found no benefit of percutaneous intervention (PCI) as compared to medical therapy on a composite endpoint of death or nonfatal myocardial infarction or in total mortality at 4.6 years follow-up. The authors now report 15-year follow-up of the same patients.

Study design: Randomized, controlled trial.

Setting: The majority of the patients were from Veterans Affairs (VA) medical centers, although non-VA hospitals in the U.S. also were included.

Synopsis: Originally, 2,287 patients with stable ischemic heart disease and either an abnormal stress test or evidence of ischemia on ECG, as well at least 70% stenosis on angiography, were randomized to medical therapy or medical therapy plus PCI. Now, investigators have obtained extended follow-up information for 1,211 of the original patients (53%). They concluded that after 15 years of follow-up, there was no survival difference for the patients who initially received PCI in addition to medical management.

One limitation of the study was that it did not reflect important advances in both medical and interventional management of ischemic heart disease that have taken place since the study was conducted, which may affect patient mortality. It is also noteworthy that the investigators were unable to determine how many patients in the medical management group subsequently underwent revascularization after the study concluded and therefore may have crossed over between groups. Nevertheless, for now it appears that the major utility of PCI in stable ischemic heart disease is in symptomatic management.

Bottom Line: After 15 years of follow-up, there was still no mortality benefit to PCI as compared to optimal medical therapy for stable ischemic heart disease.

Citation: Sedlis SP, Hartigan PM, Teo KK, et al. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med. 2015;373(20):1937-1946

Short Take

Cauti Infections Are Rarely Clinically Relevant and Associated with Low Complication Rate

A single-center retrospective study in the ICU setting shows that the definition of catheter-associated urinary tract infections (CAUTIs) is nonspecific and they’re mostly diagnosed when urine cultures are sent for workup of fever. Most of the time, there are alternative explanations for the fever.

Citation: Tedja R, Wentink J, O’Horo J, Thompson R, Sampathkumar P et al. Catheter-associated urinary tract infections in intensive care unit patients. Infect Control Hosp Epidemiol. 2015;36(11):1330-1334.

Clinical question: Can cardiac catheterization prolong survival in patients with stable ischemic heart disease?

Background: Previous results from the COURAGE trial found no benefit of percutaneous intervention (PCI) as compared to medical therapy on a composite endpoint of death or nonfatal myocardial infarction or in total mortality at 4.6 years follow-up. The authors now report 15-year follow-up of the same patients.

Study design: Randomized, controlled trial.

Setting: The majority of the patients were from Veterans Affairs (VA) medical centers, although non-VA hospitals in the U.S. also were included.

Synopsis: Originally, 2,287 patients with stable ischemic heart disease and either an abnormal stress test or evidence of ischemia on ECG, as well at least 70% stenosis on angiography, were randomized to medical therapy or medical therapy plus PCI. Now, investigators have obtained extended follow-up information for 1,211 of the original patients (53%). They concluded that after 15 years of follow-up, there was no survival difference for the patients who initially received PCI in addition to medical management.

One limitation of the study was that it did not reflect important advances in both medical and interventional management of ischemic heart disease that have taken place since the study was conducted, which may affect patient mortality. It is also noteworthy that the investigators were unable to determine how many patients in the medical management group subsequently underwent revascularization after the study concluded and therefore may have crossed over between groups. Nevertheless, for now it appears that the major utility of PCI in stable ischemic heart disease is in symptomatic management.

Bottom Line: After 15 years of follow-up, there was still no mortality benefit to PCI as compared to optimal medical therapy for stable ischemic heart disease.

Citation: Sedlis SP, Hartigan PM, Teo KK, et al. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med. 2015;373(20):1937-1946

Short Take

Cauti Infections Are Rarely Clinically Relevant and Associated with Low Complication Rate

A single-center retrospective study in the ICU setting shows that the definition of catheter-associated urinary tract infections (CAUTIs) is nonspecific and they’re mostly diagnosed when urine cultures are sent for workup of fever. Most of the time, there are alternative explanations for the fever.

Citation: Tedja R, Wentink J, O’Horo J, Thompson R, Sampathkumar P et al. Catheter-associated urinary tract infections in intensive care unit patients. Infect Control Hosp Epidemiol. 2015;36(11):1330-1334.

Clinical question: Can cardiac catheterization prolong survival in patients with stable ischemic heart disease?

Background: Previous results from the COURAGE trial found no benefit of percutaneous intervention (PCI) as compared to medical therapy on a composite endpoint of death or nonfatal myocardial infarction or in total mortality at 4.6 years follow-up. The authors now report 15-year follow-up of the same patients.

Study design: Randomized, controlled trial.

Setting: The majority of the patients were from Veterans Affairs (VA) medical centers, although non-VA hospitals in the U.S. also were included.

Synopsis: Originally, 2,287 patients with stable ischemic heart disease and either an abnormal stress test or evidence of ischemia on ECG, as well at least 70% stenosis on angiography, were randomized to medical therapy or medical therapy plus PCI. Now, investigators have obtained extended follow-up information for 1,211 of the original patients (53%). They concluded that after 15 years of follow-up, there was no survival difference for the patients who initially received PCI in addition to medical management.

One limitation of the study was that it did not reflect important advances in both medical and interventional management of ischemic heart disease that have taken place since the study was conducted, which may affect patient mortality. It is also noteworthy that the investigators were unable to determine how many patients in the medical management group subsequently underwent revascularization after the study concluded and therefore may have crossed over between groups. Nevertheless, for now it appears that the major utility of PCI in stable ischemic heart disease is in symptomatic management.

Bottom Line: After 15 years of follow-up, there was still no mortality benefit to PCI as compared to optimal medical therapy for stable ischemic heart disease.

Citation: Sedlis SP, Hartigan PM, Teo KK, et al. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med. 2015;373(20):1937-1946

Short Take

Cauti Infections Are Rarely Clinically Relevant and Associated with Low Complication Rate

A single-center retrospective study in the ICU setting shows that the definition of catheter-associated urinary tract infections (CAUTIs) is nonspecific and they’re mostly diagnosed when urine cultures are sent for workup of fever. Most of the time, there are alternative explanations for the fever.

Citation: Tedja R, Wentink J, O’Horo J, Thompson R, Sampathkumar P et al. Catheter-associated urinary tract infections in intensive care unit patients. Infect Control Hosp Epidemiol. 2015;36(11):1330-1334.

Clinical question: Have healthcare-associated pneumonia (HCAP) guidelines improved treatment accuracy?

Background: Guidelines released in 2005 call for the use of broad-spectrum antibiotics for patients presenting with pneumonia who have had recent healthcare exposure. However, there is scant evidence to support the risk factors they identify, and the guidelines are likely to increase use of broad-spectrum antibiotics.

Study design: Observational, retrospective.

Setting: VA medical centers, 2006–2010.

Synopsis: In this study, VA medical center physicians evaluated 95,511 hospitalizations for pneumonia at 128 hospitals between 2006 and 2010, the years following the 2005 guidelines. Annual analyses were performed to assess antibiotics selection as well as evidence of resistant bacteria from blood and respiratory cultures. Researchers found that while the use of broad-spectrum antibiotics increased drastically during the study period (vancomycin from 16% to 31% and piperacillin-tazobactam from 16% to 27%, P<0.001 for both), the incidence of resistant organisms either decreased or remained stable.  

Additionally, physicians were no better at matching broad-spectrum antibiotics to patients infected with resistant organisms at the end of the study period than they were at the start. They conclude that more research is urgently needed to identify patients at risk for resistant organisms in order to more appropriately prescribe broad-spectrum antibiotics.

This study did not evaluate patients’ clinical outcomes, so it is unclear whether they may have benefitted clinically from the implementation of the guidelines. For now, the optimal approach to empiric therapy for HCAP remains undefined.

Bottom line: Despite a marked increase in the use of broad-spectrum antibiotics for HCAP in the years following a change in treatment guidelines, doctors showed no improvement at matching these antibiotics to patients infected with resistant organisms.

Citation: Jones BE, Jones MM, Huttner B, et al. Trends in antibiotic use and nosocomial pathogens in hospitalized veterans with pneumonia at 128 medical centers, 2006-2010. Clin Infect Dis. 2015;61(9):1403-1410.

Clinical question: Have healthcare-associated pneumonia (HCAP) guidelines improved treatment accuracy?

Background: Guidelines released in 2005 call for the use of broad-spectrum antibiotics for patients presenting with pneumonia who have had recent healthcare exposure. However, there is scant evidence to support the risk factors they identify, and the guidelines are likely to increase use of broad-spectrum antibiotics.

Study design: Observational, retrospective.

Setting: VA medical centers, 2006–2010.

Synopsis: In this study, VA medical center physicians evaluated 95,511 hospitalizations for pneumonia at 128 hospitals between 2006 and 2010, the years following the 2005 guidelines. Annual analyses were performed to assess antibiotics selection as well as evidence of resistant bacteria from blood and respiratory cultures. Researchers found that while the use of broad-spectrum antibiotics increased drastically during the study period (vancomycin from 16% to 31% and piperacillin-tazobactam from 16% to 27%, P<0.001 for both), the incidence of resistant organisms either decreased or remained stable.  

Additionally, physicians were no better at matching broad-spectrum antibiotics to patients infected with resistant organisms at the end of the study period than they were at the start. They conclude that more research is urgently needed to identify patients at risk for resistant organisms in order to more appropriately prescribe broad-spectrum antibiotics.

This study did not evaluate patients’ clinical outcomes, so it is unclear whether they may have benefitted clinically from the implementation of the guidelines. For now, the optimal approach to empiric therapy for HCAP remains undefined.

Bottom line: Despite a marked increase in the use of broad-spectrum antibiotics for HCAP in the years following a change in treatment guidelines, doctors showed no improvement at matching these antibiotics to patients infected with resistant organisms.

Citation: Jones BE, Jones MM, Huttner B, et al. Trends in antibiotic use and nosocomial pathogens in hospitalized veterans with pneumonia at 128 medical centers, 2006-2010. Clin Infect Dis. 2015;61(9):1403-1410.

Clinical question: Have healthcare-associated pneumonia (HCAP) guidelines improved treatment accuracy?

Background: Guidelines released in 2005 call for the use of broad-spectrum antibiotics for patients presenting with pneumonia who have had recent healthcare exposure. However, there is scant evidence to support the risk factors they identify, and the guidelines are likely to increase use of broad-spectrum antibiotics.

Study design: Observational, retrospective.

Setting: VA medical centers, 2006–2010.

Synopsis: In this study, VA medical center physicians evaluated 95,511 hospitalizations for pneumonia at 128 hospitals between 2006 and 2010, the years following the 2005 guidelines. Annual analyses were performed to assess antibiotics selection as well as evidence of resistant bacteria from blood and respiratory cultures. Researchers found that while the use of broad-spectrum antibiotics increased drastically during the study period (vancomycin from 16% to 31% and piperacillin-tazobactam from 16% to 27%, P<0.001 for both), the incidence of resistant organisms either decreased or remained stable.  

Additionally, physicians were no better at matching broad-spectrum antibiotics to patients infected with resistant organisms at the end of the study period than they were at the start. They conclude that more research is urgently needed to identify patients at risk for resistant organisms in order to more appropriately prescribe broad-spectrum antibiotics.

This study did not evaluate patients’ clinical outcomes, so it is unclear whether they may have benefitted clinically from the implementation of the guidelines. For now, the optimal approach to empiric therapy for HCAP remains undefined.

Bottom line: Despite a marked increase in the use of broad-spectrum antibiotics for HCAP in the years following a change in treatment guidelines, doctors showed no improvement at matching these antibiotics to patients infected with resistant organisms.

Citation: Jones BE, Jones MM, Huttner B, et al. Trends in antibiotic use and nosocomial pathogens in hospitalized veterans with pneumonia at 128 medical centers, 2006-2010. Clin Infect Dis. 2015;61(9):1403-1410.

NEW YORK (Reuters Health) - U.S. hospitals save money when they use the novel oral anticoagulant rivaroxaban instead of warfarin to treat patients with venous thromboembolism (VTE), a new analysis finds.

"These days it's important to consider the cost of new drugs to the health system," Dr. Steven Deitelzweig from Ochsner Health System in New Orleans, Louisiana, noted in an interview with Reuters Health.

"This retrospective observational analysis had an ample number of patients, they had very good clinical outcomes with rivaroxaban, and we also demonstrated that those clinical outcomes could be achieved with a notable reduction in the all-important utilization side of healthcare," he said.

It's estimated that VTE affects more than 900,000 Americans each year, at a cost to the healthcare system between $13 and $27 billion.

Dr. Deitelzweig and his colleagues did an economic analysis of rivaroxaban versus low-molecular-weight heparin (LMWH)/warfarin for VTE in the hospital setting.

Using Truven MarketScan Hospital Drug Database, they identified more than 2,400 older adults hospitalized for primary VTE between 2012 and 2013. They created two groups of 1,223 patients each. Each group included 751 pulmonary embolism (PE) patients and 472 deep vein thrombosis (DVT) patients.

According to the analysis, total hospitalization costs - including room rate, laboratory tests, inpatient procedures, pharmacy costs and all other inpatient services - were significantly lower and length of stay was significantly shorter for patients treated with rivaroxaban rather than LMWH/warfarin.

Patients receiving rivaroxaban spent an average of 1.5 fewer days in the hospital than their peers on LMWH/warfarin (3.7 versus 5.2 days, p<0.001).

"This finding is consistent with the length of stay reduction found in the EINSTEIN VTE clinical trials," the researchers note in their poster presented March 7 at the Society of Hospital Medicine annual meeting in San Diego, California.

"Length of stay is one metric that we track quite closely and care about. Even one day less in a hospital is a significant cost savings and allows hospitals that are very busy to take care of the next patient, as appropriate," Dr. Deitelzweig told Reuters Health.

The rivaroxaban group had an adjusted average cost savings of $1,888 per admission compared with the LMWH/warfarin group ($8,387 versus $10,275; p<0.001), the study found.

Limitations of the study include the fact that patient medical history was limited to the patient's current admission. Outpatient treatment prior to admission, particularly whether they had received either rivaroxaban or LMWH/warfarin prior to admission was unknown. And despite propensity score matching and further statistical modeling, there remains the potential for unmeasured confounders, they note.

The study was funded by Janssen Scientific Affairs, LLC. Janssen Pharmaceuticals markets rivaroxaban under the trade name Xarelto. Four authors are employees of Janssen Research and Development, LLC.

NEW YORK (Reuters Health) - U.S. hospitals save money when they use the novel oral anticoagulant rivaroxaban instead of warfarin to treat patients with venous thromboembolism (VTE), a new analysis finds.

"These days it's important to consider the cost of new drugs to the health system," Dr. Steven Deitelzweig from Ochsner Health System in New Orleans, Louisiana, noted in an interview with Reuters Health.

"This retrospective observational analysis had an ample number of patients, they had very good clinical outcomes with rivaroxaban, and we also demonstrated that those clinical outcomes could be achieved with a notable reduction in the all-important utilization side of healthcare," he said.

It's estimated that VTE affects more than 900,000 Americans each year, at a cost to the healthcare system between $13 and $27 billion.

Dr. Deitelzweig and his colleagues did an economic analysis of rivaroxaban versus low-molecular-weight heparin (LMWH)/warfarin for VTE in the hospital setting.

Using Truven MarketScan Hospital Drug Database, they identified more than 2,400 older adults hospitalized for primary VTE between 2012 and 2013. They created two groups of 1,223 patients each. Each group included 751 pulmonary embolism (PE) patients and 472 deep vein thrombosis (DVT) patients.

According to the analysis, total hospitalization costs - including room rate, laboratory tests, inpatient procedures, pharmacy costs and all other inpatient services - were significantly lower and length of stay was significantly shorter for patients treated with rivaroxaban rather than LMWH/warfarin.

Patients receiving rivaroxaban spent an average of 1.5 fewer days in the hospital than their peers on LMWH/warfarin (3.7 versus 5.2 days, p<0.001).

"This finding is consistent with the length of stay reduction found in the EINSTEIN VTE clinical trials," the researchers note in their poster presented March 7 at the Society of Hospital Medicine annual meeting in San Diego, California.

"Length of stay is one metric that we track quite closely and care about. Even one day less in a hospital is a significant cost savings and allows hospitals that are very busy to take care of the next patient, as appropriate," Dr. Deitelzweig told Reuters Health.

The rivaroxaban group had an adjusted average cost savings of $1,888 per admission compared with the LMWH/warfarin group ($8,387 versus $10,275; p<0.001), the study found.

Limitations of the study include the fact that patient medical history was limited to the patient's current admission. Outpatient treatment prior to admission, particularly whether they had received either rivaroxaban or LMWH/warfarin prior to admission was unknown. And despite propensity score matching and further statistical modeling, there remains the potential for unmeasured confounders, they note.

The study was funded by Janssen Scientific Affairs, LLC. Janssen Pharmaceuticals markets rivaroxaban under the trade name Xarelto. Four authors are employees of Janssen Research and Development, LLC.

NEW YORK (Reuters Health) - U.S. hospitals save money when they use the novel oral anticoagulant rivaroxaban instead of warfarin to treat patients with venous thromboembolism (VTE), a new analysis finds.

"These days it's important to consider the cost of new drugs to the health system," Dr. Steven Deitelzweig from Ochsner Health System in New Orleans, Louisiana, noted in an interview with Reuters Health.

"This retrospective observational analysis had an ample number of patients, they had very good clinical outcomes with rivaroxaban, and we also demonstrated that those clinical outcomes could be achieved with a notable reduction in the all-important utilization side of healthcare," he said.

It's estimated that VTE affects more than 900,000 Americans each year, at a cost to the healthcare system between $13 and $27 billion.

Dr. Deitelzweig and his colleagues did an economic analysis of rivaroxaban versus low-molecular-weight heparin (LMWH)/warfarin for VTE in the hospital setting.

Using Truven MarketScan Hospital Drug Database, they identified more than 2,400 older adults hospitalized for primary VTE between 2012 and 2013. They created two groups of 1,223 patients each. Each group included 751 pulmonary embolism (PE) patients and 472 deep vein thrombosis (DVT) patients.

According to the analysis, total hospitalization costs - including room rate, laboratory tests, inpatient procedures, pharmacy costs and all other inpatient services - were significantly lower and length of stay was significantly shorter for patients treated with rivaroxaban rather than LMWH/warfarin.

Patients receiving rivaroxaban spent an average of 1.5 fewer days in the hospital than their peers on LMWH/warfarin (3.7 versus 5.2 days, p<0.001).

"This finding is consistent with the length of stay reduction found in the EINSTEIN VTE clinical trials," the researchers note in their poster presented March 7 at the Society of Hospital Medicine annual meeting in San Diego, California.

"Length of stay is one metric that we track quite closely and care about. Even one day less in a hospital is a significant cost savings and allows hospitals that are very busy to take care of the next patient, as appropriate," Dr. Deitelzweig told Reuters Health.

The rivaroxaban group had an adjusted average cost savings of $1,888 per admission compared with the LMWH/warfarin group ($8,387 versus $10,275; p<0.001), the study found.

Limitations of the study include the fact that patient medical history was limited to the patient's current admission. Outpatient treatment prior to admission, particularly whether they had received either rivaroxaban or LMWH/warfarin prior to admission was unknown. And despite propensity score matching and further statistical modeling, there remains the potential for unmeasured confounders, they note.

The study was funded by Janssen Scientific Affairs, LLC. Janssen Pharmaceuticals markets rivaroxaban under the trade name Xarelto. Four authors are employees of Janssen Research and Development, LLC.

Teaching quality improvement and patient safety is no longer an elective—it’s a necessity. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) provides medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula. This year, QSEA will be held May 23–25 at Tempe Mission Palms Hotel and Conference Center in Arizona.

Here are the top 10 reasons you can’t afford to miss it—and will be glad you went!

1. Unparalleled Education: Develop and refine your knowledge in the field of quality and patient safety.
2. Curriculum Development: Return to your institution with a collection of new curriculum ideas from QSEA faculty and peers.
3. Professional Development: Spend focused time developing and reflecting on your career goals as a physician educator in quality and safety.
4. Networking: Build a network of quality and safety educators with both faculty mentors and colleagues with similar career interests.
5. Institutional Support: Learn strategies to engage your institutional and program leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System/Clinical Learning Environment Review (CLER) expectations and improve patient care.
6. Hands-On Activities: Dive in to an interactive learning environment with a 10-to-1 student-to-faculty ratio, including facilitated large group sessions, small group activities, and mentor groups.
7. Variety of Content: Each day features a variety of topics, such as the principles of quality improvement and patient safety, mentoring trainees in quality improvement project work, high-value care curriculum, curriculum development and assessment in medical education, and many others.
8. Distinguished Faculty: All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
9. Valuable Resources: Leave with a tool kit of educational resources for quality and safety education.
10. Desert Beauty: Enjoy sunny Tempe, Arizona, or travel to nearby Phoenix or Scottsdale!

It’s no surprise that QSEA sold out each of the past four years, so don’t delay—it’s almost here! Register online or via phone at 800-843-3360. Questions? Email [email protected].

Teaching quality improvement and patient safety is no longer an elective—it’s a necessity. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) provides medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula. This year, QSEA will be held May 23–25 at Tempe Mission Palms Hotel and Conference Center in Arizona.

Here are the top 10 reasons you can’t afford to miss it—and will be glad you went!

1. Unparalleled Education: Develop and refine your knowledge in the field of quality and patient safety.
2. Curriculum Development: Return to your institution with a collection of new curriculum ideas from QSEA faculty and peers.
3. Professional Development: Spend focused time developing and reflecting on your career goals as a physician educator in quality and safety.
4. Networking: Build a network of quality and safety educators with both faculty mentors and colleagues with similar career interests.
5. Institutional Support: Learn strategies to engage your institutional and program leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System/Clinical Learning Environment Review (CLER) expectations and improve patient care.
6. Hands-On Activities: Dive in to an interactive learning environment with a 10-to-1 student-to-faculty ratio, including facilitated large group sessions, small group activities, and mentor groups.
7. Variety of Content: Each day features a variety of topics, such as the principles of quality improvement and patient safety, mentoring trainees in quality improvement project work, high-value care curriculum, curriculum development and assessment in medical education, and many others.
8. Distinguished Faculty: All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
9. Valuable Resources: Leave with a tool kit of educational resources for quality and safety education.
10. Desert Beauty: Enjoy sunny Tempe, Arizona, or travel to nearby Phoenix or Scottsdale!

It’s no surprise that QSEA sold out each of the past four years, so don’t delay—it’s almost here! Register online or via phone at 800-843-3360. Questions? Email [email protected].

Teaching quality improvement and patient safety is no longer an elective—it’s a necessity. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) provides medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula. This year, QSEA will be held May 23–25 at Tempe Mission Palms Hotel and Conference Center in Arizona.

Here are the top 10 reasons you can’t afford to miss it—and will be glad you went!

1. Unparalleled Education: Develop and refine your knowledge in the field of quality and patient safety.
2. Curriculum Development: Return to your institution with a collection of new curriculum ideas from QSEA faculty and peers.
3. Professional Development: Spend focused time developing and reflecting on your career goals as a physician educator in quality and safety.
4. Networking: Build a network of quality and safety educators with both faculty mentors and colleagues with similar career interests.
5. Institutional Support: Learn strategies to engage your institutional and program leaders to support and implement a quality and patient safety curriculum to meet the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System/Clinical Learning Environment Review (CLER) expectations and improve patient care.
6. Hands-On Activities: Dive in to an interactive learning environment with a 10-to-1 student-to-faculty ratio, including facilitated large group sessions, small group activities, and mentor groups.
7. Variety of Content: Each day features a variety of topics, such as the principles of quality improvement and patient safety, mentoring trainees in quality improvement project work, high-value care curriculum, curriculum development and assessment in medical education, and many others.
8. Distinguished Faculty: All sessions are led by experienced physicians known for their ability to practice and teach quality improvement and patient safety, mentor junior faculty, and guide educators in curriculum development.
9. Valuable Resources: Leave with a tool kit of educational resources for quality and safety education.
10. Desert Beauty: Enjoy sunny Tempe, Arizona, or travel to nearby Phoenix or Scottsdale!

It’s no surprise that QSEA sold out each of the past four years, so don’t delay—it’s almost here! Register online or via phone at 800-843-3360. Questions? Email [email protected].

MHM

Tina Budnitz, MPH, MHM

Greg Maynard, MD, MHM

Eric Howell, MD, MHM

FHM

Nicole Adler, MD, FHM

Tochukwu Agbata, MD, FHM

Alka Aggarwal, MD, FHM

Gaurav Ahuja, MD, MBBS, FHM

Sameena Akhtar, MD, FHM

Karan Singh S. Alag, MD, MBBS, FHM

Venkata N. Allada, MD, FACP, FHM

Margaret M. Ameyaw, MBChB, FHM

Robert L. Anderson, MD, FHM

Jorge Arboleda, DO, FHM

Michael Aref, MD, PhD, FACP, FHM

Elizabeth M. Arias, MD, FACP, FHM

Amarpreet S. Bains, MD, FHM

Ebrahim Barkoudah, MD, MPH, FACP, FHM

Wanes Barsemian, MD, FHM

Jeffrey T. Bates, MD, FACP, FHM

John F. Bell, MD, MPH, FHM

Kjell Benson, MD, FHM

Azmina Bhaiji, MD, FHM

Sai-Sridhar Boddupalli, MD, FHM

Ani Bodoutchian, MD, MBA, FAAFP, FHM

Tanya M. Boldenow, MD, FHM

Dennis T. Bolger Jr., MD, FHM

Greg D. Bowling, MD, FHM

David A. Bozaan, MD, FHM

Marcia Carbo, MD, FAAP, FHM

Donna Cardoza, MD, FHM

Frank R. Carson Jr., MD, FHM

Kelly Caverzagie, MD, FACP, FHM

Elizabeth A. Cerceo, MD, FACP, FHM

Jeffrey M. Ceresnak, MD, FHM

Romil Chadha, MD, MPH, FACP, FHM

Charles Charman, MD, FHM

Bushra I. Chaudhry, MD, FHM

Justin J. Chow, MD, FHM

Douglas E. Cohen, MD, FHM

John M. Colombo Jr., MD, FHM

Steven Connelly, MD, FACP, FHM

David Corman, MD, FHM

Christopher C. Costa, MD, FHM

William C. Crowe Jr., DNP, ACNP, FNP, MSN, RN, FHM

Ria Dancel, MD, FAAP, FHM

Zubaer Dawlah, MD, FHM

Chandrasekhar R. Dinasarapu, MD, MBBS, MPH, FHM

Vijay Saradhi Dontu, MD, FHM

Oleg Dulkin, MD, FHM

Kevin C. Eaton, PA-C, FHM

Eric Edwards, MD, FHM

Mary E. Fedor, MD, FHM

John W. Fowler Jr., MD, FACP, FHM

Maria G. Frank, MD, FACP, FHM

Yelena Galumyan, MD, FHM

Christopher D. Gamble, MD, FACP, FHM

David J. Goldstein, MD, FHM

Kalpana Gorthi, MD, FHM

Manjula V. Gunawardane, MD, FHM

Craig G. Gunderson, MD, FHM

Theodore J. Haland, MD, FHM

Aaron C. Hamilton, MD, MBA, FHM

Anil Hanuman, DO, FHM

Catriona M. Harrop, MD, FHM

Hossan Hassan, FAAFP, FHM

Eileen Hennrikus, MD, FHM

Arif Hussain, MD, FHM

Javid Iqbal, MD, FHM

Shadi Jarjous, MD, FHM

Jeremy Jaskunas, MD, FHM

John David Johnston, MD, FHM

Gurmeet Kaur Kalra, MD, FHM

Stephen K. Keiser, FHM

Sirajabid Khatib, MD, FHM

Joanna Kipnes, MD, FHM

Mukesh Kumar, MBBS, MD, FACP, FHM

Rumman A. Langah, MD, FACP, FHM

Rebecca Lauderdale, MD, FHM

Lajide R. Lawoyin, MD, FACP, FHM

Lien Le, MD, FHM

Alex Leung, FHM

William I. Levin, MD, FHM

David Lichtman, PA, FHM

Doris Wei-Hwa Lin, MD, FHM

Caroline E. Lyon, MD, MPH, FHM

John D. Machado, DO, FHM

Yvonne Maduka, MD, FHM

Lawrence L. Magras, MD, MBA, FHM

Anamaria Massier, MD, FHM

Daniel McFarlane, MD, FHM

Tresa A. McNeal, MD, FHM

Johnny Mei, MD, MHA, FACP, FHM

Rovie Mesola, MD, FHM

Henry J. Michtalik, MD, MHS, MPH, FHM

Prateek Mishra, MD, FHM

Adrian M. Mogos, MD, FHM

Wajahath A. Mohsini, MD, FACP, FHM

Ashwin Narasimhan, MD, FACP, FHM

Sivakumar Natanasabapathy, MRCP, FHM

Monica C. Necula, MD, FHM

Naomi Nomizu, MD, FHM

Shervin Nourparvar, MD, FHM

Allan L. Ong, MD, FHM

Pia Ong, MD, FHM

Chike Onyejekwe, MD, FHM

Binu T. Pappachen, MD, FHM

Akash Parashar MD, MBBS, FHM

Hiren B. Parikh, MD, MBA, FHM

Jung Hyun Park, MD, FHM

Shailesh Mansukh Patel, DO, FHM

Frank A. Perry, MD, FHM

Jeffrey W. Petry, MD, MMM, FHM

John R. Pierce Jr., MD, MPH, FHM

Jeffrey Poulos, MD, FHM

Richard N. Pulido, MD, FHM

Charu Puri, MD, FHM

Carolyn Quan, MD, FHM

Saraswathi V. Racherla, MD, FHM

Aisha Rahim, MD, FHM

Edwin Q. Ravano, MD, FHM

Behzad Razavi, MD, FACP, FHM

Erin N. Reis, MD, FHM

Maria Anaizza Aurora Reyna, MD, FHM

Mark Safalow, MD, FHM

Javaid Saleem, MD, MBBS, FHM

Mandeep S. Saluja, MD, FHM

Edward R. Sampt, MD, FHM

Jorge Santibanez, MD, FHM

Anne E. Sayers, MD, FHM

Brian Schroeder, FACHE, MHA, FHM

Scott E. Sears, MD, FACP, FHM

Meghan M. Sebasky, MD, FHM

Patricia L. Seymour, MD, FHM

Neel B. Shah, MB, BCh, FACP, FACMG, FHM

Poonam Sharma, MD, FHM

Umesh Sharma, MD, MS, FACP, FHM

Ashwin B. Shivakumar, MD, MSPH, FHM

Mohammed Fazil Siddiqi, MD, FHM

Sonya Sidhu-Izzo, MD, FHM

Alana E. Sigmund, MD, FHM

Shantnu Singh, MBBS, FHM

Amith Skandhan, MD, FHM

Christopher G. Skinner, MD, FACP, FHM

Dustin T. Smith, MD, FHM

Todd I. Smith, MD, FHM

Jeffrey D. Solomon, MD, FHM

Alberto Enrique Soyano, MD, FHM

Rodney R. Story, MD, FHM

John R. Sullivan, MD, FHM

Joseph G. Surber, DO, FHM

Heather R. Swanson, MD, FHM

Preetham Talari, MD, FHM

Sofia Teferi, MD, FAAP, FHM

Rafael A. Teran, MD, FHM

Abey K. Thomas, MD, FACP, FHM

Anca R. Udrea, MD, FHM

Shawn N. Usery, MD, FHM

Moncy Varughese, MD, FACP, FHM

Leigh Vaughan, MD, FHM

Manivannan Veerasamy, MD, FACP, FHM

Ruvan Chandika Wickramasinghe, MD, FHM

Michael Williams, DO, FHM

Sandra C. Wilson, MD, FACP, MA, FHM

Kareem Z. Yahya, MD, FHM

Deyun Yang, MD, PhD, FACP, FHM

Hector L. Yordan, MD, FHM

Elham A. Yousef, MD, MSc, FHM

Anthony M. Zepeda, MD, FHM

SFHM

Ashfaq Ahmad, MD, MBA, SFHM

Aziz Ansari, DO, SFHM

Anna M. Arroyo Plasencia, MD, SFHM

Andy Arwari, MD, FACP, SFHM

Jonathan G. Bae, MD, SFHM

Ankush K. Bansal, MD, FACP, SFHM

Jitendra Barmecha, MD, MPH, SFHM

Bishara A. Bates, BS, MHA, SFHM

Valerie F. Briones-Pryor, MD, FACP, SFHM

Michael E. Burton, MD, SFHM

Tracy E. Cardin, ACNP-BC, SFHM

Chris Cockerham, MD, SFHM

Timothy J. Crone, MD, SFHM

Debasish Dasgupta, MBBS, MHA, FACP, FACHE, SFHM, CPE, CPHQ

Kapil J. Dave, MD, SFHM

Shaker M. Eid, MD, MBA, SFHM

Howard R. Epstein, MD, SFHM

Christopher M. Frost, MD, SFHM

Timothy M. Gawronski, PA-C, SFHM

Amy S. Giarrusso, MD, SFHM

Jeffrey A. Gindi, MD, SFHM

Jason A. Green, MD, SFHM

Paul William Helgerson, MD, SFHM

Maliha Iqbal, MD, SFHM

James J. Jeffries II, MD, FACP, SFHM

Ian H. Jenkins, MD, SFHM

Scott Kaatz, DO, MSc, FACP, SFHM

Khurram Kamran, MD, SFHM

Anand Kartha, MD, MS, SFHM

Attila Kasza, MD, SFHM

Amy M. Keech, MD, SFHM

William A. Landis, MD, SFHM

Jimmie E. Lewis Jr., MD, MHA, SFHM

James W. Leyhane, MD, SFHM

Michael Lin, MD, SFHM

Julianna Lindsey, MD, SFHM

Madaiah Lokeshwari, MD, SFHM

Laszlo I. Madaras, MD, MPH, SFHM

Murthy V. Madduri, MD, SFHM

Arun V. Mohan, MD, SFHM

David R. Munoz, MD, SFHM

Mark A. Murray, MD, SFHM

Vasantha Natarajan, MD, SFHM

G. Xon Ng, MD, SFHM

Andy Odden, MD, SFHM

Tiffani M. Panek, MA, CLHM, SFHM

Shannon Connor Phillips, MD, MPH, SFHM

Preethi Prakash, MD, FACP, SFHM

Alberto Puig, MD, PhD, SFHM

Rebecca P. Ramirez, MD, SFHM

Allen B. Repp, MD, FACP, MS, SFHM

Scott C. Rissmiller, MD, SFHM

Frank Romero Jr., MD, SFHM

Marcus Lindley Scarbrough, MD, FACP, SFHM

Anneliese M. Schleyer, MD, SFHM

Eric R. Schumacher, DO, SFHM

Noppon Pooh Setji, MD, SFHM

Mohammad R. Shaheed, MD, SFHM

Jeffrey Scott Shapiro, MD, SFHM

Ann Sheehy, MD, MS, SFHM

R. Lucas Shelly, DO, SFHM

Andres F. Soto, MD, SFHM

John R. Stephens, MD, SFHM

Camille N. Upchurch, MD, SFHM

Fernando S. Waldemar, MD, SFHM

Michael D. Wang, MD, SFHM

Charlotta Weaver, MD, SFHM

Andrew White, MD, SFHM

Anthony Williams, MD, MBA, SFHM

MHM

Tina Budnitz, MPH, MHM

Greg Maynard, MD, MHM

Eric Howell, MD, MHM

FHM

Nicole Adler, MD, FHM

Tochukwu Agbata, MD, FHM

Alka Aggarwal, MD, FHM

Gaurav Ahuja, MD, MBBS, FHM

Sameena Akhtar, MD, FHM

Karan Singh S. Alag, MD, MBBS, FHM

Venkata N. Allada, MD, FACP, FHM

Margaret M. Ameyaw, MBChB, FHM

Robert L. Anderson, MD, FHM

Jorge Arboleda, DO, FHM

Michael Aref, MD, PhD, FACP, FHM

Elizabeth M. Arias, MD, FACP, FHM

Amarpreet S. Bains, MD, FHM

Ebrahim Barkoudah, MD, MPH, FACP, FHM

Wanes Barsemian, MD, FHM

Jeffrey T. Bates, MD, FACP, FHM

John F. Bell, MD, MPH, FHM

Kjell Benson, MD, FHM

Azmina Bhaiji, MD, FHM

Sai-Sridhar Boddupalli, MD, FHM

Ani Bodoutchian, MD, MBA, FAAFP, FHM

Tanya M. Boldenow, MD, FHM

Dennis T. Bolger Jr., MD, FHM

Greg D. Bowling, MD, FHM

David A. Bozaan, MD, FHM

Marcia Carbo, MD, FAAP, FHM

Donna Cardoza, MD, FHM

Frank R. Carson Jr., MD, FHM

Kelly Caverzagie, MD, FACP, FHM

Elizabeth A. Cerceo, MD, FACP, FHM

Jeffrey M. Ceresnak, MD, FHM

Romil Chadha, MD, MPH, FACP, FHM

Charles Charman, MD, FHM

Bushra I. Chaudhry, MD, FHM

Justin J. Chow, MD, FHM

Douglas E. Cohen, MD, FHM

John M. Colombo Jr., MD, FHM

Steven Connelly, MD, FACP, FHM

David Corman, MD, FHM

Christopher C. Costa, MD, FHM

William C. Crowe Jr., DNP, ACNP, FNP, MSN, RN, FHM

Ria Dancel, MD, FAAP, FHM

Zubaer Dawlah, MD, FHM

Chandrasekhar R. Dinasarapu, MD, MBBS, MPH, FHM

Vijay Saradhi Dontu, MD, FHM

Oleg Dulkin, MD, FHM

Kevin C. Eaton, PA-C, FHM

Eric Edwards, MD, FHM

Mary E. Fedor, MD, FHM

John W. Fowler Jr., MD, FACP, FHM

Maria G. Frank, MD, FACP, FHM

Yelena Galumyan, MD, FHM

Christopher D. Gamble, MD, FACP, FHM

David J. Goldstein, MD, FHM

Kalpana Gorthi, MD, FHM

Manjula V. Gunawardane, MD, FHM

Craig G. Gunderson, MD, FHM

Theodore J. Haland, MD, FHM

Aaron C. Hamilton, MD, MBA, FHM

Anil Hanuman, DO, FHM

Catriona M. Harrop, MD, FHM

Hossan Hassan, FAAFP, FHM

Eileen Hennrikus, MD, FHM

Arif Hussain, MD, FHM

Javid Iqbal, MD, FHM

Shadi Jarjous, MD, FHM

Jeremy Jaskunas, MD, FHM

John David Johnston, MD, FHM

Gurmeet Kaur Kalra, MD, FHM

Stephen K. Keiser, FHM

Sirajabid Khatib, MD, FHM

Joanna Kipnes, MD, FHM

Mukesh Kumar, MBBS, MD, FACP, FHM

Rumman A. Langah, MD, FACP, FHM

Rebecca Lauderdale, MD, FHM

Lajide R. Lawoyin, MD, FACP, FHM

Lien Le, MD, FHM

Alex Leung, FHM

William I. Levin, MD, FHM

David Lichtman, PA, FHM

Doris Wei-Hwa Lin, MD, FHM

Caroline E. Lyon, MD, MPH, FHM

John D. Machado, DO, FHM

Yvonne Maduka, MD, FHM

Lawrence L. Magras, MD, MBA, FHM

Anamaria Massier, MD, FHM

Daniel McFarlane, MD, FHM

Tresa A. McNeal, MD, FHM

Johnny Mei, MD, MHA, FACP, FHM

Rovie Mesola, MD, FHM

Henry J. Michtalik, MD, MHS, MPH, FHM

Prateek Mishra, MD, FHM

Adrian M. Mogos, MD, FHM

Wajahath A. Mohsini, MD, FACP, FHM

Ashwin Narasimhan, MD, FACP, FHM

Sivakumar Natanasabapathy, MRCP, FHM

Monica C. Necula, MD, FHM

Naomi Nomizu, MD, FHM

Shervin Nourparvar, MD, FHM

Allan L. Ong, MD, FHM

Pia Ong, MD, FHM

Chike Onyejekwe, MD, FHM

Binu T. Pappachen, MD, FHM

Akash Parashar MD, MBBS, FHM

Hiren B. Parikh, MD, MBA, FHM

Jung Hyun Park, MD, FHM

Shailesh Mansukh Patel, DO, FHM

Frank A. Perry, MD, FHM

Jeffrey W. Petry, MD, MMM, FHM

John R. Pierce Jr., MD, MPH, FHM

Jeffrey Poulos, MD, FHM

Richard N. Pulido, MD, FHM

Charu Puri, MD, FHM

Carolyn Quan, MD, FHM

Saraswathi V. Racherla, MD, FHM

Aisha Rahim, MD, FHM

Edwin Q. Ravano, MD, FHM

Behzad Razavi, MD, FACP, FHM

Erin N. Reis, MD, FHM

Maria Anaizza Aurora Reyna, MD, FHM

Mark Safalow, MD, FHM

Javaid Saleem, MD, MBBS, FHM

Mandeep S. Saluja, MD, FHM

Edward R. Sampt, MD, FHM

Jorge Santibanez, MD, FHM

Anne E. Sayers, MD, FHM

Brian Schroeder, FACHE, MHA, FHM

Scott E. Sears, MD, FACP, FHM

Meghan M. Sebasky, MD, FHM

Patricia L. Seymour, MD, FHM

Neel B. Shah, MB, BCh, FACP, FACMG, FHM

Poonam Sharma, MD, FHM

Umesh Sharma, MD, MS, FACP, FHM

Ashwin B. Shivakumar, MD, MSPH, FHM

Mohammed Fazil Siddiqi, MD, FHM

Sonya Sidhu-Izzo, MD, FHM

Alana E. Sigmund, MD, FHM

Shantnu Singh, MBBS, FHM

Amith Skandhan, MD, FHM

Christopher G. Skinner, MD, FACP, FHM

Dustin T. Smith, MD, FHM

Todd I. Smith, MD, FHM

Jeffrey D. Solomon, MD, FHM

Alberto Enrique Soyano, MD, FHM

Rodney R. Story, MD, FHM

John R. Sullivan, MD, FHM

Joseph G. Surber, DO, FHM

Heather R. Swanson, MD, FHM

Preetham Talari, MD, FHM

Sofia Teferi, MD, FAAP, FHM

Rafael A. Teran, MD, FHM

Abey K. Thomas, MD, FACP, FHM

Anca R. Udrea, MD, FHM

Shawn N. Usery, MD, FHM

Moncy Varughese, MD, FACP, FHM

Leigh Vaughan, MD, FHM

Manivannan Veerasamy, MD, FACP, FHM

Ruvan Chandika Wickramasinghe, MD, FHM

Michael Williams, DO, FHM

Sandra C. Wilson, MD, FACP, MA, FHM

Kareem Z. Yahya, MD, FHM

Deyun Yang, MD, PhD, FACP, FHM

Hector L. Yordan, MD, FHM

Elham A. Yousef, MD, MSc, FHM

Anthony M. Zepeda, MD, FHM

SFHM

Ashfaq Ahmad, MD, MBA, SFHM

Aziz Ansari, DO, SFHM

Anna M. Arroyo Plasencia, MD, SFHM

Andy Arwari, MD, FACP, SFHM

Jonathan G. Bae, MD, SFHM

Ankush K. Bansal, MD, FACP, SFHM

Jitendra Barmecha, MD, MPH, SFHM

Bishara A. Bates, BS, MHA, SFHM

Valerie F. Briones-Pryor, MD, FACP, SFHM

Michael E. Burton, MD, SFHM

Tracy E. Cardin, ACNP-BC, SFHM

Chris Cockerham, MD, SFHM

Timothy J. Crone, MD, SFHM

Debasish Dasgupta, MBBS, MHA, FACP, FACHE, SFHM, CPE, CPHQ

Kapil J. Dave, MD, SFHM

Shaker M. Eid, MD, MBA, SFHM

Howard R. Epstein, MD, SFHM

Christopher M. Frost, MD, SFHM

Timothy M. Gawronski, PA-C, SFHM

Amy S. Giarrusso, MD, SFHM

Jeffrey A. Gindi, MD, SFHM

Jason A. Green, MD, SFHM

Paul William Helgerson, MD, SFHM

Maliha Iqbal, MD, SFHM

James J. Jeffries II, MD, FACP, SFHM

Ian H. Jenkins, MD, SFHM

Scott Kaatz, DO, MSc, FACP, SFHM

Khurram Kamran, MD, SFHM

Anand Kartha, MD, MS, SFHM

Attila Kasza, MD, SFHM

Amy M. Keech, MD, SFHM

William A. Landis, MD, SFHM

Jimmie E. Lewis Jr., MD, MHA, SFHM

James W. Leyhane, MD, SFHM

Michael Lin, MD, SFHM

Julianna Lindsey, MD, SFHM

Madaiah Lokeshwari, MD, SFHM

Laszlo I. Madaras, MD, MPH, SFHM

Murthy V. Madduri, MD, SFHM

Arun V. Mohan, MD, SFHM

David R. Munoz, MD, SFHM

Mark A. Murray, MD, SFHM

Vasantha Natarajan, MD, SFHM

G. Xon Ng, MD, SFHM

Andy Odden, MD, SFHM

Tiffani M. Panek, MA, CLHM, SFHM

Shannon Connor Phillips, MD, MPH, SFHM

Preethi Prakash, MD, FACP, SFHM

Alberto Puig, MD, PhD, SFHM

Rebecca P. Ramirez, MD, SFHM

Allen B. Repp, MD, FACP, MS, SFHM

Scott C. Rissmiller, MD, SFHM

Frank Romero Jr., MD, SFHM

Marcus Lindley Scarbrough, MD, FACP, SFHM

Anneliese M. Schleyer, MD, SFHM

Eric R. Schumacher, DO, SFHM

Noppon Pooh Setji, MD, SFHM

Mohammad R. Shaheed, MD, SFHM

Jeffrey Scott Shapiro, MD, SFHM

Ann Sheehy, MD, MS, SFHM

R. Lucas Shelly, DO, SFHM

Andres F. Soto, MD, SFHM

John R. Stephens, MD, SFHM

Camille N. Upchurch, MD, SFHM

Fernando S. Waldemar, MD, SFHM

Michael D. Wang, MD, SFHM

Charlotta Weaver, MD, SFHM

Andrew White, MD, SFHM

Anthony Williams, MD, MBA, SFHM

MHM

Tina Budnitz, MPH, MHM

Greg Maynard, MD, MHM

Eric Howell, MD, MHM

FHM

Nicole Adler, MD, FHM

Tochukwu Agbata, MD, FHM

Alka Aggarwal, MD, FHM

Gaurav Ahuja, MD, MBBS, FHM

Sameena Akhtar, MD, FHM

Karan Singh S. Alag, MD, MBBS, FHM

Venkata N. Allada, MD, FACP, FHM

Margaret M. Ameyaw, MBChB, FHM

Robert L. Anderson, MD, FHM

Jorge Arboleda, DO, FHM

Michael Aref, MD, PhD, FACP, FHM

Elizabeth M. Arias, MD, FACP, FHM

Amarpreet S. Bains, MD, FHM

Ebrahim Barkoudah, MD, MPH, FACP, FHM

Wanes Barsemian, MD, FHM

Jeffrey T. Bates, MD, FACP, FHM

John F. Bell, MD, MPH, FHM

Kjell Benson, MD, FHM

Azmina Bhaiji, MD, FHM

Sai-Sridhar Boddupalli, MD, FHM

Ani Bodoutchian, MD, MBA, FAAFP, FHM

Tanya M. Boldenow, MD, FHM

Dennis T. Bolger Jr., MD, FHM

Greg D. Bowling, MD, FHM

David A. Bozaan, MD, FHM

Marcia Carbo, MD, FAAP, FHM

Donna Cardoza, MD, FHM

Frank R. Carson Jr., MD, FHM

Kelly Caverzagie, MD, FACP, FHM

Elizabeth A. Cerceo, MD, FACP, FHM

Jeffrey M. Ceresnak, MD, FHM

Romil Chadha, MD, MPH, FACP, FHM

Charles Charman, MD, FHM

Bushra I. Chaudhry, MD, FHM

Justin J. Chow, MD, FHM

Douglas E. Cohen, MD, FHM

John M. Colombo Jr., MD, FHM

Steven Connelly, MD, FACP, FHM

David Corman, MD, FHM

Christopher C. Costa, MD, FHM

William C. Crowe Jr., DNP, ACNP, FNP, MSN, RN, FHM

Ria Dancel, MD, FAAP, FHM

Zubaer Dawlah, MD, FHM

Chandrasekhar R. Dinasarapu, MD, MBBS, MPH, FHM

Vijay Saradhi Dontu, MD, FHM

Oleg Dulkin, MD, FHM

Kevin C. Eaton, PA-C, FHM

Eric Edwards, MD, FHM

Mary E. Fedor, MD, FHM

John W. Fowler Jr., MD, FACP, FHM

Maria G. Frank, MD, FACP, FHM

Yelena Galumyan, MD, FHM

Christopher D. Gamble, MD, FACP, FHM

David J. Goldstein, MD, FHM

Kalpana Gorthi, MD, FHM

Manjula V. Gunawardane, MD, FHM

Craig G. Gunderson, MD, FHM

Theodore J. Haland, MD, FHM

Aaron C. Hamilton, MD, MBA, FHM

Anil Hanuman, DO, FHM

Catriona M. Harrop, MD, FHM

Hossan Hassan, FAAFP, FHM

Eileen Hennrikus, MD, FHM

Arif Hussain, MD, FHM

Javid Iqbal, MD, FHM

Shadi Jarjous, MD, FHM

Jeremy Jaskunas, MD, FHM

John David Johnston, MD, FHM

Gurmeet Kaur Kalra, MD, FHM

Stephen K. Keiser, FHM

Sirajabid Khatib, MD, FHM

Joanna Kipnes, MD, FHM

Mukesh Kumar, MBBS, MD, FACP, FHM

Rumman A. Langah, MD, FACP, FHM

Rebecca Lauderdale, MD, FHM

Lajide R. Lawoyin, MD, FACP, FHM

Lien Le, MD, FHM

Alex Leung, FHM

William I. Levin, MD, FHM

David Lichtman, PA, FHM

Doris Wei-Hwa Lin, MD, FHM

Caroline E. Lyon, MD, MPH, FHM

John D. Machado, DO, FHM

Yvonne Maduka, MD, FHM

Lawrence L. Magras, MD, MBA, FHM

Anamaria Massier, MD, FHM

Daniel McFarlane, MD, FHM

Tresa A. McNeal, MD, FHM

Johnny Mei, MD, MHA, FACP, FHM

Rovie Mesola, MD, FHM

Henry J. Michtalik, MD, MHS, MPH, FHM

Prateek Mishra, MD, FHM

Adrian M. Mogos, MD, FHM

Wajahath A. Mohsini, MD, FACP, FHM

Ashwin Narasimhan, MD, FACP, FHM

Sivakumar Natanasabapathy, MRCP, FHM

Monica C. Necula, MD, FHM

Naomi Nomizu, MD, FHM

Shervin Nourparvar, MD, FHM

Allan L. Ong, MD, FHM

Pia Ong, MD, FHM

Chike Onyejekwe, MD, FHM

Binu T. Pappachen, MD, FHM

Akash Parashar MD, MBBS, FHM

Hiren B. Parikh, MD, MBA, FHM

Jung Hyun Park, MD, FHM

Shailesh Mansukh Patel, DO, FHM

Frank A. Perry, MD, FHM

Jeffrey W. Petry, MD, MMM, FHM

John R. Pierce Jr., MD, MPH, FHM

Jeffrey Poulos, MD, FHM

Richard N. Pulido, MD, FHM

Charu Puri, MD, FHM

Carolyn Quan, MD, FHM

Saraswathi V. Racherla, MD, FHM

Aisha Rahim, MD, FHM

Edwin Q. Ravano, MD, FHM

Behzad Razavi, MD, FACP, FHM

Erin N. Reis, MD, FHM

Maria Anaizza Aurora Reyna, MD, FHM

Mark Safalow, MD, FHM

Javaid Saleem, MD, MBBS, FHM

Mandeep S. Saluja, MD, FHM

Edward R. Sampt, MD, FHM

Jorge Santibanez, MD, FHM

Anne E. Sayers, MD, FHM

Brian Schroeder, FACHE, MHA, FHM

Scott E. Sears, MD, FACP, FHM

Meghan M. Sebasky, MD, FHM

Patricia L. Seymour, MD, FHM

Neel B. Shah, MB, BCh, FACP, FACMG, FHM

Poonam Sharma, MD, FHM

Umesh Sharma, MD, MS, FACP, FHM

Ashwin B. Shivakumar, MD, MSPH, FHM

Mohammed Fazil Siddiqi, MD, FHM

Sonya Sidhu-Izzo, MD, FHM

Alana E. Sigmund, MD, FHM

Shantnu Singh, MBBS, FHM

Amith Skandhan, MD, FHM

Christopher G. Skinner, MD, FACP, FHM

Dustin T. Smith, MD, FHM

Todd I. Smith, MD, FHM

Jeffrey D. Solomon, MD, FHM

Alberto Enrique Soyano, MD, FHM

Rodney R. Story, MD, FHM

John R. Sullivan, MD, FHM

Joseph G. Surber, DO, FHM

Heather R. Swanson, MD, FHM

Preetham Talari, MD, FHM

Sofia Teferi, MD, FAAP, FHM

Rafael A. Teran, MD, FHM

Abey K. Thomas, MD, FACP, FHM

Anca R. Udrea, MD, FHM

Shawn N. Usery, MD, FHM

Moncy Varughese, MD, FACP, FHM

Leigh Vaughan, MD, FHM

Manivannan Veerasamy, MD, FACP, FHM

Ruvan Chandika Wickramasinghe, MD, FHM

Michael Williams, DO, FHM

Sandra C. Wilson, MD, FACP, MA, FHM

Kareem Z. Yahya, MD, FHM

Deyun Yang, MD, PhD, FACP, FHM

Hector L. Yordan, MD, FHM

Elham A. Yousef, MD, MSc, FHM

Anthony M. Zepeda, MD, FHM

SFHM

Ashfaq Ahmad, MD, MBA, SFHM

Aziz Ansari, DO, SFHM

Anna M. Arroyo Plasencia, MD, SFHM

Andy Arwari, MD, FACP, SFHM

Jonathan G. Bae, MD, SFHM

Ankush K. Bansal, MD, FACP, SFHM

Jitendra Barmecha, MD, MPH, SFHM

Bishara A. Bates, BS, MHA, SFHM

Valerie F. Briones-Pryor, MD, FACP, SFHM

Michael E. Burton, MD, SFHM

Tracy E. Cardin, ACNP-BC, SFHM

Chris Cockerham, MD, SFHM

Timothy J. Crone, MD, SFHM

Debasish Dasgupta, MBBS, MHA, FACP, FACHE, SFHM, CPE, CPHQ

Kapil J. Dave, MD, SFHM

Shaker M. Eid, MD, MBA, SFHM

Howard R. Epstein, MD, SFHM

Christopher M. Frost, MD, SFHM

Timothy M. Gawronski, PA-C, SFHM

Amy S. Giarrusso, MD, SFHM

Jeffrey A. Gindi, MD, SFHM

Jason A. Green, MD, SFHM

Paul William Helgerson, MD, SFHM

Maliha Iqbal, MD, SFHM

James J. Jeffries II, MD, FACP, SFHM

Ian H. Jenkins, MD, SFHM

Scott Kaatz, DO, MSc, FACP, SFHM

Khurram Kamran, MD, SFHM

Anand Kartha, MD, MS, SFHM

Attila Kasza, MD, SFHM

Amy M. Keech, MD, SFHM

William A. Landis, MD, SFHM

Jimmie E. Lewis Jr., MD, MHA, SFHM

James W. Leyhane, MD, SFHM

Michael Lin, MD, SFHM

Julianna Lindsey, MD, SFHM

Madaiah Lokeshwari, MD, SFHM

Laszlo I. Madaras, MD, MPH, SFHM

Murthy V. Madduri, MD, SFHM

Arun V. Mohan, MD, SFHM

David R. Munoz, MD, SFHM

Mark A. Murray, MD, SFHM

Vasantha Natarajan, MD, SFHM

G. Xon Ng, MD, SFHM

Andy Odden, MD, SFHM

Tiffani M. Panek, MA, CLHM, SFHM

Shannon Connor Phillips, MD, MPH, SFHM

Preethi Prakash, MD, FACP, SFHM

Alberto Puig, MD, PhD, SFHM

Rebecca P. Ramirez, MD, SFHM

Allen B. Repp, MD, FACP, MS, SFHM

Scott C. Rissmiller, MD, SFHM

Frank Romero Jr., MD, SFHM

Marcus Lindley Scarbrough, MD, FACP, SFHM

Anneliese M. Schleyer, MD, SFHM

Eric R. Schumacher, DO, SFHM

Noppon Pooh Setji, MD, SFHM

Mohammad R. Shaheed, MD, SFHM

Jeffrey Scott Shapiro, MD, SFHM

Ann Sheehy, MD, MS, SFHM

R. Lucas Shelly, DO, SFHM

Andres F. Soto, MD, SFHM

John R. Stephens, MD, SFHM

Camille N. Upchurch, MD, SFHM

Fernando S. Waldemar, MD, SFHM

Michael D. Wang, MD, SFHM

Charlotta Weaver, MD, SFHM

Andrew White, MD, SFHM

Anthony Williams, MD, MBA, SFHM

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

SAN DIEGO — If you arrived late, or even right on time, to the session on becoming a better attending, you’d better have been ready to find a clear spot on the floor or have had the energy to stand for an hour.

Read more about the speakers at HM16.

But the dynamic talk, you could even say performance, by Jeffrey Wiese, MD, MHM, crackled with energy, so there was plenty of it to go around. The session, in its 10th year and now practically an institution of its own at the annual meeting, was a highlight among the offerings on career development at HM16.

Dr. Wiese liberally seasoned the session with role-playing and humor—the “patient” on the session-room floor but without a pillow meant “Press Ganey’s going to take a hit on this one,” he joked. He emphasized the importance of attending physicians to give reasons to support the expectations they have for their trainees.

“The key piece is giving that rationale. Once they have a reason for why they’re going to do it, now the expectation’s grounded, now it actually makes sense,” said Dr. Wiese, professor of medicine at Tulane University Health Sciences Center in New Orleans and a past SHM president. “You don’t do that, they’re going to fill in the gaps with their own expectations.”

Other points of emphasis:

• The importance of autonomy and choice so that trainees have a sense of purpose;
• The transition from self-interested medical students to residents who are concerned with the well-being of team members;
• The assurance of an endpoint so that hectic periods don’t spiral out of control; and
• Acts of ritual, such as using Purell before entering a patient’s room, as moments of “genuflect” to regain perspective.

Charles Kast, MD, an attending physician at Long Island Jewish Medical Center in New Hyde Park, N.Y., said the relationship theme resonated with him the most.

“It’s more the relationships the attendings have with their residents and with their students, and it’s more of an emotional connection,” he said. “Whether it’s education or mentoring or what have you, it’s all about developing that trust between the resident and the attending.”

But it’s a gradual process.

“It’s baby steps,” Dr. Kast added. “There were 17 different lists in there, right? So you’ve got to pick one and kind of go with it. I think it’s kind of an organic process, where one thing kind of leads to the next.”

Tactics to avoid burnout—by cultivating a sense of purpose while understanding and relating to trainees’ concerns—were a key part of Dr. Wiese’s message. Burnout was a topic that HM16 attendees returned to again and again when discussing their take-homes from the meeting. The subject popped up in almost every session to one degree or another.

David Nevin, MD, a hospitalist at ThedaCare in Wisconsin, said that he was reminded in one session—“Staying in the Game: Self-Care for Hospitalists”—that taking even brief moments for yourself can make a difference.

“Focusing on the positive for a moment and what’s good about your life, and doing that kind of exercise, helps sort of deal with burnout and bring things into perspective,” he said. “You get sort of worn down, you’re not as sharp, you miss things when you’re not at your peak in terms of looking at things.”

Ariana Peters, DO, who works at Mayo Clinic in Scottsdale, Ariz., said a similar message resonated with her, as well. There are ample situations when, if she doesn’t consciously take time for herself, things will seem to mushroom.

In just one recent example, she reflected on an especially difficult day.

“I had 18 patients, and it was horrible,” she said. “I left my office in the morning and didn’t come back until 8 p.m. that night. I was literally eating peanut butter and graham crackers on the floor.

“It doesn’t take long to just stop and take a breath. Twenty seconds is not a long time.”

Waiting for a session on personal productivity to start, Adam Garber, MD, assistant professor at Virginia Commonwealth University in Richmond, said that he found the introduction to the SMART approach (Specific, Measurable, Achievable, Relevant, and Time-Bound), meaning being able to be done within a certain period, was a good guideline to approaching projects of all kinds.

“I think you can apply it to any problem and career-development project you want to work on,” he said. “It just kind of gives you that framework of how to organize it, present it logically, and carry it out.” TH

Clinical question: Is discontinuation of inhaled corticosteroids (ICSs) in patients with COPD associated with a decreased risk of pneumonia?

Background: ICSs are used in up to 85% of patients treated for COPD but may be associated with adverse systemic side effects including pneumonia. Trials looking at weaning patients off ICSs and replacing with long-acting bronchodilators have found few adverse outcomes; however, the benefits of discontinuation on adverse events, including pneumonia, have been unclear.

Study design: Case-control study.

Setting: Quebec health systems.

Synopsis: Using the Quebec health insurance databases, a study cohort of 103,386 patients with COPD on ICSs was created. Patients were followed for a mean of 4.9 years; 14,020 patients who were hospitalized for pneumonia or died from pneumonia outside the hospital were matched to control subjects. Discontinuation of ICSs was associated with a 37% decrease in serious pneumonia (relative risk [RR] 0.63; 95% CI, 0.60–0.66). The risk reduction occurred as early as one month after discontinuation of ICSs. Risk reduction was greater with fluticasone (RR 0.58; 95% CI, 0.54–0.61) than with budesonide (RR 0.87; 95% CI, 0.7–0.97).

Population size and follow-up may contribute to why risk reduction in pneumonia was seen in this study but not in other recent randomized trials on discontinuation of ICSs. A limitation of this study was its observational design; however, its results suggest that use of ICSs in COPD patients should be highly selective, as indiscriminate use can subject patients to elevated risk of hospitalization or death from pneumonia.

Bottom line: Discontinuation of ICSs in patients with COPD is associated with a decreased risk of contracting serious pneumonia. This reduction appears greatest with fluticasone.

Citation: Suissa S, Coulombe J, Ernst P. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest. 2015;148(5):1177-1183.

Short Take

Increase in Rates of Prescription Drug Use and Polypharmacy Seen

The percentage of Americans who reported taking prescription medications increased substantially from 1999 to 2012 (51% to 59%), as did the percentage who reported taking at least five prescription medications.

Citation: Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818-1830.

Clinical question: Is discontinuation of inhaled corticosteroids (ICSs) in patients with COPD associated with a decreased risk of pneumonia?

Background: ICSs are used in up to 85% of patients treated for COPD but may be associated with adverse systemic side effects including pneumonia. Trials looking at weaning patients off ICSs and replacing with long-acting bronchodilators have found few adverse outcomes; however, the benefits of discontinuation on adverse events, including pneumonia, have been unclear.

Study design: Case-control study.

Setting: Quebec health systems.

Synopsis: Using the Quebec health insurance databases, a study cohort of 103,386 patients with COPD on ICSs was created. Patients were followed for a mean of 4.9 years; 14,020 patients who were hospitalized for pneumonia or died from pneumonia outside the hospital were matched to control subjects. Discontinuation of ICSs was associated with a 37% decrease in serious pneumonia (relative risk [RR] 0.63; 95% CI, 0.60–0.66). The risk reduction occurred as early as one month after discontinuation of ICSs. Risk reduction was greater with fluticasone (RR 0.58; 95% CI, 0.54–0.61) than with budesonide (RR 0.87; 95% CI, 0.7–0.97).

Population size and follow-up may contribute to why risk reduction in pneumonia was seen in this study but not in other recent randomized trials on discontinuation of ICSs. A limitation of this study was its observational design; however, its results suggest that use of ICSs in COPD patients should be highly selective, as indiscriminate use can subject patients to elevated risk of hospitalization or death from pneumonia.

Bottom line: Discontinuation of ICSs in patients with COPD is associated with a decreased risk of contracting serious pneumonia. This reduction appears greatest with fluticasone.

Citation: Suissa S, Coulombe J, Ernst P. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest. 2015;148(5):1177-1183.

Short Take

Increase in Rates of Prescription Drug Use and Polypharmacy Seen

The percentage of Americans who reported taking prescription medications increased substantially from 1999 to 2012 (51% to 59%), as did the percentage who reported taking at least five prescription medications.

Citation: Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818-1830.

Clinical question: Is discontinuation of inhaled corticosteroids (ICSs) in patients with COPD associated with a decreased risk of pneumonia?

Background: ICSs are used in up to 85% of patients treated for COPD but may be associated with adverse systemic side effects including pneumonia. Trials looking at weaning patients off ICSs and replacing with long-acting bronchodilators have found few adverse outcomes; however, the benefits of discontinuation on adverse events, including pneumonia, have been unclear.

Study design: Case-control study.

Setting: Quebec health systems.

Synopsis: Using the Quebec health insurance databases, a study cohort of 103,386 patients with COPD on ICSs was created. Patients were followed for a mean of 4.9 years; 14,020 patients who were hospitalized for pneumonia or died from pneumonia outside the hospital were matched to control subjects. Discontinuation of ICSs was associated with a 37% decrease in serious pneumonia (relative risk [RR] 0.63; 95% CI, 0.60–0.66). The risk reduction occurred as early as one month after discontinuation of ICSs. Risk reduction was greater with fluticasone (RR 0.58; 95% CI, 0.54–0.61) than with budesonide (RR 0.87; 95% CI, 0.7–0.97).

Population size and follow-up may contribute to why risk reduction in pneumonia was seen in this study but not in other recent randomized trials on discontinuation of ICSs. A limitation of this study was its observational design; however, its results suggest that use of ICSs in COPD patients should be highly selective, as indiscriminate use can subject patients to elevated risk of hospitalization or death from pneumonia.

Bottom line: Discontinuation of ICSs in patients with COPD is associated with a decreased risk of contracting serious pneumonia. This reduction appears greatest with fluticasone.

Citation: Suissa S, Coulombe J, Ernst P. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest. 2015;148(5):1177-1183.

Short Take

Increase in Rates of Prescription Drug Use and Polypharmacy Seen

The percentage of Americans who reported taking prescription medications increased substantially from 1999 to 2012 (51% to 59%), as did the percentage who reported taking at least five prescription medications.

Citation: Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818-1830.

Clinical question: Which illness severity score best predicts outcomes in emergency department (ED) patients presenting with infection?

Background: Several scoring models have been developed to predict illness severity and mortality in patients with infection. Some scores were developed specifically for patients with sepsis and others for patients in a general critical care setting. These different scoring models have not been specifically compared and validated in the ED setting in patients with infection of various severities.

Study design: Prospective, observational study.

Setting: Adult ED in a metropolitan tertiary, university-affiliated hospital.

Synopsis: Investigators prospectively identified 8,871 adult inpatients with infection from a single-center ED. Data to calculate five prediction models were collected. The models were:

• Mortality in Emergency Department Sepsis (MEDS) score;
• Acute Physiology and Chronic Health Evaluation II (APACHE II);
• Simplified Acute Physiology Score II (SAPS II);
• Sequential Organ Failure Assessment (SOFA); and
• Severe Sepsis Score (SSS).

Severity score performance was assessed for the overall cohort and for subgroups, including infection without systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. The MEDS score best predicted mortality in the cohort, with an area under the receiver operating characteristics curve of 0.92. However, older scoring models such as the APACHE II and SAPS II still discriminated well, especially in patients who were admitted to the ICU. All scores tended to overestimate mortality.

Bottom line: The MEDS score may best predict illness severity in septic patients presenting to the ED, but other scoring models may be better-suited for specific patient populations.

Citation: Williams JM, Greenslade JH, Chu K, Brown AF, Lipman J. Severity scores in emergency department patients with presumed infection: a prospective validation study. Crit Care Med. 2016;44(3):539-547.

Clinical question: Which illness severity score best predicts outcomes in emergency department (ED) patients presenting with infection?

Background: Several scoring models have been developed to predict illness severity and mortality in patients with infection. Some scores were developed specifically for patients with sepsis and others for patients in a general critical care setting. These different scoring models have not been specifically compared and validated in the ED setting in patients with infection of various severities.

Study design: Prospective, observational study.

Setting: Adult ED in a metropolitan tertiary, university-affiliated hospital.

Synopsis: Investigators prospectively identified 8,871 adult inpatients with infection from a single-center ED. Data to calculate five prediction models were collected. The models were:

• Mortality in Emergency Department Sepsis (MEDS) score;
• Acute Physiology and Chronic Health Evaluation II (APACHE II);
• Simplified Acute Physiology Score II (SAPS II);
• Sequential Organ Failure Assessment (SOFA); and
• Severe Sepsis Score (SSS).

Severity score performance was assessed for the overall cohort and for subgroups, including infection without systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. The MEDS score best predicted mortality in the cohort, with an area under the receiver operating characteristics curve of 0.92. However, older scoring models such as the APACHE II and SAPS II still discriminated well, especially in patients who were admitted to the ICU. All scores tended to overestimate mortality.

Bottom line: The MEDS score may best predict illness severity in septic patients presenting to the ED, but other scoring models may be better-suited for specific patient populations.

Citation: Williams JM, Greenslade JH, Chu K, Brown AF, Lipman J. Severity scores in emergency department patients with presumed infection: a prospective validation study. Crit Care Med. 2016;44(3):539-547.

Clinical question: Which illness severity score best predicts outcomes in emergency department (ED) patients presenting with infection?

Background: Several scoring models have been developed to predict illness severity and mortality in patients with infection. Some scores were developed specifically for patients with sepsis and others for patients in a general critical care setting. These different scoring models have not been specifically compared and validated in the ED setting in patients with infection of various severities.

Study design: Prospective, observational study.

Setting: Adult ED in a metropolitan tertiary, university-affiliated hospital.

Synopsis: Investigators prospectively identified 8,871 adult inpatients with infection from a single-center ED. Data to calculate five prediction models were collected. The models were:

• Mortality in Emergency Department Sepsis (MEDS) score;
• Acute Physiology and Chronic Health Evaluation II (APACHE II);
• Simplified Acute Physiology Score II (SAPS II);
• Sequential Organ Failure Assessment (SOFA); and
• Severe Sepsis Score (SSS).

Severity score performance was assessed for the overall cohort and for subgroups, including infection without systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. The MEDS score best predicted mortality in the cohort, with an area under the receiver operating characteristics curve of 0.92. However, older scoring models such as the APACHE II and SAPS II still discriminated well, especially in patients who were admitted to the ICU. All scores tended to overestimate mortality.

Bottom line: The MEDS score may best predict illness severity in septic patients presenting to the ED, but other scoring models may be better-suited for specific patient populations.

Citation: Williams JM, Greenslade JH, Chu K, Brown AF, Lipman J. Severity scores in emergency department patients with presumed infection: a prospective validation study. Crit Care Med. 2016;44(3):539-547.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

(Reuters Health) - For people with Alzheimer's disease, having gum disease is tied to faster cognitive decline, according to a new study.

"What we have shown is that regardless of the severity of dementia (within this mild to moderate impaired group) that patients with more severe gum disease are declining more rapidly," said senior author Clive Holmes of the University of Southampton in the UK.

In other studies, Holmes and his coauthors have found that conditions such as chest infections, urinary tract infections, rheumatoid arthritis and diabetes are associated with faster disease progression in Alzheimer's, he said.

"We hadn't previously looked at gum disease because MDs tendto leave this in the hands of dentists but it is an important common low grade chronic infection," Holmes told Reuters Health by email.

The researchers observed 60 people with mild to moderate Alzheimer's disease living at home for six months. The participants did not smoke, had not been treated for gum disease within the previous six months, and had at least 10 teeth.

At the start, each participant completed a cognitive assessment, gave a blood sample, was examined by a dental hygienist and their main caregiver was interviewed to provide a medical and dental history. The same tests and interviews were repeated six months later.

Of the 60 people in the study, 22 had moderate to severe gum disease at the beginning of the study. By six months later, one participant had died, three had withdrawn from the study and three were lost to follow-up.

Cognitive score declined more for those who had periodontitis to begin with than for those who did not, the researchers reported February 24 in PLoS One.

According to one theory, cognitive impairment leads to adverse oral health due to inattention to routine oral hygiene and care, said Dr. James M. Noble of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York City, who was not part of the new study.

"The second, and the one I'm most intrigued by, is whether or not periodontal disease has an influence on cognitive outcomes of aging, either as an independent risk factor for (new-onset) cognitive impairment including Alzheimer's disease, or more rapid decline once (Alzheimer's disease) has been diagnosed, as was suggested by this study," Noble told Reuters Health by email.

Gum disease may cause chronic low-grade inflammation in the rest of the body, and inflammation is associated with changes in the brain, he said.

"It is known that gum disease is associated with increased markers of inflammation," Holmes said.

But the new study indicates a connection between gum disease and cognitive decline, not necessarily that one causes the other, he said. Further studies need to assess whether treatingthe gum disease would also slow cognitive decline.

"Periodontitis has been associated with heart disease and stroke among other conditions," Noble said. Based on this and other studies, "it seems to be good advice to brush and floss," Noble said.

“Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Below is a chart of the “key communication” tactics.

“Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Below is a chart of the “key communication” tactics.

“Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Below is a chart of the “key communication” tactics.