Thomas R. Collins

SANDESTIN, FLA. – Lyme disease is spreading in the United States, which makes it a high priority for rheumatologists, who will need to care for an increasing number of patients with posttreatment disorders affecting the joints, an expert said at the annual Congress of Clinical Rheumatology.

Sheila Arvikar, MD, an instructor in the rheumatology division at Harvard Medical School, Boston, said that the disease – the most common vector-borne illness in the United States – is no longer strictly confined to the U.S. Northeast and the upper Midwest, according to reports from the Centers for Disease Control and Prevention. Neighboring areas are increasingly affected, the reports have shown.

That the disease may be spreading makes the need for awareness and better testing more acute, she said. Current testing is limited by a lack of sensitivity in early disease, and the standard two-tier combination of enzyme-linked immunosorbent assay and Western blot can be time consuming. But recent studies have found that whole cell sonicate ELISA combined with an ELISA for peptide C6 are equally or even more effective than the more cumbersome, two-tier version, Dr. Arvikar said.

A problem encountered by rheumatologists are patients who contracted Lyme disease but who continue to have joint pain and other symptoms despite treatment for the disease. This so-called posttreatment Lyme disease syndrome (PTLDS) can be similar to fibromyalgia or chronic fatigue syndrome, involving chronic symptoms but no chronic infection and no objective synovitis or inflammation.

There are no Food and Drug Administration–approved treatments for it, but options such as tricyclics, serotonin norepinephrine reuptake inhibitors, gabapentin, and pregabalin can be helpful, she said, along with exercise and cognitive-behavioral therapy. She also noted myriad alternative treatments marketed for PTLDS that have not been shown to be effective and can even be harmful, such as urine ingestion and treatment with bee venom.

“These patients are really desperate for anything to help with their symptoms, and there are lot of people out there who are preying on them with these therapies that aren’t really helpful. It’s important for us to be aware that these things are out there.”

Dr. Arvikar reported having no financial disclosures.

SOURCE: Arvikar S, CCR 2018.

SANDESTIN, FLA. – Lyme disease is spreading in the United States, which makes it a high priority for rheumatologists, who will need to care for an increasing number of patients with posttreatment disorders affecting the joints, an expert said at the annual Congress of Clinical Rheumatology.

Sheila Arvikar, MD, an instructor in the rheumatology division at Harvard Medical School, Boston, said that the disease – the most common vector-borne illness in the United States – is no longer strictly confined to the U.S. Northeast and the upper Midwest, according to reports from the Centers for Disease Control and Prevention. Neighboring areas are increasingly affected, the reports have shown.

That the disease may be spreading makes the need for awareness and better testing more acute, she said. Current testing is limited by a lack of sensitivity in early disease, and the standard two-tier combination of enzyme-linked immunosorbent assay and Western blot can be time consuming. But recent studies have found that whole cell sonicate ELISA combined with an ELISA for peptide C6 are equally or even more effective than the more cumbersome, two-tier version, Dr. Arvikar said.

A problem encountered by rheumatologists are patients who contracted Lyme disease but who continue to have joint pain and other symptoms despite treatment for the disease. This so-called posttreatment Lyme disease syndrome (PTLDS) can be similar to fibromyalgia or chronic fatigue syndrome, involving chronic symptoms but no chronic infection and no objective synovitis or inflammation.

There are no Food and Drug Administration–approved treatments for it, but options such as tricyclics, serotonin norepinephrine reuptake inhibitors, gabapentin, and pregabalin can be helpful, she said, along with exercise and cognitive-behavioral therapy. She also noted myriad alternative treatments marketed for PTLDS that have not been shown to be effective and can even be harmful, such as urine ingestion and treatment with bee venom.

“These patients are really desperate for anything to help with their symptoms, and there are lot of people out there who are preying on them with these therapies that aren’t really helpful. It’s important for us to be aware that these things are out there.”

Dr. Arvikar reported having no financial disclosures.

SOURCE: Arvikar S, CCR 2018.

SANDESTIN, FLA. – Lyme disease is spreading in the United States, which makes it a high priority for rheumatologists, who will need to care for an increasing number of patients with posttreatment disorders affecting the joints, an expert said at the annual Congress of Clinical Rheumatology.

Sheila Arvikar, MD, an instructor in the rheumatology division at Harvard Medical School, Boston, said that the disease – the most common vector-borne illness in the United States – is no longer strictly confined to the U.S. Northeast and the upper Midwest, according to reports from the Centers for Disease Control and Prevention. Neighboring areas are increasingly affected, the reports have shown.

That the disease may be spreading makes the need for awareness and better testing more acute, she said. Current testing is limited by a lack of sensitivity in early disease, and the standard two-tier combination of enzyme-linked immunosorbent assay and Western blot can be time consuming. But recent studies have found that whole cell sonicate ELISA combined with an ELISA for peptide C6 are equally or even more effective than the more cumbersome, two-tier version, Dr. Arvikar said.

A problem encountered by rheumatologists are patients who contracted Lyme disease but who continue to have joint pain and other symptoms despite treatment for the disease. This so-called posttreatment Lyme disease syndrome (PTLDS) can be similar to fibromyalgia or chronic fatigue syndrome, involving chronic symptoms but no chronic infection and no objective synovitis or inflammation.

There are no Food and Drug Administration–approved treatments for it, but options such as tricyclics, serotonin norepinephrine reuptake inhibitors, gabapentin, and pregabalin can be helpful, she said, along with exercise and cognitive-behavioral therapy. She also noted myriad alternative treatments marketed for PTLDS that have not been shown to be effective and can even be harmful, such as urine ingestion and treatment with bee venom.

“These patients are really desperate for anything to help with their symptoms, and there are lot of people out there who are preying on them with these therapies that aren’t really helpful. It’s important for us to be aware that these things are out there.”

Dr. Arvikar reported having no financial disclosures.

SOURCE: Arvikar S, CCR 2018.

SANDESTIN, FLA. – Big data informing patient treatment, computer algorithms reading imaging instead of humans, and even accurate patient self-diagnosis could emerge over the next 10 years in the treatment of rheumatoid arthritis, an expert said at the annual Congress of Clinical Rheumatology.

Gerd Burmester, MD, director of rheumatology and clinical immunology at Charité University in Berlin, trotted out staggering numbers on future medical data collection on patients. Data analytics companies project that more than 1,000 terabytes of data per lifetime is expected to be gathered, with just 10% expected to be clinical information and 30% in the form of “-omics,” such as proteomics and genomics, he said. The other 60% is expected to come from sensors and wearables that patients essentially collect themselves with their own devices, he said.

“We will have to use data in the interest of the patient,” he said. “This is the real secret. In order to do this, we need cognitive computing, which assesses structured and unstructured data and is self-learning.”

The days of images being read by human radiologists could be numbered, he said.

“There will be a revolution in imaging scoring,” he said, with computer algorithms generating scores, more quickly separating the normal scans from those that need clinical attention.

He described a possible scenario in which patients get genetic analyses, blood biomarker testing, and imaging performed at kiosks about town, producing a diagnosis without a single physician visit. It might seem fanciful, but when he asked the audience how many thought it was impossible over the next decade, no one raised a hand.

With advances such as the self-rheumatoid arthritis examination tool Rheuma-Check and the decline in cost for whole genome sequencing – along with wait times to see rheumatologists sometimes as long as 6 months – such a scenario might not be far fetched, Dr. Burmester said. It is possible, he said, because patient histories that used to sit in charts, images that used to be on film only, and genetic data that used to be unavailable, are all now in structured, digital form.

Referring to a recent commentary in the New England Journal of Medicine, Dr. Burmester said physicians have to accept the coming role of computer algorithms.

“If medicine wishes to stay in control of its own future,” he said, “physicians will not only have to embrace algorithms, they will also have to excel at developing and evaluating them, bringing machine-learning methods into the medical domain.”

SOURCE: Burmester, G. CCR 2018.

SANDESTIN, FLA. – Big data informing patient treatment, computer algorithms reading imaging instead of humans, and even accurate patient self-diagnosis could emerge over the next 10 years in the treatment of rheumatoid arthritis, an expert said at the annual Congress of Clinical Rheumatology.

Gerd Burmester, MD, director of rheumatology and clinical immunology at Charité University in Berlin, trotted out staggering numbers on future medical data collection on patients. Data analytics companies project that more than 1,000 terabytes of data per lifetime is expected to be gathered, with just 10% expected to be clinical information and 30% in the form of “-omics,” such as proteomics and genomics, he said. The other 60% is expected to come from sensors and wearables that patients essentially collect themselves with their own devices, he said.

“We will have to use data in the interest of the patient,” he said. “This is the real secret. In order to do this, we need cognitive computing, which assesses structured and unstructured data and is self-learning.”

The days of images being read by human radiologists could be numbered, he said.

“There will be a revolution in imaging scoring,” he said, with computer algorithms generating scores, more quickly separating the normal scans from those that need clinical attention.

He described a possible scenario in which patients get genetic analyses, blood biomarker testing, and imaging performed at kiosks about town, producing a diagnosis without a single physician visit. It might seem fanciful, but when he asked the audience how many thought it was impossible over the next decade, no one raised a hand.

With advances such as the self-rheumatoid arthritis examination tool Rheuma-Check and the decline in cost for whole genome sequencing – along with wait times to see rheumatologists sometimes as long as 6 months – such a scenario might not be far fetched, Dr. Burmester said. It is possible, he said, because patient histories that used to sit in charts, images that used to be on film only, and genetic data that used to be unavailable, are all now in structured, digital form.

Referring to a recent commentary in the New England Journal of Medicine, Dr. Burmester said physicians have to accept the coming role of computer algorithms.

“If medicine wishes to stay in control of its own future,” he said, “physicians will not only have to embrace algorithms, they will also have to excel at developing and evaluating them, bringing machine-learning methods into the medical domain.”

SOURCE: Burmester, G. CCR 2018.

SANDESTIN, FLA. – Big data informing patient treatment, computer algorithms reading imaging instead of humans, and even accurate patient self-diagnosis could emerge over the next 10 years in the treatment of rheumatoid arthritis, an expert said at the annual Congress of Clinical Rheumatology.

Gerd Burmester, MD, director of rheumatology and clinical immunology at Charité University in Berlin, trotted out staggering numbers on future medical data collection on patients. Data analytics companies project that more than 1,000 terabytes of data per lifetime is expected to be gathered, with just 10% expected to be clinical information and 30% in the form of “-omics,” such as proteomics and genomics, he said. The other 60% is expected to come from sensors and wearables that patients essentially collect themselves with their own devices, he said.

“We will have to use data in the interest of the patient,” he said. “This is the real secret. In order to do this, we need cognitive computing, which assesses structured and unstructured data and is self-learning.”

The days of images being read by human radiologists could be numbered, he said.

“There will be a revolution in imaging scoring,” he said, with computer algorithms generating scores, more quickly separating the normal scans from those that need clinical attention.

He described a possible scenario in which patients get genetic analyses, blood biomarker testing, and imaging performed at kiosks about town, producing a diagnosis without a single physician visit. It might seem fanciful, but when he asked the audience how many thought it was impossible over the next decade, no one raised a hand.

With advances such as the self-rheumatoid arthritis examination tool Rheuma-Check and the decline in cost for whole genome sequencing – along with wait times to see rheumatologists sometimes as long as 6 months – such a scenario might not be far fetched, Dr. Burmester said. It is possible, he said, because patient histories that used to sit in charts, images that used to be on film only, and genetic data that used to be unavailable, are all now in structured, digital form.

Referring to a recent commentary in the New England Journal of Medicine, Dr. Burmester said physicians have to accept the coming role of computer algorithms.

“If medicine wishes to stay in control of its own future,” he said, “physicians will not only have to embrace algorithms, they will also have to excel at developing and evaluating them, bringing machine-learning methods into the medical domain.”

SOURCE: Burmester, G. CCR 2018.

Food and Drug Administration postmarketing requirement (PMR) studies for cancer drugs tend to be completed on schedule, but the drugs can remain on the market even if primary endpoints in those studies are not met, according to a research letter in JAMA Oncology.

“These examples underscore the importance of collecting the additional clinical safety and efficacy data outlined in the PMRs and the need for collaborative efforts between the FDA, sponsors, and investigators,” wrote Chadi Nabhan, MD, MBA, chief medical officer at Cardinal Health in Dublin, Ohio, and Marjorie Zettler, PhD, MPH, senior scientist at Cardinal Health.

The researchers reviewed the FDA’s Novel Drug Summary and compared the requirements listed there with information in the FDA’s Postmarket Requirements and Commitments database and on the Clinicaltrials.gov website.

The FDA has relied on its accelerated approval program, using surrogate or intermediate endpoints deemed to reasonably predict clinical benefit, in order to balance expeditious approval with patient safety. And it has used postmarketing requirements to try to mitigate the risk of this program.

From January 2011 to December 2016, 49 new drugs were approved in oncology, 23 of which were granted an accelerated approval. Of those 23, 17 had postmarketing requirements to complete, including 34 clinical trials. Of the 34 trials, researchers found, 15 have been completed, 14 are ongoing, 2 have been terminated, and 3 are pending.

Out of the 15 clinical studies that have been completed, 3 failed to meet their primary efficacy end points – for atezolizumab, nivolumab and pembrolizumab. None of the drugs have been pulled from the market, researchers noted.

The two terminated studies, both for idelalisib, were stopped because of safety concerns. One product, ponatinib, was temporarily pulled, and the FDA required further studies, with a risk evaluation and mitigation study. That postmarketing study was eventually resumed and completed.

SOURCE: Nabhan C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0610.

Food and Drug Administration postmarketing requirement (PMR) studies for cancer drugs tend to be completed on schedule, but the drugs can remain on the market even if primary endpoints in those studies are not met, according to a research letter in JAMA Oncology.

“These examples underscore the importance of collecting the additional clinical safety and efficacy data outlined in the PMRs and the need for collaborative efforts between the FDA, sponsors, and investigators,” wrote Chadi Nabhan, MD, MBA, chief medical officer at Cardinal Health in Dublin, Ohio, and Marjorie Zettler, PhD, MPH, senior scientist at Cardinal Health.

The researchers reviewed the FDA’s Novel Drug Summary and compared the requirements listed there with information in the FDA’s Postmarket Requirements and Commitments database and on the Clinicaltrials.gov website.

The FDA has relied on its accelerated approval program, using surrogate or intermediate endpoints deemed to reasonably predict clinical benefit, in order to balance expeditious approval with patient safety. And it has used postmarketing requirements to try to mitigate the risk of this program.

From January 2011 to December 2016, 49 new drugs were approved in oncology, 23 of which were granted an accelerated approval. Of those 23, 17 had postmarketing requirements to complete, including 34 clinical trials. Of the 34 trials, researchers found, 15 have been completed, 14 are ongoing, 2 have been terminated, and 3 are pending.

Out of the 15 clinical studies that have been completed, 3 failed to meet their primary efficacy end points – for atezolizumab, nivolumab and pembrolizumab. None of the drugs have been pulled from the market, researchers noted.

The two terminated studies, both for idelalisib, were stopped because of safety concerns. One product, ponatinib, was temporarily pulled, and the FDA required further studies, with a risk evaluation and mitigation study. That postmarketing study was eventually resumed and completed.

SOURCE: Nabhan C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0610.

Food and Drug Administration postmarketing requirement (PMR) studies for cancer drugs tend to be completed on schedule, but the drugs can remain on the market even if primary endpoints in those studies are not met, according to a research letter in JAMA Oncology.

“These examples underscore the importance of collecting the additional clinical safety and efficacy data outlined in the PMRs and the need for collaborative efforts between the FDA, sponsors, and investigators,” wrote Chadi Nabhan, MD, MBA, chief medical officer at Cardinal Health in Dublin, Ohio, and Marjorie Zettler, PhD, MPH, senior scientist at Cardinal Health.

The researchers reviewed the FDA’s Novel Drug Summary and compared the requirements listed there with information in the FDA’s Postmarket Requirements and Commitments database and on the Clinicaltrials.gov website.

The FDA has relied on its accelerated approval program, using surrogate or intermediate endpoints deemed to reasonably predict clinical benefit, in order to balance expeditious approval with patient safety. And it has used postmarketing requirements to try to mitigate the risk of this program.

From January 2011 to December 2016, 49 new drugs were approved in oncology, 23 of which were granted an accelerated approval. Of those 23, 17 had postmarketing requirements to complete, including 34 clinical trials. Of the 34 trials, researchers found, 15 have been completed, 14 are ongoing, 2 have been terminated, and 3 are pending.

Out of the 15 clinical studies that have been completed, 3 failed to meet their primary efficacy end points – for atezolizumab, nivolumab and pembrolizumab. None of the drugs have been pulled from the market, researchers noted.

The two terminated studies, both for idelalisib, were stopped because of safety concerns. One product, ponatinib, was temporarily pulled, and the FDA required further studies, with a risk evaluation and mitigation study. That postmarketing study was eventually resumed and completed.

SOURCE: Nabhan C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0610.

Checkpoint inhibitors got to melanoma, non–small cell lung cancer, and renal cell carcinoma patients quickly in clinical practice after Food and Drug Administration approval – usually within 4 months – but the patients treated in clinical settings tended to be older than those treated in trials, which has caused concern about whether real-world efficacy will prove to be the same, according to a study in JAMA Oncology.

“Such rapid adoption stands in contrast to older estimates that suggest it takes years or even decades for new treatments to be adopted,” wrote lead author Cary Gross, MD, professor of medicine at Yale University, New Haven, and his coauthors. “We found significant differences in age between patients treated in practice and those treated in trials, which highlights the need to clarify the risks and benefits of checkpoint inhibitors in general populations of patients.”

Researchers drew data on nivolumab and pembrolizumab use from the Flatiron Health longitudinal EHR database, which included 233 academic and community oncology practices. In each of the three disease cohorts, adoption was seen within 4 months for at least 60% of patients. Uptake was quickest for the melanoma patients, 76% of whom received a checkpoint inhibitor within 4 months, investigators wrote. Factors for the fast adoption could include high disease severity, a preference for novelty, perceived gains over existing treatments, and promotional activities, such as media reports and advertising directly to consumers, they wrote.

More patients in real-world practice were aged 65 years or older, ranging from as little as 61% at the lowest end of the range at one center to as much as 64% at the highest end at another. In the clinical trials, the percentage of patients aged 65 years or older ranged from 32% in one trial to 41% in another. Researchers wrote that these higher real-world rates are concerning because there are still questions regarding whether differences in immune responses will cause differences in efficacy between older and younger patients, as well as safety considerations among different age groups.

“Although data suggest that outcomes are similar between older and younger patients receiving anti–PD-1 agents for melanoma, there is little evidence to guide anti–PD-1 treatment of older patients with NSCLC [non–small cell lung cancer],” Dr. Gross and his coinvestigators wrote.

Investigators wrote that the findings are cause for caution.

“As FDA officials develop more flexible standards for approval, which the 21st Century Cures Act requires them to do, it is possible that many patients will receive drugs before much is known about clinical outcomes,” Dr. Gross said. “Further integrations of real-world evidence might allow the FDA to better assess the drugs that they approve on the basis of nonrepresentative trial participants.”

SOURCE: Gross C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0798.






 

Checkpoint inhibitors got to melanoma, non–small cell lung cancer, and renal cell carcinoma patients quickly in clinical practice after Food and Drug Administration approval – usually within 4 months – but the patients treated in clinical settings tended to be older than those treated in trials, which has caused concern about whether real-world efficacy will prove to be the same, according to a study in JAMA Oncology.

“Such rapid adoption stands in contrast to older estimates that suggest it takes years or even decades for new treatments to be adopted,” wrote lead author Cary Gross, MD, professor of medicine at Yale University, New Haven, and his coauthors. “We found significant differences in age between patients treated in practice and those treated in trials, which highlights the need to clarify the risks and benefits of checkpoint inhibitors in general populations of patients.”

Researchers drew data on nivolumab and pembrolizumab use from the Flatiron Health longitudinal EHR database, which included 233 academic and community oncology practices. In each of the three disease cohorts, adoption was seen within 4 months for at least 60% of patients. Uptake was quickest for the melanoma patients, 76% of whom received a checkpoint inhibitor within 4 months, investigators wrote. Factors for the fast adoption could include high disease severity, a preference for novelty, perceived gains over existing treatments, and promotional activities, such as media reports and advertising directly to consumers, they wrote.

More patients in real-world practice were aged 65 years or older, ranging from as little as 61% at the lowest end of the range at one center to as much as 64% at the highest end at another. In the clinical trials, the percentage of patients aged 65 years or older ranged from 32% in one trial to 41% in another. Researchers wrote that these higher real-world rates are concerning because there are still questions regarding whether differences in immune responses will cause differences in efficacy between older and younger patients, as well as safety considerations among different age groups.

“Although data suggest that outcomes are similar between older and younger patients receiving anti–PD-1 agents for melanoma, there is little evidence to guide anti–PD-1 treatment of older patients with NSCLC [non–small cell lung cancer],” Dr. Gross and his coinvestigators wrote.

Investigators wrote that the findings are cause for caution.

“As FDA officials develop more flexible standards for approval, which the 21st Century Cures Act requires them to do, it is possible that many patients will receive drugs before much is known about clinical outcomes,” Dr. Gross said. “Further integrations of real-world evidence might allow the FDA to better assess the drugs that they approve on the basis of nonrepresentative trial participants.”

SOURCE: Gross C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0798.






 

Checkpoint inhibitors got to melanoma, non–small cell lung cancer, and renal cell carcinoma patients quickly in clinical practice after Food and Drug Administration approval – usually within 4 months – but the patients treated in clinical settings tended to be older than those treated in trials, which has caused concern about whether real-world efficacy will prove to be the same, according to a study in JAMA Oncology.

“Such rapid adoption stands in contrast to older estimates that suggest it takes years or even decades for new treatments to be adopted,” wrote lead author Cary Gross, MD, professor of medicine at Yale University, New Haven, and his coauthors. “We found significant differences in age between patients treated in practice and those treated in trials, which highlights the need to clarify the risks and benefits of checkpoint inhibitors in general populations of patients.”

Researchers drew data on nivolumab and pembrolizumab use from the Flatiron Health longitudinal EHR database, which included 233 academic and community oncology practices. In each of the three disease cohorts, adoption was seen within 4 months for at least 60% of patients. Uptake was quickest for the melanoma patients, 76% of whom received a checkpoint inhibitor within 4 months, investigators wrote. Factors for the fast adoption could include high disease severity, a preference for novelty, perceived gains over existing treatments, and promotional activities, such as media reports and advertising directly to consumers, they wrote.

More patients in real-world practice were aged 65 years or older, ranging from as little as 61% at the lowest end of the range at one center to as much as 64% at the highest end at another. In the clinical trials, the percentage of patients aged 65 years or older ranged from 32% in one trial to 41% in another. Researchers wrote that these higher real-world rates are concerning because there are still questions regarding whether differences in immune responses will cause differences in efficacy between older and younger patients, as well as safety considerations among different age groups.

“Although data suggest that outcomes are similar between older and younger patients receiving anti–PD-1 agents for melanoma, there is little evidence to guide anti–PD-1 treatment of older patients with NSCLC [non–small cell lung cancer],” Dr. Gross and his coinvestigators wrote.

Investigators wrote that the findings are cause for caution.

“As FDA officials develop more flexible standards for approval, which the 21st Century Cures Act requires them to do, it is possible that many patients will receive drugs before much is known about clinical outcomes,” Dr. Gross said. “Further integrations of real-world evidence might allow the FDA to better assess the drugs that they approve on the basis of nonrepresentative trial participants.”

SOURCE: Gross C et al. JAMA Oncol. 2018 May 10. doi: 10.1001/jamaoncol.2018.0798.






 

ORLANDO – If you think enough progress is being made to fix gender disparity in medical leadership, consider this observation made in an HM18 session on Tuesday by speaker Elizabeth Harry, MD, SFHM, assistant program director, internal medicine residency: director of wellness,  Brigham and Women’s Hospital, Boston.*

“One might say, ‘Well, that’s okay, we’ll just let it even itself out. I mean, it’s getting better and we’re getting more women positions of leadership,’ ” she said. “But if we continue at the current rate that we are at, of women getting positions of leadership, we will get gender parity in leadership in 67 years – so the year 2085 ... I’m hoping that we as a group can say, ‘That’s a little too slow for our taste. We would like to accelerate this process a little bit.’ ”

The jarring number came near the start of the “Gender Disparities in Hospital Medicine: Where Do We Stand?” session, in which Dr. Harry explored the ways in which gender disparity manifests itself and coaxed ideas for improvement from the audience.

But that was just one of the jarring numbers. Even though women make up 78% of the health care workforce, only 14% of executive officers are women, Dr. Harry said.

And it’s not that large numbers of women joining the physician workforce is a relatively recent phenomenon. There is close to a 50/50 gender split in medical school applicants, students, and residents. But, after that, the parity falls away. Only 38% of medical school faculty members are women, only 21% of full professors are women, and only 16% of deans (Pediatr Res. 2015 Nov;78[5]:589-93).

“There’s definitely a leaky pipeline here,” Dr. Harry said.

She highlighted the ways in which gender disparity seems to be baked into medical education, research, and culture. One study found that women used professional titles 95% of the time when introducing men at internal medicine grand rounds, compared with 49% when men were introducing women (J Womens Health 2017 May;26[5]:413-9).

In hospital medicine, a 2015 study found that women make $14,000 a year less than men, and about $30,000 less in pediatrics. (J Hosp Med. 2015 Aug;10[8]:486-90).

Dr. Harry told the audience to think about the gender disparity problem in a structured way, similar to a design process, by defining the problem, thinking of ideas, developing prototypes to put those ideas into action, and testing them.

During this session, audience members made some suggestions to simplify some of life’s logistics: creating rooms in which physicians could nurse their babies, with a phone and a laptop to make use of the room more practical; building flexible schedules to allow for picking up children and running errands; and – Dr. Harry’s favorite – installing an Amazon locker at hospitals that would allow doctors to pick up packages and make returns.

One audience member asked why the tenor of the conversation seemed to involve an implicit acceptance that it was up to women to handle errands, wondering, “Why are we anchoring on to that?” Dr. Harry agreed that it is up to each household to decide how to divide those responsibilities, and that, personally, she and her husband divide them evenly.

“So what I want to encourage you to do is actually take one of these prototypes home and try it – and it’s not going to work the first time,” Dr. Harry said. “This is culture change, and culture change is really, really hard. That means it takes time and means you’ll have to knock on lots of doors to get to where you want to be eventually.”

Correction, 4/11/18: An earlier version of this article misstated Dr. Harry's position at Brigham and Women's.

ORLANDO – If you think enough progress is being made to fix gender disparity in medical leadership, consider this observation made in an HM18 session on Tuesday by speaker Elizabeth Harry, MD, SFHM, assistant program director, internal medicine residency: director of wellness,  Brigham and Women’s Hospital, Boston.*

“One might say, ‘Well, that’s okay, we’ll just let it even itself out. I mean, it’s getting better and we’re getting more women positions of leadership,’ ” she said. “But if we continue at the current rate that we are at, of women getting positions of leadership, we will get gender parity in leadership in 67 years – so the year 2085 ... I’m hoping that we as a group can say, ‘That’s a little too slow for our taste. We would like to accelerate this process a little bit.’ ”

The jarring number came near the start of the “Gender Disparities in Hospital Medicine: Where Do We Stand?” session, in which Dr. Harry explored the ways in which gender disparity manifests itself and coaxed ideas for improvement from the audience.

But that was just one of the jarring numbers. Even though women make up 78% of the health care workforce, only 14% of executive officers are women, Dr. Harry said.

And it’s not that large numbers of women joining the physician workforce is a relatively recent phenomenon. There is close to a 50/50 gender split in medical school applicants, students, and residents. But, after that, the parity falls away. Only 38% of medical school faculty members are women, only 21% of full professors are women, and only 16% of deans (Pediatr Res. 2015 Nov;78[5]:589-93).

“There’s definitely a leaky pipeline here,” Dr. Harry said.

She highlighted the ways in which gender disparity seems to be baked into medical education, research, and culture. One study found that women used professional titles 95% of the time when introducing men at internal medicine grand rounds, compared with 49% when men were introducing women (J Womens Health 2017 May;26[5]:413-9).

In hospital medicine, a 2015 study found that women make $14,000 a year less than men, and about $30,000 less in pediatrics. (J Hosp Med. 2015 Aug;10[8]:486-90).

Dr. Harry told the audience to think about the gender disparity problem in a structured way, similar to a design process, by defining the problem, thinking of ideas, developing prototypes to put those ideas into action, and testing them.

During this session, audience members made some suggestions to simplify some of life’s logistics: creating rooms in which physicians could nurse their babies, with a phone and a laptop to make use of the room more practical; building flexible schedules to allow for picking up children and running errands; and – Dr. Harry’s favorite – installing an Amazon locker at hospitals that would allow doctors to pick up packages and make returns.

One audience member asked why the tenor of the conversation seemed to involve an implicit acceptance that it was up to women to handle errands, wondering, “Why are we anchoring on to that?” Dr. Harry agreed that it is up to each household to decide how to divide those responsibilities, and that, personally, she and her husband divide them evenly.

“So what I want to encourage you to do is actually take one of these prototypes home and try it – and it’s not going to work the first time,” Dr. Harry said. “This is culture change, and culture change is really, really hard. That means it takes time and means you’ll have to knock on lots of doors to get to where you want to be eventually.”

Correction, 4/11/18: An earlier version of this article misstated Dr. Harry's position at Brigham and Women's.

ORLANDO – If you think enough progress is being made to fix gender disparity in medical leadership, consider this observation made in an HM18 session on Tuesday by speaker Elizabeth Harry, MD, SFHM, assistant program director, internal medicine residency: director of wellness,  Brigham and Women’s Hospital, Boston.*

“One might say, ‘Well, that’s okay, we’ll just let it even itself out. I mean, it’s getting better and we’re getting more women positions of leadership,’ ” she said. “But if we continue at the current rate that we are at, of women getting positions of leadership, we will get gender parity in leadership in 67 years – so the year 2085 ... I’m hoping that we as a group can say, ‘That’s a little too slow for our taste. We would like to accelerate this process a little bit.’ ”

The jarring number came near the start of the “Gender Disparities in Hospital Medicine: Where Do We Stand?” session, in which Dr. Harry explored the ways in which gender disparity manifests itself and coaxed ideas for improvement from the audience.

But that was just one of the jarring numbers. Even though women make up 78% of the health care workforce, only 14% of executive officers are women, Dr. Harry said.

And it’s not that large numbers of women joining the physician workforce is a relatively recent phenomenon. There is close to a 50/50 gender split in medical school applicants, students, and residents. But, after that, the parity falls away. Only 38% of medical school faculty members are women, only 21% of full professors are women, and only 16% of deans (Pediatr Res. 2015 Nov;78[5]:589-93).

“There’s definitely a leaky pipeline here,” Dr. Harry said.

She highlighted the ways in which gender disparity seems to be baked into medical education, research, and culture. One study found that women used professional titles 95% of the time when introducing men at internal medicine grand rounds, compared with 49% when men were introducing women (J Womens Health 2017 May;26[5]:413-9).

In hospital medicine, a 2015 study found that women make $14,000 a year less than men, and about $30,000 less in pediatrics. (J Hosp Med. 2015 Aug;10[8]:486-90).

Dr. Harry told the audience to think about the gender disparity problem in a structured way, similar to a design process, by defining the problem, thinking of ideas, developing prototypes to put those ideas into action, and testing them.

During this session, audience members made some suggestions to simplify some of life’s logistics: creating rooms in which physicians could nurse their babies, with a phone and a laptop to make use of the room more practical; building flexible schedules to allow for picking up children and running errands; and – Dr. Harry’s favorite – installing an Amazon locker at hospitals that would allow doctors to pick up packages and make returns.

One audience member asked why the tenor of the conversation seemed to involve an implicit acceptance that it was up to women to handle errands, wondering, “Why are we anchoring on to that?” Dr. Harry agreed that it is up to each household to decide how to divide those responsibilities, and that, personally, she and her husband divide them evenly.

“So what I want to encourage you to do is actually take one of these prototypes home and try it – and it’s not going to work the first time,” Dr. Harry said. “This is culture change, and culture change is really, really hard. That means it takes time and means you’ll have to knock on lots of doors to get to where you want to be eventually.”

Correction, 4/11/18: An earlier version of this article misstated Dr. Harry's position at Brigham and Women's.

ORLANDO – The top award in the research arm of the Research, Innovations and Clinical Vignettes (RIV) competition, bestowed Monday night at HM18, went to investigators at Brigham and Women’s Hospital in Boston, who looked for trouble spots in interhospital transfers across more than 24,000 cases.

In the innovations category, also awarded Tuesday night, the top award went to clinicians and researchers at the University of Iowa in Iowa City, who attempted to use “virtual hospitalists” to improve local care at rural, critical-access hospitals.

The winning study in the research arm set out to pinpoint problems that could be attributed to process in cases of patients being transferred from one acute care facility to another, and was presented by Stephanie Mueller, MD, MPH, SFHM, associate physician in the hospital medicine unit at Brigham and Women’s.

Dr. Mueller and her colleagues looked at transfers to the hospital from 2005 to 2013. They analyzed the effects that three factors – day of the week, time of day, and admission team “busyness” on the day of the transfer – had on transfers to intensive care within 48 hours and on 30-day mortality. They looked at data for Monday through Thursday, compared with Friday through Sunday, at day, evening, and night transfers as well as the number of patient admissions and discharges to the admitting team on that day.

They found that nighttime arrival was linked with an increased chance of being transferred to the ICU and with 30-day mortality. They also found that weekday arrival was associated with lower odds of mortality among patients getting cardiothoracic and gastrointestinal surgery.

“I think that these are potential targets in which we can actually do something to mitigate the outcomes for these patients,” Dr. Mueller said. “I’m working on a number of studies related to this topic and so it’s sort of validating that this is an important topic and that I should continue doing what I’m doing.”

Raj Sehgal, MD, FHM, a judge in the research arm and associate professor at University of Texas, San Antonio, praised the relevance of the project.

“Interhospital transfer is a topic that a lot of hospitals are dealing with right now,” he said. “It’s always a group of patients that we worry about.”

“One of the strongest things about this poster was the strong methodology,” said another judge, Vineet Gupta, MD, FHM, assistant clinical professor at the University of California, San Diego. “The statistical analysis was really good, very strong, very robust.”

The innovations award–winning study, presented by Ethan Kuperman, MD, MSc, FHM, clinical assistant professor at the University of Iowa, involved an attempt to reduce transfers from the emergency departments of critical-access hospitals in rural Iowa to urban medical centers by providing care with “virtual hospitalists” using tablets.

“Our goal was to treat more patients locally, to keep those patients happy in their communities. That’s what patients get out of it,” Dr. Kuperman told judges. “The hospitals get to keep their family practice doctors doing primary care, stay open, and get more patients. Win, win, win.”

At the critical-access hospital pilot site, virtual hospitalists at the University of Iowa handled all inpatient and observation admissions, with the assistance of local advance practice professionals. The percentage of outside transfers from the emergency department over 64 weeks after implementation was 12.9%, a statistically significant drop from the 16.6% seen in a 24-week baseline period. This did not lead to another goal – a higher daily census at the hospital – though, because there was also a drop in ED visits that ended in a hospital admission.

At two other sites, where virtual hospitalists provided fewer services – at one site, they also helped with preoperative work – there was less of an impact, Dr. Kuperman said. He said he was encouraged that the mean time reported by virtual hospitalists for patient care and documentation was just 2.8 hours a day, but there were days when that hit 12 hours, so there could be a need for “surge” coverage.

He said he’s gratified that the award draws more attention to attempts to improve the care at rural hospitals and that he plans to continue to develop the program.

“Hopefully, this helps get the word out,” Dr. Kuperman said. “I think a lot of work still needs to be done.”

The awards capped a 2-hour competition in which judges went from poster to poster, hearing short presentations from researchers and asking rapid-fire questions. The decisions were difficult in both categories, the judges said. The judges in the innovations category, for instance, deliberated at a table outside the exhibit hall for about 20 minutes before coming to a decision.

The pool of 20 finalists – 10 in each category – were chosen from hundreds of submissions considered during the final two rounds of judging on Tuesday night. In the research category, 261 abstracts were accepted from the 319 submitted; in the innovations category, 140 were accepted from the 207 submitted.

ORLANDO – The top award in the research arm of the Research, Innovations and Clinical Vignettes (RIV) competition, bestowed Monday night at HM18, went to investigators at Brigham and Women’s Hospital in Boston, who looked for trouble spots in interhospital transfers across more than 24,000 cases.

In the innovations category, also awarded Tuesday night, the top award went to clinicians and researchers at the University of Iowa in Iowa City, who attempted to use “virtual hospitalists” to improve local care at rural, critical-access hospitals.

The winning study in the research arm set out to pinpoint problems that could be attributed to process in cases of patients being transferred from one acute care facility to another, and was presented by Stephanie Mueller, MD, MPH, SFHM, associate physician in the hospital medicine unit at Brigham and Women’s.

Dr. Mueller and her colleagues looked at transfers to the hospital from 2005 to 2013. They analyzed the effects that three factors – day of the week, time of day, and admission team “busyness” on the day of the transfer – had on transfers to intensive care within 48 hours and on 30-day mortality. They looked at data for Monday through Thursday, compared with Friday through Sunday, at day, evening, and night transfers as well as the number of patient admissions and discharges to the admitting team on that day.

They found that nighttime arrival was linked with an increased chance of being transferred to the ICU and with 30-day mortality. They also found that weekday arrival was associated with lower odds of mortality among patients getting cardiothoracic and gastrointestinal surgery.

“I think that these are potential targets in which we can actually do something to mitigate the outcomes for these patients,” Dr. Mueller said. “I’m working on a number of studies related to this topic and so it’s sort of validating that this is an important topic and that I should continue doing what I’m doing.”

Raj Sehgal, MD, FHM, a judge in the research arm and associate professor at University of Texas, San Antonio, praised the relevance of the project.

“Interhospital transfer is a topic that a lot of hospitals are dealing with right now,” he said. “It’s always a group of patients that we worry about.”

“One of the strongest things about this poster was the strong methodology,” said another judge, Vineet Gupta, MD, FHM, assistant clinical professor at the University of California, San Diego. “The statistical analysis was really good, very strong, very robust.”

The innovations award–winning study, presented by Ethan Kuperman, MD, MSc, FHM, clinical assistant professor at the University of Iowa, involved an attempt to reduce transfers from the emergency departments of critical-access hospitals in rural Iowa to urban medical centers by providing care with “virtual hospitalists” using tablets.

“Our goal was to treat more patients locally, to keep those patients happy in their communities. That’s what patients get out of it,” Dr. Kuperman told judges. “The hospitals get to keep their family practice doctors doing primary care, stay open, and get more patients. Win, win, win.”

At the critical-access hospital pilot site, virtual hospitalists at the University of Iowa handled all inpatient and observation admissions, with the assistance of local advance practice professionals. The percentage of outside transfers from the emergency department over 64 weeks after implementation was 12.9%, a statistically significant drop from the 16.6% seen in a 24-week baseline period. This did not lead to another goal – a higher daily census at the hospital – though, because there was also a drop in ED visits that ended in a hospital admission.

At two other sites, where virtual hospitalists provided fewer services – at one site, they also helped with preoperative work – there was less of an impact, Dr. Kuperman said. He said he was encouraged that the mean time reported by virtual hospitalists for patient care and documentation was just 2.8 hours a day, but there were days when that hit 12 hours, so there could be a need for “surge” coverage.

He said he’s gratified that the award draws more attention to attempts to improve the care at rural hospitals and that he plans to continue to develop the program.

“Hopefully, this helps get the word out,” Dr. Kuperman said. “I think a lot of work still needs to be done.”

The awards capped a 2-hour competition in which judges went from poster to poster, hearing short presentations from researchers and asking rapid-fire questions. The decisions were difficult in both categories, the judges said. The judges in the innovations category, for instance, deliberated at a table outside the exhibit hall for about 20 minutes before coming to a decision.

The pool of 20 finalists – 10 in each category – were chosen from hundreds of submissions considered during the final two rounds of judging on Tuesday night. In the research category, 261 abstracts were accepted from the 319 submitted; in the innovations category, 140 were accepted from the 207 submitted.

ORLANDO – The top award in the research arm of the Research, Innovations and Clinical Vignettes (RIV) competition, bestowed Monday night at HM18, went to investigators at Brigham and Women’s Hospital in Boston, who looked for trouble spots in interhospital transfers across more than 24,000 cases.

In the innovations category, also awarded Tuesday night, the top award went to clinicians and researchers at the University of Iowa in Iowa City, who attempted to use “virtual hospitalists” to improve local care at rural, critical-access hospitals.

The winning study in the research arm set out to pinpoint problems that could be attributed to process in cases of patients being transferred from one acute care facility to another, and was presented by Stephanie Mueller, MD, MPH, SFHM, associate physician in the hospital medicine unit at Brigham and Women’s.

Dr. Mueller and her colleagues looked at transfers to the hospital from 2005 to 2013. They analyzed the effects that three factors – day of the week, time of day, and admission team “busyness” on the day of the transfer – had on transfers to intensive care within 48 hours and on 30-day mortality. They looked at data for Monday through Thursday, compared with Friday through Sunday, at day, evening, and night transfers as well as the number of patient admissions and discharges to the admitting team on that day.

They found that nighttime arrival was linked with an increased chance of being transferred to the ICU and with 30-day mortality. They also found that weekday arrival was associated with lower odds of mortality among patients getting cardiothoracic and gastrointestinal surgery.

“I think that these are potential targets in which we can actually do something to mitigate the outcomes for these patients,” Dr. Mueller said. “I’m working on a number of studies related to this topic and so it’s sort of validating that this is an important topic and that I should continue doing what I’m doing.”

Raj Sehgal, MD, FHM, a judge in the research arm and associate professor at University of Texas, San Antonio, praised the relevance of the project.

“Interhospital transfer is a topic that a lot of hospitals are dealing with right now,” he said. “It’s always a group of patients that we worry about.”

“One of the strongest things about this poster was the strong methodology,” said another judge, Vineet Gupta, MD, FHM, assistant clinical professor at the University of California, San Diego. “The statistical analysis was really good, very strong, very robust.”

The innovations award–winning study, presented by Ethan Kuperman, MD, MSc, FHM, clinical assistant professor at the University of Iowa, involved an attempt to reduce transfers from the emergency departments of critical-access hospitals in rural Iowa to urban medical centers by providing care with “virtual hospitalists” using tablets.

“Our goal was to treat more patients locally, to keep those patients happy in their communities. That’s what patients get out of it,” Dr. Kuperman told judges. “The hospitals get to keep their family practice doctors doing primary care, stay open, and get more patients. Win, win, win.”

At the critical-access hospital pilot site, virtual hospitalists at the University of Iowa handled all inpatient and observation admissions, with the assistance of local advance practice professionals. The percentage of outside transfers from the emergency department over 64 weeks after implementation was 12.9%, a statistically significant drop from the 16.6% seen in a 24-week baseline period. This did not lead to another goal – a higher daily census at the hospital – though, because there was also a drop in ED visits that ended in a hospital admission.

At two other sites, where virtual hospitalists provided fewer services – at one site, they also helped with preoperative work – there was less of an impact, Dr. Kuperman said. He said he was encouraged that the mean time reported by virtual hospitalists for patient care and documentation was just 2.8 hours a day, but there were days when that hit 12 hours, so there could be a need for “surge” coverage.

He said he’s gratified that the award draws more attention to attempts to improve the care at rural hospitals and that he plans to continue to develop the program.

“Hopefully, this helps get the word out,” Dr. Kuperman said. “I think a lot of work still needs to be done.”

The awards capped a 2-hour competition in which judges went from poster to poster, hearing short presentations from researchers and asking rapid-fire questions. The decisions were difficult in both categories, the judges said. The judges in the innovations category, for instance, deliberated at a table outside the exhibit hall for about 20 minutes before coming to a decision.

The pool of 20 finalists – 10 in each category – were chosen from hundreds of submissions considered during the final two rounds of judging on Tuesday night. In the research category, 261 abstracts were accepted from the 319 submitted; in the innovations category, 140 were accepted from the 207 submitted.

If there’s one thing hospital medicine is not, it’s static. And that’s truer today than it’s ever been in the more than 20 years since the field came into existence: As the role of hospitalists continue to expand, it’s now in the setting of a rapidly changing health care scene.

So when Society of Hospital Medicine CEO Larry Wellikson, MD, MHM, takes the annual conference podium this morning for his talk on “Future Challenges for Hospital Medicine,” he’ll have a lot to cover.

His overall message, though, will boil down to this: Learn the skills you’ll need.

With hospitalists managing acute and palliative care and being involved in surgical comanagement, many may need additional training.

“There’s a blurring of our role as we link to the emergency department or critical care units, or even a blurring of where does inpatient care end and outpatient care begin?” he said. “Many of these roles hospitalists haven’t been completely trained for.” He’ll also remind the audience that one of SHM’s main roles is to help provide that training.

He said the urgency of learning new skills is only intensified by the health care field’s transition from volume-based payment to value-based payment and by consolidation of previously separate pieces of the landscape, such as the acquisition of Aetna by CVS, with its nearly 10,000 pharmacy locations and more than 1,000 MinuteClinics.

“The real cost for them is hospitalization,” Dr. Wellikson said. “Any money they spend on hospitalization is money they don’t have left over. That puts pressure on hospitalists.”

Future Challenges for Hospital Medicine
Tuesday, 9:35-10:00 a.m.
Palms Ballroom

If there’s one thing hospital medicine is not, it’s static. And that’s truer today than it’s ever been in the more than 20 years since the field came into existence: As the role of hospitalists continue to expand, it’s now in the setting of a rapidly changing health care scene.

So when Society of Hospital Medicine CEO Larry Wellikson, MD, MHM, takes the annual conference podium this morning for his talk on “Future Challenges for Hospital Medicine,” he’ll have a lot to cover.

His overall message, though, will boil down to this: Learn the skills you’ll need.

With hospitalists managing acute and palliative care and being involved in surgical comanagement, many may need additional training.

“There’s a blurring of our role as we link to the emergency department or critical care units, or even a blurring of where does inpatient care end and outpatient care begin?” he said. “Many of these roles hospitalists haven’t been completely trained for.” He’ll also remind the audience that one of SHM’s main roles is to help provide that training.

He said the urgency of learning new skills is only intensified by the health care field’s transition from volume-based payment to value-based payment and by consolidation of previously separate pieces of the landscape, such as the acquisition of Aetna by CVS, with its nearly 10,000 pharmacy locations and more than 1,000 MinuteClinics.

“The real cost for them is hospitalization,” Dr. Wellikson said. “Any money they spend on hospitalization is money they don’t have left over. That puts pressure on hospitalists.”

Future Challenges for Hospital Medicine
Tuesday, 9:35-10:00 a.m.
Palms Ballroom

If there’s one thing hospital medicine is not, it’s static. And that’s truer today than it’s ever been in the more than 20 years since the field came into existence: As the role of hospitalists continue to expand, it’s now in the setting of a rapidly changing health care scene.

So when Society of Hospital Medicine CEO Larry Wellikson, MD, MHM, takes the annual conference podium this morning for his talk on “Future Challenges for Hospital Medicine,” he’ll have a lot to cover.

His overall message, though, will boil down to this: Learn the skills you’ll need.

With hospitalists managing acute and palliative care and being involved in surgical comanagement, many may need additional training.

“There’s a blurring of our role as we link to the emergency department or critical care units, or even a blurring of where does inpatient care end and outpatient care begin?” he said. “Many of these roles hospitalists haven’t been completely trained for.” He’ll also remind the audience that one of SHM’s main roles is to help provide that training.

He said the urgency of learning new skills is only intensified by the health care field’s transition from volume-based payment to value-based payment and by consolidation of previously separate pieces of the landscape, such as the acquisition of Aetna by CVS, with its nearly 10,000 pharmacy locations and more than 1,000 MinuteClinics.

“The real cost for them is hospitalization,” Dr. Wellikson said. “Any money they spend on hospitalization is money they don’t have left over. That puts pressure on hospitalists.”

Future Challenges for Hospital Medicine
Tuesday, 9:35-10:00 a.m.
Palms Ballroom

The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.

New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.

During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.

“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”

Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.

“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”

At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.

Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom

Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom

The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.

New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.

During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.

“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”

Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.

“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”

At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.

Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom

Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom

The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.

New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.

During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.

“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”

Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.

“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”

At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.

Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom

Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”