Richard Quinn

A Centers for Medicare & Medicaid Services (CMS) report that shows a nearly 300% increase in bonus payments under Medicare's Physician Quality Reporting Initiative (PQRI) is further evidence that hospitalists are embracing pay-for-reporting measures, according to the chair of SHM's Performance and Standards Committee.

Patrick Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., says increased usage of pay incentives to push quality reform is "past that tipping point, but what's really unknown right now is what's going to happen with the healthcare reform in front of us right now."

"It's an evolution for physicians to accept that pay for performance, starting with pay for reporting, is here to stay," Dr. Torcson says. "It's really a matter of the practice management that's necessary to include performance reporting as part of the workflow of how you take care of patients and report your billing claims."

In 2008, CMS paid $92 million in bonuses under the PQRI program, an increase from $36 million in 2007. However, the program was only active for the second half of 2007, so Dr. Torcson cautions against reading too much into the increase. Still, CMS reported that payments were distributed to more than 85,500 physicians with an average payment of $1,000. In Dr. Torcson's 10-hospitalist group, the average bonus was $1,400. He predicts an average 2009 payment of $2,400 for members of his group.

Dr. Torcson expects more hospitalists will use the incentive program once more HM-specific performance measures are put in place, including yardsticks focused on care transitions and inpatient management of heart failure.

"This truly is the platform for the future pay-for-performance model that's going to affect every hospitalist," he adds. "I can't see any reason to ignore it.”

For more information about reporting PQRI measures, visit the CMS Web site and check out the PQRI toolkit. Visit SHM's Web site for information about getting your hospitalist program started in Medicare's voluntary pay-for-reporting program.

A Centers for Medicare & Medicaid Services (CMS) report that shows a nearly 300% increase in bonus payments under Medicare's Physician Quality Reporting Initiative (PQRI) is further evidence that hospitalists are embracing pay-for-reporting measures, according to the chair of SHM's Performance and Standards Committee.

Patrick Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., says increased usage of pay incentives to push quality reform is "past that tipping point, but what's really unknown right now is what's going to happen with the healthcare reform in front of us right now."

"It's an evolution for physicians to accept that pay for performance, starting with pay for reporting, is here to stay," Dr. Torcson says. "It's really a matter of the practice management that's necessary to include performance reporting as part of the workflow of how you take care of patients and report your billing claims."

In 2008, CMS paid $92 million in bonuses under the PQRI program, an increase from $36 million in 2007. However, the program was only active for the second half of 2007, so Dr. Torcson cautions against reading too much into the increase. Still, CMS reported that payments were distributed to more than 85,500 physicians with an average payment of $1,000. In Dr. Torcson's 10-hospitalist group, the average bonus was $1,400. He predicts an average 2009 payment of $2,400 for members of his group.

Dr. Torcson expects more hospitalists will use the incentive program once more HM-specific performance measures are put in place, including yardsticks focused on care transitions and inpatient management of heart failure.

"This truly is the platform for the future pay-for-performance model that's going to affect every hospitalist," he adds. "I can't see any reason to ignore it.”

For more information about reporting PQRI measures, visit the CMS Web site and check out the PQRI toolkit. Visit SHM's Web site for information about getting your hospitalist program started in Medicare's voluntary pay-for-reporting program.

A Centers for Medicare & Medicaid Services (CMS) report that shows a nearly 300% increase in bonus payments under Medicare's Physician Quality Reporting Initiative (PQRI) is further evidence that hospitalists are embracing pay-for-reporting measures, according to the chair of SHM's Performance and Standards Committee.

Patrick Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., says increased usage of pay incentives to push quality reform is "past that tipping point, but what's really unknown right now is what's going to happen with the healthcare reform in front of us right now."

"It's an evolution for physicians to accept that pay for performance, starting with pay for reporting, is here to stay," Dr. Torcson says. "It's really a matter of the practice management that's necessary to include performance reporting as part of the workflow of how you take care of patients and report your billing claims."

In 2008, CMS paid $92 million in bonuses under the PQRI program, an increase from $36 million in 2007. However, the program was only active for the second half of 2007, so Dr. Torcson cautions against reading too much into the increase. Still, CMS reported that payments were distributed to more than 85,500 physicians with an average payment of $1,000. In Dr. Torcson's 10-hospitalist group, the average bonus was $1,400. He predicts an average 2009 payment of $2,400 for members of his group.

Dr. Torcson expects more hospitalists will use the incentive program once more HM-specific performance measures are put in place, including yardsticks focused on care transitions and inpatient management of heart failure.

"This truly is the platform for the future pay-for-performance model that's going to affect every hospitalist," he adds. "I can't see any reason to ignore it.”

For more information about reporting PQRI measures, visit the CMS Web site and check out the PQRI toolkit. Visit SHM's Web site for information about getting your hospitalist program started in Medicare's voluntary pay-for-reporting program.

Nearly one in five hospitalists admitted uncertainty about transitional patient-care plans after service change, according to a report to be published in this month’s Journal of Hospital Medicine.

The review, a single-institution study conducted at the University of Chicago, found 18% of respondents acknowledged uncertainty, 13% reported incomplete handoffs, and 16% attributed at least one “near miss” to incomplete communication. The study suggests that “investments in improving service change could not only improve patient safety, but they could improve hospitalists’ daily workflow,” says senior author Vineet Arora, MD, MAPP, an academic hospitalist and associate director of Internal Medicine Residency at the University of Chicago.

Keiki Hinami, MD, MS, instructor of medicine in the Division of Hospital Medicine at the Northwestern University Feinberg School of Medicine, says a unique facet of the report, titled “Understanding Communication During Hospitalist Service Changes: A Mixed Methods Study,” was the understanding by physicians that successful handoffs often involve more than a brief conversation or a pass-through of documentation.

“The outgoing doctor would come back to the incoming doctor and ask for updates, or they would solicit the incoming doctor for more information if they needed it,” says Dr. Hinami, who was one of the study’s authors while employed as a clinical associate by University of Chicago. “The participants of our study naturally adopted a strategy acknowledging that one conversation is not usually sufficient.”

The study measured 60 service changes among 17 hospitalists on a non-teaching service from May to December 2007. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about care plans (71% incomplete vs. 10% complete, P<0.01), discovery of missing information (71% vs. 24%, P=0.01), and near misses/adverse events (57% vs. 10%, P<0.01).

Dr. Arora says work is under way to develop educational programs and evaluation tools to train hospitalists and others to improve service change handoffs.

“How do you teach people to communicate only pertinent information?” Dr. Hinami says. “That’s really a difficult challenge. Even though handoffs are something we do every day, most people have never had any formal training in communicating that.”

Nearly one in five hospitalists admitted uncertainty about transitional patient-care plans after service change, according to a report to be published in this month’s Journal of Hospital Medicine.

The review, a single-institution study conducted at the University of Chicago, found 18% of respondents acknowledged uncertainty, 13% reported incomplete handoffs, and 16% attributed at least one “near miss” to incomplete communication. The study suggests that “investments in improving service change could not only improve patient safety, but they could improve hospitalists’ daily workflow,” says senior author Vineet Arora, MD, MAPP, an academic hospitalist and associate director of Internal Medicine Residency at the University of Chicago.

Keiki Hinami, MD, MS, instructor of medicine in the Division of Hospital Medicine at the Northwestern University Feinberg School of Medicine, says a unique facet of the report, titled “Understanding Communication During Hospitalist Service Changes: A Mixed Methods Study,” was the understanding by physicians that successful handoffs often involve more than a brief conversation or a pass-through of documentation.

“The outgoing doctor would come back to the incoming doctor and ask for updates, or they would solicit the incoming doctor for more information if they needed it,” says Dr. Hinami, who was one of the study’s authors while employed as a clinical associate by University of Chicago. “The participants of our study naturally adopted a strategy acknowledging that one conversation is not usually sufficient.”

The study measured 60 service changes among 17 hospitalists on a non-teaching service from May to December 2007. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about care plans (71% incomplete vs. 10% complete, P<0.01), discovery of missing information (71% vs. 24%, P=0.01), and near misses/adverse events (57% vs. 10%, P<0.01).

Dr. Arora says work is under way to develop educational programs and evaluation tools to train hospitalists and others to improve service change handoffs.

“How do you teach people to communicate only pertinent information?” Dr. Hinami says. “That’s really a difficult challenge. Even though handoffs are something we do every day, most people have never had any formal training in communicating that.”

Nearly one in five hospitalists admitted uncertainty about transitional patient-care plans after service change, according to a report to be published in this month’s Journal of Hospital Medicine.

The review, a single-institution study conducted at the University of Chicago, found 18% of respondents acknowledged uncertainty, 13% reported incomplete handoffs, and 16% attributed at least one “near miss” to incomplete communication. The study suggests that “investments in improving service change could not only improve patient safety, but they could improve hospitalists’ daily workflow,” says senior author Vineet Arora, MD, MAPP, an academic hospitalist and associate director of Internal Medicine Residency at the University of Chicago.

Keiki Hinami, MD, MS, instructor of medicine in the Division of Hospital Medicine at the Northwestern University Feinberg School of Medicine, says a unique facet of the report, titled “Understanding Communication During Hospitalist Service Changes: A Mixed Methods Study,” was the understanding by physicians that successful handoffs often involve more than a brief conversation or a pass-through of documentation.

“The outgoing doctor would come back to the incoming doctor and ask for updates, or they would solicit the incoming doctor for more information if they needed it,” says Dr. Hinami, who was one of the study’s authors while employed as a clinical associate by University of Chicago. “The participants of our study naturally adopted a strategy acknowledging that one conversation is not usually sufficient.”

The study measured 60 service changes among 17 hospitalists on a non-teaching service from May to December 2007. Hospitalists who reported incomplete handoffs were more likely to report uncertainty about care plans (71% incomplete vs. 10% complete, P<0.01), discovery of missing information (71% vs. 24%, P=0.01), and near misses/adverse events (57% vs. 10%, P<0.01).

Dr. Arora says work is under way to develop educational programs and evaluation tools to train hospitalists and others to improve service change handoffs.

“How do you teach people to communicate only pertinent information?” Dr. Hinami says. “That’s really a difficult challenge. Even though handoffs are something we do every day, most people have never had any formal training in communicating that.”

New Generics

• Nateglinide (generic Starlix) tablets1

New Drugs, Indications, and Dosage Forms

• Abatacept (Orencia), a selective costimulation modulator used in treating moderate to severe juvenile idiopathic arthritis and rheumatoid arthritis (RA), has undergone a label change regarding earlier use in methotrexate-naïve patients with moderate to severe RA of less than two years’ disease duration.2,3
• Aliskiren/valsartan (Valturna) has been approved by the FDA for treating hypertension in patients with inadequate hypertension control using aliskiren or valsartan alone. It’s also approved for first-line treatment of patients who are likely to need multiple agents to manage their hypertension.4
• Cethromycin (Restanza) has been granted orphan drug approval as a once-daily agent for the prophylaxis of anthrax, tularemia, and the plague. Studies are being conducted on the drug as a potential bioterrorism countermeasure agent through a Department of Defense contract.5
• Ganciclovir ophthalmic gel 0.15% (Zirgan) has been approved by the FDA for treating acute herpetic keratitis. It held orphan drug status for this indication since April 2007. Comparable clinical resolution of herpetic keratitis was obtained compared with acyclovir at day seven in an open-label, multicenter study of 213 patients (77% ganciclovir; 72% acyclovir). The most common adverse effects in clinical trials were blurred vision, eye irritation, punctate keratitis, and conjunctival hyperemia. Dosing recommendations are to instill one drop of ganciclovir in the affected eye five times daily until the ulcer heals, then instill one drop three times daily for seven days. It is anticipated that this product will be available in a 5-g tube in early 2010.6
• Glycerol phenylbutyrate (HPN-100), an experimental intermittent or chronic treatment for patients with cirrhosis and hepatic encephalopathy, has received orphan drug status. A phase-2 trial is planned for late 2009 or early 2010.7 Glycerol phenylbutyrate is a pre-pro-drug of phenylacetic acid, the active component of buphenyl (approved by the FDA to treat urea cycle disorders). Glycerol phenylbutyrate is administered in liquid form and also has orphan drug status for treating urea cycle disorders.
• Guanfacine extended-release tablets (Intuiv), a once-daily, nonstimulant treatment for attention deficit hyperactivity disorder (ADHD), has been approved by the FDA for treating patients 6 to 17 years old. Because guanfacine is not a controlled substance, a 90-day supply can be prescribed.8
• Pancrelipase (Zenpep), a delayed-release pancrelipase enzyme product, has been approved by the FDA for treating adults and children (ages 1 to 12) with cystic fibrosis. The most common adverse effects reported in clinical trials were flatulence, abdominal pain, headache, and cough. The product is available in four prescription strengths: “Eurand 5” is 5,000 USP units of lipase, 17,000 USP units of protease, and 27,000 USP units of amylase; “Eurand 10” is 10,000 units lipase, 34,000 units protease, and 55,000 units amylase; “Eurand 15” is 15,000 units lipase, 51,000 units protease, and 82,000 units amylase; and “Eurand 20” is 20,000 units lipase, 68,000 units protease, and 109,000 units amylase.9,10
• Vigabatrin (Sabril) has been approved by the FDA in an oral solution as monotherapy for treating infantile spasms in children ages one month to 2 years. The tablets also are approved for adjunctive therapy for refractory complex partial seizures in adults who have not adequately responded to other treatments. It is available in 500-mg powder packets for oral solution preparation and 500-mg tablets.11 One severe adverse effect is progressive peripheral vision loss with the potential to decrease visual acuity. Due to this risk of permanent vision loss, vigabatrin is available only through a restricted distribution program.

Pipeline

• Human papillomavirus quadrivalent (Types 6, 11, 16 and 18; Gardasil) has been recommended for approval to prevent genital warts in boys and young men 9 to 26 years old. The FDA is expected to make a decision by the end of 2009.12,13 This vaccine already is approved for use in men in 112 countries.
• Oral insulin (Ora-Lyn) is a proprietary formulation that delivers insulin spray through the buccal mucosa.14 In September, Ora-Lyn was approved under the FDA’s Treatment Investigational New Drug (IND) program for both Type 1 and Type 2 diabetes mellitus. This program allows manufacturers to provide early medication access to investigational drugs for patients with life-threatening or other serious conditions for which there are no satisfactory treatment alternatives. Doctors must register with the IND program to obtain the medication for their patients.15Ora-Lyn already is approved abroad.

Drug Information

• On Sept. 22, the FDA banned candy- and fruit-flavored cigarettes under the Family Smoking Prevention and Tobacco Control Act. The goal is to reduce smoking in America.16 Menthol cigarettes and flavored tobacco products are not part of this ban, but they are being evaluated as many of these products are seen as a gateway for children and young adults to begin smoking. More information is available at www.fda.gov/flavoredtobacco. TH

Michele B. Kaufman, PharmD, BSc, RPh, is a freelance medical writer based in New York City and a clinical pharmacist at New York Downtown Hospital.

References

1. Par Pharma to begin marketing Starlix generic. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/news/news64185.html. Accessed Sept. 23, 2009.
2. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/125118s0086lbl.pdf Accessed Sept. 23, 2009.
3. Bratulic A. Bristol Myers Squibb: Orencia label updated to support earlier use in adults with RA. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=DA78CDE71605485C9BC1B3B40392B1C0&logRowId=323904. Accessed Sept. 23, 2009.
4. Bratulic A. FDA approves Novartis’ Valturna for hypertension. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=4D45881D26B8447D950A4D63E80B806C&logRowId=327307. Accessed Sept. 23, 2009.
5. Advanced Life Sciences’ Restanza could treat plague and anthrax. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/News/News64553.html. Accessed Sept. 23, 2009.
6. FDA approves Zirgan. Drugs.com Web site. Available at: www.drugs.com/newdrugs/sirion-therapeutics-announces-fda-approval-zirgan-ganciclovir-ophthalmic-gel-0-15-herpetic-keratitis-1657.html. Accessed Sept. 23, 2009.
7. 7. Hyperion Therapeutics receives orphan drug designation for HPN-100 for the treatment of hepatic encephalopathy. Hyperion Therapeutics Web site. Available at: www.hyperiontx.com/press/release/pr_1253144476. Accessed Sept. 23, 2009.
8. George J. FDA approves nonstimulant Shire ADHD drug. Philadelphia Business Journal Web site. Available at: philadelphia.bizjournals.com/philadelphia/stories/2009/08/31/daily40.html?surround=etf&ana=e_article. Accessed Sept. 23, 2009.
9. Petrochko C. FDA approves first EPI drug for kids. Medpage Today Web site. Available at: www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/15734. Accessed Sept. 23, 2009.
10. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/022210s000lbl.pdf. Accessed Sept. 23, 2009.
11. Sabril approved for infantile spasms and adult epileptic seizures. Monthly Prescribing Reference Web site. Available at: www.empr.com/Sabril-approved-for-infantile-spasms-and-adult-epileptic-seizures/article/147148/. Accessed Sept. 23, 2009.
12. FDA advisory committee recommends approval for use of Gardasil in boys and men. Merck Web site. Available at: www.merck.com/newsroom/press_releases/product/2009_0909.html. Accessed Sept. 23, 2009.
13. Bratulic A. Merck & Co.’s Gardasil recommended by FDA panel for use in boys and men. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=352E8E6109E14925B0168FF465E27C1F&logRowId=325991. Accessed Sept. 23, 2009.
14. Generex technology. Generex Biotechnology Web site. Available at: www.generex.com/technology.php. Accessed Sept. 23, 2009.
15. Reidy C. Generex Drug is OK’d under special FDA program. The Boston Globe Web site. www.generex.com/fckuploads/file/Boston_Globe_09_10_09.pdf. Accessed Sept. 23, 2009.
16. Quinn K. Candy and fruit flavored cigarettes now illegal in United States; step is first under new tobacco law. Food and Drug Administration Web site. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183211.htm. Accessed Sept. 23, 2009.

New Generics

• Nateglinide (generic Starlix) tablets1

New Drugs, Indications, and Dosage Forms

• Abatacept (Orencia), a selective costimulation modulator used in treating moderate to severe juvenile idiopathic arthritis and rheumatoid arthritis (RA), has undergone a label change regarding earlier use in methotrexate-naïve patients with moderate to severe RA of less than two years’ disease duration.2,3
• Aliskiren/valsartan (Valturna) has been approved by the FDA for treating hypertension in patients with inadequate hypertension control using aliskiren or valsartan alone. It’s also approved for first-line treatment of patients who are likely to need multiple agents to manage their hypertension.4
• Cethromycin (Restanza) has been granted orphan drug approval as a once-daily agent for the prophylaxis of anthrax, tularemia, and the plague. Studies are being conducted on the drug as a potential bioterrorism countermeasure agent through a Department of Defense contract.5
• Ganciclovir ophthalmic gel 0.15% (Zirgan) has been approved by the FDA for treating acute herpetic keratitis. It held orphan drug status for this indication since April 2007. Comparable clinical resolution of herpetic keratitis was obtained compared with acyclovir at day seven in an open-label, multicenter study of 213 patients (77% ganciclovir; 72% acyclovir). The most common adverse effects in clinical trials were blurred vision, eye irritation, punctate keratitis, and conjunctival hyperemia. Dosing recommendations are to instill one drop of ganciclovir in the affected eye five times daily until the ulcer heals, then instill one drop three times daily for seven days. It is anticipated that this product will be available in a 5-g tube in early 2010.6
• Glycerol phenylbutyrate (HPN-100), an experimental intermittent or chronic treatment for patients with cirrhosis and hepatic encephalopathy, has received orphan drug status. A phase-2 trial is planned for late 2009 or early 2010.7 Glycerol phenylbutyrate is a pre-pro-drug of phenylacetic acid, the active component of buphenyl (approved by the FDA to treat urea cycle disorders). Glycerol phenylbutyrate is administered in liquid form and also has orphan drug status for treating urea cycle disorders.
• Guanfacine extended-release tablets (Intuiv), a once-daily, nonstimulant treatment for attention deficit hyperactivity disorder (ADHD), has been approved by the FDA for treating patients 6 to 17 years old. Because guanfacine is not a controlled substance, a 90-day supply can be prescribed.8
• Pancrelipase (Zenpep), a delayed-release pancrelipase enzyme product, has been approved by the FDA for treating adults and children (ages 1 to 12) with cystic fibrosis. The most common adverse effects reported in clinical trials were flatulence, abdominal pain, headache, and cough. The product is available in four prescription strengths: “Eurand 5” is 5,000 USP units of lipase, 17,000 USP units of protease, and 27,000 USP units of amylase; “Eurand 10” is 10,000 units lipase, 34,000 units protease, and 55,000 units amylase; “Eurand 15” is 15,000 units lipase, 51,000 units protease, and 82,000 units amylase; and “Eurand 20” is 20,000 units lipase, 68,000 units protease, and 109,000 units amylase.9,10
• Vigabatrin (Sabril) has been approved by the FDA in an oral solution as monotherapy for treating infantile spasms in children ages one month to 2 years. The tablets also are approved for adjunctive therapy for refractory complex partial seizures in adults who have not adequately responded to other treatments. It is available in 500-mg powder packets for oral solution preparation and 500-mg tablets.11 One severe adverse effect is progressive peripheral vision loss with the potential to decrease visual acuity. Due to this risk of permanent vision loss, vigabatrin is available only through a restricted distribution program.

Pipeline

• Human papillomavirus quadrivalent (Types 6, 11, 16 and 18; Gardasil) has been recommended for approval to prevent genital warts in boys and young men 9 to 26 years old. The FDA is expected to make a decision by the end of 2009.12,13 This vaccine already is approved for use in men in 112 countries.
• Oral insulin (Ora-Lyn) is a proprietary formulation that delivers insulin spray through the buccal mucosa.14 In September, Ora-Lyn was approved under the FDA’s Treatment Investigational New Drug (IND) program for both Type 1 and Type 2 diabetes mellitus. This program allows manufacturers to provide early medication access to investigational drugs for patients with life-threatening or other serious conditions for which there are no satisfactory treatment alternatives. Doctors must register with the IND program to obtain the medication for their patients.15Ora-Lyn already is approved abroad.

Drug Information

• On Sept. 22, the FDA banned candy- and fruit-flavored cigarettes under the Family Smoking Prevention and Tobacco Control Act. The goal is to reduce smoking in America.16 Menthol cigarettes and flavored tobacco products are not part of this ban, but they are being evaluated as many of these products are seen as a gateway for children and young adults to begin smoking. More information is available at www.fda.gov/flavoredtobacco. TH

Michele B. Kaufman, PharmD, BSc, RPh, is a freelance medical writer based in New York City and a clinical pharmacist at New York Downtown Hospital.

References

1. Par Pharma to begin marketing Starlix generic. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/news/news64185.html. Accessed Sept. 23, 2009.
2. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/125118s0086lbl.pdf Accessed Sept. 23, 2009.
3. Bratulic A. Bristol Myers Squibb: Orencia label updated to support earlier use in adults with RA. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=DA78CDE71605485C9BC1B3B40392B1C0&logRowId=323904. Accessed Sept. 23, 2009.
4. Bratulic A. FDA approves Novartis’ Valturna for hypertension. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=4D45881D26B8447D950A4D63E80B806C&logRowId=327307. Accessed Sept. 23, 2009.
5. Advanced Life Sciences’ Restanza could treat plague and anthrax. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/News/News64553.html. Accessed Sept. 23, 2009.
6. FDA approves Zirgan. Drugs.com Web site. Available at: www.drugs.com/newdrugs/sirion-therapeutics-announces-fda-approval-zirgan-ganciclovir-ophthalmic-gel-0-15-herpetic-keratitis-1657.html. Accessed Sept. 23, 2009.
7. 7. Hyperion Therapeutics receives orphan drug designation for HPN-100 for the treatment of hepatic encephalopathy. Hyperion Therapeutics Web site. Available at: www.hyperiontx.com/press/release/pr_1253144476. Accessed Sept. 23, 2009.
8. George J. FDA approves nonstimulant Shire ADHD drug. Philadelphia Business Journal Web site. Available at: philadelphia.bizjournals.com/philadelphia/stories/2009/08/31/daily40.html?surround=etf&ana=e_article. Accessed Sept. 23, 2009.
9. Petrochko C. FDA approves first EPI drug for kids. Medpage Today Web site. Available at: www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/15734. Accessed Sept. 23, 2009.
10. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/022210s000lbl.pdf. Accessed Sept. 23, 2009.
11. Sabril approved for infantile spasms and adult epileptic seizures. Monthly Prescribing Reference Web site. Available at: www.empr.com/Sabril-approved-for-infantile-spasms-and-adult-epileptic-seizures/article/147148/. Accessed Sept. 23, 2009.
12. FDA advisory committee recommends approval for use of Gardasil in boys and men. Merck Web site. Available at: www.merck.com/newsroom/press_releases/product/2009_0909.html. Accessed Sept. 23, 2009.
13. Bratulic A. Merck & Co.’s Gardasil recommended by FDA panel for use in boys and men. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=352E8E6109E14925B0168FF465E27C1F&logRowId=325991. Accessed Sept. 23, 2009.
14. Generex technology. Generex Biotechnology Web site. Available at: www.generex.com/technology.php. Accessed Sept. 23, 2009.
15. Reidy C. Generex Drug is OK’d under special FDA program. The Boston Globe Web site. www.generex.com/fckuploads/file/Boston_Globe_09_10_09.pdf. Accessed Sept. 23, 2009.
16. Quinn K. Candy and fruit flavored cigarettes now illegal in United States; step is first under new tobacco law. Food and Drug Administration Web site. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183211.htm. Accessed Sept. 23, 2009.

New Generics

• Nateglinide (generic Starlix) tablets1

New Drugs, Indications, and Dosage Forms

• Abatacept (Orencia), a selective costimulation modulator used in treating moderate to severe juvenile idiopathic arthritis and rheumatoid arthritis (RA), has undergone a label change regarding earlier use in methotrexate-naïve patients with moderate to severe RA of less than two years’ disease duration.2,3
• Aliskiren/valsartan (Valturna) has been approved by the FDA for treating hypertension in patients with inadequate hypertension control using aliskiren or valsartan alone. It’s also approved for first-line treatment of patients who are likely to need multiple agents to manage their hypertension.4
• Cethromycin (Restanza) has been granted orphan drug approval as a once-daily agent for the prophylaxis of anthrax, tularemia, and the plague. Studies are being conducted on the drug as a potential bioterrorism countermeasure agent through a Department of Defense contract.5
• Ganciclovir ophthalmic gel 0.15% (Zirgan) has been approved by the FDA for treating acute herpetic keratitis. It held orphan drug status for this indication since April 2007. Comparable clinical resolution of herpetic keratitis was obtained compared with acyclovir at day seven in an open-label, multicenter study of 213 patients (77% ganciclovir; 72% acyclovir). The most common adverse effects in clinical trials were blurred vision, eye irritation, punctate keratitis, and conjunctival hyperemia. Dosing recommendations are to instill one drop of ganciclovir in the affected eye five times daily until the ulcer heals, then instill one drop three times daily for seven days. It is anticipated that this product will be available in a 5-g tube in early 2010.6
• Glycerol phenylbutyrate (HPN-100), an experimental intermittent or chronic treatment for patients with cirrhosis and hepatic encephalopathy, has received orphan drug status. A phase-2 trial is planned for late 2009 or early 2010.7 Glycerol phenylbutyrate is a pre-pro-drug of phenylacetic acid, the active component of buphenyl (approved by the FDA to treat urea cycle disorders). Glycerol phenylbutyrate is administered in liquid form and also has orphan drug status for treating urea cycle disorders.
• Guanfacine extended-release tablets (Intuiv), a once-daily, nonstimulant treatment for attention deficit hyperactivity disorder (ADHD), has been approved by the FDA for treating patients 6 to 17 years old. Because guanfacine is not a controlled substance, a 90-day supply can be prescribed.8
• Pancrelipase (Zenpep), a delayed-release pancrelipase enzyme product, has been approved by the FDA for treating adults and children (ages 1 to 12) with cystic fibrosis. The most common adverse effects reported in clinical trials were flatulence, abdominal pain, headache, and cough. The product is available in four prescription strengths: “Eurand 5” is 5,000 USP units of lipase, 17,000 USP units of protease, and 27,000 USP units of amylase; “Eurand 10” is 10,000 units lipase, 34,000 units protease, and 55,000 units amylase; “Eurand 15” is 15,000 units lipase, 51,000 units protease, and 82,000 units amylase; and “Eurand 20” is 20,000 units lipase, 68,000 units protease, and 109,000 units amylase.9,10
• Vigabatrin (Sabril) has been approved by the FDA in an oral solution as monotherapy for treating infantile spasms in children ages one month to 2 years. The tablets also are approved for adjunctive therapy for refractory complex partial seizures in adults who have not adequately responded to other treatments. It is available in 500-mg powder packets for oral solution preparation and 500-mg tablets.11 One severe adverse effect is progressive peripheral vision loss with the potential to decrease visual acuity. Due to this risk of permanent vision loss, vigabatrin is available only through a restricted distribution program.

Pipeline

• Human papillomavirus quadrivalent (Types 6, 11, 16 and 18; Gardasil) has been recommended for approval to prevent genital warts in boys and young men 9 to 26 years old. The FDA is expected to make a decision by the end of 2009.12,13 This vaccine already is approved for use in men in 112 countries.
• Oral insulin (Ora-Lyn) is a proprietary formulation that delivers insulin spray through the buccal mucosa.14 In September, Ora-Lyn was approved under the FDA’s Treatment Investigational New Drug (IND) program for both Type 1 and Type 2 diabetes mellitus. This program allows manufacturers to provide early medication access to investigational drugs for patients with life-threatening or other serious conditions for which there are no satisfactory treatment alternatives. Doctors must register with the IND program to obtain the medication for their patients.15Ora-Lyn already is approved abroad.

Drug Information

• On Sept. 22, the FDA banned candy- and fruit-flavored cigarettes under the Family Smoking Prevention and Tobacco Control Act. The goal is to reduce smoking in America.16 Menthol cigarettes and flavored tobacco products are not part of this ban, but they are being evaluated as many of these products are seen as a gateway for children and young adults to begin smoking. More information is available at www.fda.gov/flavoredtobacco. TH

Michele B. Kaufman, PharmD, BSc, RPh, is a freelance medical writer based in New York City and a clinical pharmacist at New York Downtown Hospital.

References

1. Par Pharma to begin marketing Starlix generic. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/news/news64185.html. Accessed Sept. 23, 2009.
2. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/125118s0086lbl.pdf Accessed Sept. 23, 2009.
3. Bratulic A. Bristol Myers Squibb: Orencia label updated to support earlier use in adults with RA. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=DA78CDE71605485C9BC1B3B40392B1C0&logRowId=323904. Accessed Sept. 23, 2009.
4. Bratulic A. FDA approves Novartis’ Valturna for hypertension. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=4D45881D26B8447D950A4D63E80B806C&logRowId=327307. Accessed Sept. 23, 2009.
5. Advanced Life Sciences’ Restanza could treat plague and anthrax. Pharmaceutical-Technology.com Web site. Available at: www.pharmaceutical-technology.com/News/News64553.html. Accessed Sept. 23, 2009.
6. FDA approves Zirgan. Drugs.com Web site. Available at: www.drugs.com/newdrugs/sirion-therapeutics-announces-fda-approval-zirgan-ganciclovir-ophthalmic-gel-0-15-herpetic-keratitis-1657.html. Accessed Sept. 23, 2009.
7. 7. Hyperion Therapeutics receives orphan drug designation for HPN-100 for the treatment of hepatic encephalopathy. Hyperion Therapeutics Web site. Available at: www.hyperiontx.com/press/release/pr_1253144476. Accessed Sept. 23, 2009.
8. George J. FDA approves nonstimulant Shire ADHD drug. Philadelphia Business Journal Web site. Available at: philadelphia.bizjournals.com/philadelphia/stories/2009/08/31/daily40.html?surround=etf&ana=e_article. Accessed Sept. 23, 2009.
9. Petrochko C. FDA approves first EPI drug for kids. Medpage Today Web site. Available at: www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/15734. Accessed Sept. 23, 2009.
10. Highlights of prescribing information. FDA Web site. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/022210s000lbl.pdf. Accessed Sept. 23, 2009.
11. Sabril approved for infantile spasms and adult epileptic seizures. Monthly Prescribing Reference Web site. Available at: www.empr.com/Sabril-approved-for-infantile-spasms-and-adult-epileptic-seizures/article/147148/. Accessed Sept. 23, 2009.
12. FDA advisory committee recommends approval for use of Gardasil in boys and men. Merck Web site. Available at: www.merck.com/newsroom/press_releases/product/2009_0909.html. Accessed Sept. 23, 2009.
13. Bratulic A. Merck & Co.’s Gardasil recommended by FDA panel for use in boys and men. FirstWord Web site. Available at: www.firstwordplus.com/Fws.do?articleid=352E8E6109E14925B0168FF465E27C1F&logRowId=325991. Accessed Sept. 23, 2009.
14. Generex technology. Generex Biotechnology Web site. Available at: www.generex.com/technology.php. Accessed Sept. 23, 2009.
15. Reidy C. Generex Drug is OK’d under special FDA program. The Boston Globe Web site. www.generex.com/fckuploads/file/Boston_Globe_09_10_09.pdf. Accessed Sept. 23, 2009.
16. Quinn K. Candy and fruit flavored cigarettes now illegal in United States; step is first under new tobacco law. Food and Drug Administration Web site. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183211.htm. Accessed Sept. 23, 2009.

Listen to HM pioneer Bob Wachter recap his HM09 keynote address about the quality and patient safety revolution

Listen to HM pioneer Bob Wachter recap his HM09 keynote address about the quality and patient safety revolution

Listen to HM pioneer Bob Wachter recap his HM09 keynote address about the quality and patient safety revolution

A hospitalist-led initiative to boost the implementation of glycemic controls has exceeded initial goals at an Alabama hospital, an early sign of success for the SHM-sponsored pilot program.

Steven C. Smith, MD, FHM, medical director of hospitalist services at Healthcare Authority for Medical West in Bessemer, Ala., says that after the Glycemic Control Mentored Implementation (GCMI) program was put in place earlier this year, his group set a two-week goal of 5% utilization of the program's evidence-based order set. He also set a three-month goal of 25% compliance with the order set.

"Much to my surprise, we achieved 16% utilization at two weeks," Dr. Smith says, adding that three-month data are still being tabulated. "The involvement by SHM is what made the difference. Being able to tell people on the medical staff that this is part of a national-level QI project, we're participating in something bigger—that made a big difference in getting people interested in the order set."

Representatives from several of the 30 pilot sites have reported similar success in the early stages of the yearlong project. Among other issues, the GCMI program tackles subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

Although institutions entered the program in April, Dr. Smith and his colleagues didn't begin their formal mentoring relationship until July. Since then, his HM group has stayed in touch with program mentors through teleconferences and direct e-mail exchanges. The service also has access to a data-aggregation system through the Yale Center for Medical Informatics, which encourages more attention and utilization of newly created order sets.

"We are in the process of collecting data from a period of about one year prior to our project and comparing that to data since the implementation of our order set," Dr. Smith says. The analysis "will allow us, and our mentor, to tailor our efforts to our particular institution in an ongoing fashion. The ongoing measures of our success with this project will include outcomes measures like length of stay, cost of stay, mortality and morbidity, ICU length of stay, ventilator days, and others."

A hospitalist-led initiative to boost the implementation of glycemic controls has exceeded initial goals at an Alabama hospital, an early sign of success for the SHM-sponsored pilot program.

Steven C. Smith, MD, FHM, medical director of hospitalist services at Healthcare Authority for Medical West in Bessemer, Ala., says that after the Glycemic Control Mentored Implementation (GCMI) program was put in place earlier this year, his group set a two-week goal of 5% utilization of the program's evidence-based order set. He also set a three-month goal of 25% compliance with the order set.

"Much to my surprise, we achieved 16% utilization at two weeks," Dr. Smith says, adding that three-month data are still being tabulated. "The involvement by SHM is what made the difference. Being able to tell people on the medical staff that this is part of a national-level QI project, we're participating in something bigger—that made a big difference in getting people interested in the order set."

Representatives from several of the 30 pilot sites have reported similar success in the early stages of the yearlong project. Among other issues, the GCMI program tackles subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

Although institutions entered the program in April, Dr. Smith and his colleagues didn't begin their formal mentoring relationship until July. Since then, his HM group has stayed in touch with program mentors through teleconferences and direct e-mail exchanges. The service also has access to a data-aggregation system through the Yale Center for Medical Informatics, which encourages more attention and utilization of newly created order sets.

"We are in the process of collecting data from a period of about one year prior to our project and comparing that to data since the implementation of our order set," Dr. Smith says. The analysis "will allow us, and our mentor, to tailor our efforts to our particular institution in an ongoing fashion. The ongoing measures of our success with this project will include outcomes measures like length of stay, cost of stay, mortality and morbidity, ICU length of stay, ventilator days, and others."

A hospitalist-led initiative to boost the implementation of glycemic controls has exceeded initial goals at an Alabama hospital, an early sign of success for the SHM-sponsored pilot program.

Steven C. Smith, MD, FHM, medical director of hospitalist services at Healthcare Authority for Medical West in Bessemer, Ala., says that after the Glycemic Control Mentored Implementation (GCMI) program was put in place earlier this year, his group set a two-week goal of 5% utilization of the program's evidence-based order set. He also set a three-month goal of 25% compliance with the order set.

"Much to my surprise, we achieved 16% utilization at two weeks," Dr. Smith says, adding that three-month data are still being tabulated. "The involvement by SHM is what made the difference. Being able to tell people on the medical staff that this is part of a national-level QI project, we're participating in something bigger—that made a big difference in getting people interested in the order set."

Representatives from several of the 30 pilot sites have reported similar success in the early stages of the yearlong project. Among other issues, the GCMI program tackles subcutaneous insulin protocols, transition from subcutaneous to infusion, care coordination, improving follow-up care, and hypoglycemia management.

Although institutions entered the program in April, Dr. Smith and his colleagues didn't begin their formal mentoring relationship until July. Since then, his HM group has stayed in touch with program mentors through teleconferences and direct e-mail exchanges. The service also has access to a data-aggregation system through the Yale Center for Medical Informatics, which encourages more attention and utilization of newly created order sets.

"We are in the process of collecting data from a period of about one year prior to our project and comparing that to data since the implementation of our order set," Dr. Smith says. The analysis "will allow us, and our mentor, to tailor our efforts to our particular institution in an ongoing fashion. The ongoing measures of our success with this project will include outcomes measures like length of stay, cost of stay, mortality and morbidity, ICU length of stay, ventilator days, and others."

Only one in six medical discharges receives venous thromboembolism (VTE) prophylaxis that conforms to the seventh American College of Chest Physicians (ACCP) guidelines, according to a report in the Journal of Hospital Medicine.

The study reported that, overall, 65.9% of medical discharges and 77.7% of surgical discharges received at least one order for VTE prophylaxis during hospitalization. However, when ACCP guidelines for type, dose, and duration are overlaid on the same data set, the percentage of "appropriate prophylaxis" dropped to 16.4% for medical discharges and 12.7% for surgical discharges (JHM 2009;doi 10.1002/jhm.526).

"If we're going to be in the business of healthcare safety and quality … that's not good enough," says lead investigator Alpesh Amin, MD, MBA, FHM, FACP, professor and chairman of the Department of Medicine and executive director of the hospitalist program at the University of California at Irvine. "We're only doing it appropriately [part] of the time."

Dr. Amin has turned VTE research into an area of focus, and is in San Diego today presenting two additional VTE studies at CHEST 2009. One study, "Analysis of Inpatient and Outpatient Venous Thromboembolism Prophylaxis Patterns in U.S. Critical Care Patients," found that of 1,279 discharges analyzed, only 4% continued prophylaxis. The other study, "VTE Prophylaxis Across the Continuum of Care in U.S. Medical and Surgical Patients at Risk of Venous Thromboembolism," reported nearly 90% of patients received no outpatient prophylaxis.

All three studies were supported by Sanofi-Aventis U.S. Inc. The CHEST 2009 presentations have not been published yet. Dr. Amin says the studies show hospitalists can take charge of VTE orders to assure treatment is delivered in line with approved protocols.

"The idea of these studies was to say, 'We've got these national recommendations; how well are we actually doing?' " Dr. Amin says. "You can do something, but you ought to do it according to national guidelines."

For more information on the essential elements of VTE prevention and performance improvement, visit SHM's VTE Resource Room.

Only one in six medical discharges receives venous thromboembolism (VTE) prophylaxis that conforms to the seventh American College of Chest Physicians (ACCP) guidelines, according to a report in the Journal of Hospital Medicine.

The study reported that, overall, 65.9% of medical discharges and 77.7% of surgical discharges received at least one order for VTE prophylaxis during hospitalization. However, when ACCP guidelines for type, dose, and duration are overlaid on the same data set, the percentage of "appropriate prophylaxis" dropped to 16.4% for medical discharges and 12.7% for surgical discharges (JHM 2009;doi 10.1002/jhm.526).

"If we're going to be in the business of healthcare safety and quality … that's not good enough," says lead investigator Alpesh Amin, MD, MBA, FHM, FACP, professor and chairman of the Department of Medicine and executive director of the hospitalist program at the University of California at Irvine. "We're only doing it appropriately [part] of the time."

Dr. Amin has turned VTE research into an area of focus, and is in San Diego today presenting two additional VTE studies at CHEST 2009. One study, "Analysis of Inpatient and Outpatient Venous Thromboembolism Prophylaxis Patterns in U.S. Critical Care Patients," found that of 1,279 discharges analyzed, only 4% continued prophylaxis. The other study, "VTE Prophylaxis Across the Continuum of Care in U.S. Medical and Surgical Patients at Risk of Venous Thromboembolism," reported nearly 90% of patients received no outpatient prophylaxis.

All three studies were supported by Sanofi-Aventis U.S. Inc. The CHEST 2009 presentations have not been published yet. Dr. Amin says the studies show hospitalists can take charge of VTE orders to assure treatment is delivered in line with approved protocols.

"The idea of these studies was to say, 'We've got these national recommendations; how well are we actually doing?' " Dr. Amin says. "You can do something, but you ought to do it according to national guidelines."

For more information on the essential elements of VTE prevention and performance improvement, visit SHM's VTE Resource Room.

Only one in six medical discharges receives venous thromboembolism (VTE) prophylaxis that conforms to the seventh American College of Chest Physicians (ACCP) guidelines, according to a report in the Journal of Hospital Medicine.

The study reported that, overall, 65.9% of medical discharges and 77.7% of surgical discharges received at least one order for VTE prophylaxis during hospitalization. However, when ACCP guidelines for type, dose, and duration are overlaid on the same data set, the percentage of "appropriate prophylaxis" dropped to 16.4% for medical discharges and 12.7% for surgical discharges (JHM 2009;doi 10.1002/jhm.526).

"If we're going to be in the business of healthcare safety and quality … that's not good enough," says lead investigator Alpesh Amin, MD, MBA, FHM, FACP, professor and chairman of the Department of Medicine and executive director of the hospitalist program at the University of California at Irvine. "We're only doing it appropriately [part] of the time."

Dr. Amin has turned VTE research into an area of focus, and is in San Diego today presenting two additional VTE studies at CHEST 2009. One study, "Analysis of Inpatient and Outpatient Venous Thromboembolism Prophylaxis Patterns in U.S. Critical Care Patients," found that of 1,279 discharges analyzed, only 4% continued prophylaxis. The other study, "VTE Prophylaxis Across the Continuum of Care in U.S. Medical and Surgical Patients at Risk of Venous Thromboembolism," reported nearly 90% of patients received no outpatient prophylaxis.

All three studies were supported by Sanofi-Aventis U.S. Inc. The CHEST 2009 presentations have not been published yet. Dr. Amin says the studies show hospitalists can take charge of VTE orders to assure treatment is delivered in line with approved protocols.

"The idea of these studies was to say, 'We've got these national recommendations; how well are we actually doing?' " Dr. Amin says. "You can do something, but you ought to do it according to national guidelines."

For more information on the essential elements of VTE prevention and performance improvement, visit SHM's VTE Resource Room.

A new study on the efficacy of surgical masks compared with respirator masks in combating the spread of influenza shouldn’t lead directly to increased prophylactic mask usage, one hospitalist group leader says. In fact, with hospitals and patients fully aware of another potential H1N1 flu pandemic this winter, HM groups should focus more on traditional hygiene issues and staff management to stem the impact of flu season, says William Ford, MD, FHM, medical director at Cogent Healthcare and director of the hospitalist program at Temple University in Philadelphia.

The randomized controlled trial published online (JAMA. October 2009. doi:10.1001/jama.2009.1466) ) tracked 446 nurses in EDs, medical units, and pediatric units in eight tertiary-care hospitals in Ontario. Researchers found that influenza infection occurred in 23.6% of nurses in the surgical-mask group and in 22.9% of nurses in the N95 respirator group (absolute risk difference –0.73%; 95% CI, –8.8% to 7.3%; P=0.86).

Dr. Ford says masks "can't hurt" as helpful barriers against the spread of influenza among hospital workers, but HM directors would be better served planning for staffing issues and emphasizing prevention. That includes harping on "hand-washing, hand-washing, and hand-washing," as well as being prepared to implement emergency schedules to rotate physicians into floor shifts should rank-and-file hospitalists call out sick.

"As hospitalist directors, I'd be very cognizant of my backup contingency plan," Dr. Ford says. "We have to take certain steps this year in a worst-case scenario."

A new study on the efficacy of surgical masks compared with respirator masks in combating the spread of influenza shouldn’t lead directly to increased prophylactic mask usage, one hospitalist group leader says. In fact, with hospitals and patients fully aware of another potential H1N1 flu pandemic this winter, HM groups should focus more on traditional hygiene issues and staff management to stem the impact of flu season, says William Ford, MD, FHM, medical director at Cogent Healthcare and director of the hospitalist program at Temple University in Philadelphia.

The randomized controlled trial published online (JAMA. October 2009. doi:10.1001/jama.2009.1466) ) tracked 446 nurses in EDs, medical units, and pediatric units in eight tertiary-care hospitals in Ontario. Researchers found that influenza infection occurred in 23.6% of nurses in the surgical-mask group and in 22.9% of nurses in the N95 respirator group (absolute risk difference –0.73%; 95% CI, –8.8% to 7.3%; P=0.86).

Dr. Ford says masks "can't hurt" as helpful barriers against the spread of influenza among hospital workers, but HM directors would be better served planning for staffing issues and emphasizing prevention. That includes harping on "hand-washing, hand-washing, and hand-washing," as well as being prepared to implement emergency schedules to rotate physicians into floor shifts should rank-and-file hospitalists call out sick.

"As hospitalist directors, I'd be very cognizant of my backup contingency plan," Dr. Ford says. "We have to take certain steps this year in a worst-case scenario."

A new study on the efficacy of surgical masks compared with respirator masks in combating the spread of influenza shouldn’t lead directly to increased prophylactic mask usage, one hospitalist group leader says. In fact, with hospitals and patients fully aware of another potential H1N1 flu pandemic this winter, HM groups should focus more on traditional hygiene issues and staff management to stem the impact of flu season, says William Ford, MD, FHM, medical director at Cogent Healthcare and director of the hospitalist program at Temple University in Philadelphia.

The randomized controlled trial published online (JAMA. October 2009. doi:10.1001/jama.2009.1466) ) tracked 446 nurses in EDs, medical units, and pediatric units in eight tertiary-care hospitals in Ontario. Researchers found that influenza infection occurred in 23.6% of nurses in the surgical-mask group and in 22.9% of nurses in the N95 respirator group (absolute risk difference –0.73%; 95% CI, –8.8% to 7.3%; P=0.86).

Dr. Ford says masks "can't hurt" as helpful barriers against the spread of influenza among hospital workers, but HM directors would be better served planning for staffing issues and emphasizing prevention. That includes harping on "hand-washing, hand-washing, and hand-washing," as well as being prepared to implement emergency schedules to rotate physicians into floor shifts should rank-and-file hospitalists call out sick.

"As hospitalist directors, I'd be very cognizant of my backup contingency plan," Dr. Ford says. "We have to take certain steps this year in a worst-case scenario."

A new study linking adults who play video games to greater risk for depression and a higher body mass index (BMI) raises the question of whether a gaming question should be added to the screening process used by psychiatric hospitalists.

The study found female gamers reported greater depression (M=1.57) and poorer health status (M=3.9) than females who don't play video games (depression, M=1.13; health status, M=3.57). Researchers at the Centers for Disease Control and Prevention (CDC), Emory University in Atlanta, and Andrews University in Berrian Springs, Mich., also reported that male gamers reported higher BMIs than nongamers (M=5.31 vs. M5.19; Am J Prev Med.2009;37(4):299-305).

But an accompanying commentary and an interview with a longtime psychiatric hospitalist both say more research is needed before any processes are tweaked.

“It’s sort of like drinking,” says Robert Albanese, MD, chief of the medicine service at the Boise (Idaho) Veterans Affairs Medical Center and director of its Psychiatric Consultation Service. “If people are drinking six beers a day, then that could be a significant part of their depression. If they’re drinking one beer a day, then it probably isn’t.”

The report “is something to be aware of,” Dr. Albanese continues. “But defining its role in the assessment of the psychiatric process—that's going to take some time.”

Dr. Albanese believes the impact of video gaming on adults is an area ripe for further study. He compares it to the value of research on C-reactive protein (CRP). “Many studies in many individuals have demonstrated that it is elevated in people at risk for coronary artery disease,” he notes, “but it still has not become standard of care as a screening instrument.”

A new study linking adults who play video games to greater risk for depression and a higher body mass index (BMI) raises the question of whether a gaming question should be added to the screening process used by psychiatric hospitalists.

The study found female gamers reported greater depression (M=1.57) and poorer health status (M=3.9) than females who don't play video games (depression, M=1.13; health status, M=3.57). Researchers at the Centers for Disease Control and Prevention (CDC), Emory University in Atlanta, and Andrews University in Berrian Springs, Mich., also reported that male gamers reported higher BMIs than nongamers (M=5.31 vs. M5.19; Am J Prev Med.2009;37(4):299-305).

But an accompanying commentary and an interview with a longtime psychiatric hospitalist both say more research is needed before any processes are tweaked.

“It’s sort of like drinking,” says Robert Albanese, MD, chief of the medicine service at the Boise (Idaho) Veterans Affairs Medical Center and director of its Psychiatric Consultation Service. “If people are drinking six beers a day, then that could be a significant part of their depression. If they’re drinking one beer a day, then it probably isn’t.”

The report “is something to be aware of,” Dr. Albanese continues. “But defining its role in the assessment of the psychiatric process—that's going to take some time.”

Dr. Albanese believes the impact of video gaming on adults is an area ripe for further study. He compares it to the value of research on C-reactive protein (CRP). “Many studies in many individuals have demonstrated that it is elevated in people at risk for coronary artery disease,” he notes, “but it still has not become standard of care as a screening instrument.”

A new study linking adults who play video games to greater risk for depression and a higher body mass index (BMI) raises the question of whether a gaming question should be added to the screening process used by psychiatric hospitalists.

The study found female gamers reported greater depression (M=1.57) and poorer health status (M=3.9) than females who don't play video games (depression, M=1.13; health status, M=3.57). Researchers at the Centers for Disease Control and Prevention (CDC), Emory University in Atlanta, and Andrews University in Berrian Springs, Mich., also reported that male gamers reported higher BMIs than nongamers (M=5.31 vs. M5.19; Am J Prev Med.2009;37(4):299-305).

But an accompanying commentary and an interview with a longtime psychiatric hospitalist both say more research is needed before any processes are tweaked.

“It’s sort of like drinking,” says Robert Albanese, MD, chief of the medicine service at the Boise (Idaho) Veterans Affairs Medical Center and director of its Psychiatric Consultation Service. “If people are drinking six beers a day, then that could be a significant part of their depression. If they’re drinking one beer a day, then it probably isn’t.”

The report “is something to be aware of,” Dr. Albanese continues. “But defining its role in the assessment of the psychiatric process—that's going to take some time.”

Dr. Albanese believes the impact of video gaming on adults is an area ripe for further study. He compares it to the value of research on C-reactive protein (CRP). “Many studies in many individuals have demonstrated that it is elevated in people at risk for coronary artery disease,” he notes, “but it still has not become standard of care as a screening instrument.”

The recent decision by a New York hospital system to offer a generous subsidy to affiliated physicians for adoption of electronic health records (EHR) has one hospitalist almost giddy at the thought of accessing community physician information through a seamless digital transition.

North Shore-Long Island Jewish Health System is thought to be the first nationwide to match the federal government's subsidy—$44,000 over five years—to push physicians toward EHR adoption. Mark Fitterman, MD, FACP, FHM, chief of staff and director of hospitalist services at Huntington Hospital of the North Shore-LIJ Health System, says hospitalists will benefit directly by having more access to patients' health records. That access can save valuable—and costly—time compared with the current situation, where Dr. Fitterman and others in his hospital still use paper records.

"It will help improve transitions of care both coming in and going out," Dr. Fitterman says. "We'll be able to improve patient care and record bi-directionally."

The health system, however, says in a statement that it won't judge success solely on a fiscal basis, focusing instead on "our ability to improve patient outcomes." North Shore's initiative is a $400 million project to link some 7,000 affiliated doctors to the health system's main record system.

The commitment speaks to the growing attention EHR has gathered in the healthcare reform debate. To wit, Dr. Fitterman points out that instead of launching the initiative at a few pilot sites, the system is committing to the project at an institutional level.

"It's not even an option," Dr. Fitterman says. "It's part of the evolution of better care, and those who don't jump on board will go extinct."

The recent decision by a New York hospital system to offer a generous subsidy to affiliated physicians for adoption of electronic health records (EHR) has one hospitalist almost giddy at the thought of accessing community physician information through a seamless digital transition.

North Shore-Long Island Jewish Health System is thought to be the first nationwide to match the federal government's subsidy—$44,000 over five years—to push physicians toward EHR adoption. Mark Fitterman, MD, FACP, FHM, chief of staff and director of hospitalist services at Huntington Hospital of the North Shore-LIJ Health System, says hospitalists will benefit directly by having more access to patients' health records. That access can save valuable—and costly—time compared with the current situation, where Dr. Fitterman and others in his hospital still use paper records.

"It will help improve transitions of care both coming in and going out," Dr. Fitterman says. "We'll be able to improve patient care and record bi-directionally."

The health system, however, says in a statement that it won't judge success solely on a fiscal basis, focusing instead on "our ability to improve patient outcomes." North Shore's initiative is a $400 million project to link some 7,000 affiliated doctors to the health system's main record system.

The commitment speaks to the growing attention EHR has gathered in the healthcare reform debate. To wit, Dr. Fitterman points out that instead of launching the initiative at a few pilot sites, the system is committing to the project at an institutional level.

"It's not even an option," Dr. Fitterman says. "It's part of the evolution of better care, and those who don't jump on board will go extinct."

The recent decision by a New York hospital system to offer a generous subsidy to affiliated physicians for adoption of electronic health records (EHR) has one hospitalist almost giddy at the thought of accessing community physician information through a seamless digital transition.

North Shore-Long Island Jewish Health System is thought to be the first nationwide to match the federal government's subsidy—$44,000 over five years—to push physicians toward EHR adoption. Mark Fitterman, MD, FACP, FHM, chief of staff and director of hospitalist services at Huntington Hospital of the North Shore-LIJ Health System, says hospitalists will benefit directly by having more access to patients' health records. That access can save valuable—and costly—time compared with the current situation, where Dr. Fitterman and others in his hospital still use paper records.

"It will help improve transitions of care both coming in and going out," Dr. Fitterman says. "We'll be able to improve patient care and record bi-directionally."

The health system, however, says in a statement that it won't judge success solely on a fiscal basis, focusing instead on "our ability to improve patient outcomes." North Shore's initiative is a $400 million project to link some 7,000 affiliated doctors to the health system's main record system.

The commitment speaks to the growing attention EHR has gathered in the healthcare reform debate. To wit, Dr. Fitterman points out that instead of launching the initiative at a few pilot sites, the system is committing to the project at an institutional level.

"It's not even an option," Dr. Fitterman says. "It's part of the evolution of better care, and those who don't jump on board will go extinct."

The use of a procalcitonin (PCT) algorithm reduced the usage of antibiotics in patients with lower-respiratory-tract infections (LTRI), according to a recent study that may highlight a new way for hospitalists to reduce costs.

The study found the mean duration of antibiotics exposure in the PCT group was lower than in a control group (5.7 days vs. 8.7 days). The researchers, who studied 1,359 patients at six tertiary-care hospitals in Switzerland, also reported less-frequent antibiotic-associated adverse effects, such as nausea, rashes or diarrhea, in the PCT group (JAMA. 2009;302(10):1059-1066).

Scott Flanders, MD, FHM, SHM president and director of the hospitalist program at the University of Michigan Health System in Ann Arbor, says if further review were to show more statistical impacts on costs savings, PCT usage would become more common.

"If you can reduce length-of-stay by half through treatment intervention, then this will easily pay for itself," says Dr. Flanders, who adds, "Hospitalists need to know and have at their fingertips the best avenues of treatment."

Devendra Amin, MD, director of critical-care services at Morton Plant Hospital in Clearwater, Fla., was one of the first physicians to use PCT tests after the Food and Drug Administration (FDA) approved wider usage last year. He says the overuse of antibiotics is a needless cost overrun that hospitalists using PCT tests could better control—and then tout as an example of their ability to reduce costs. Dr. Amin plans to team with a half-dozen of his health system's hospitalists next year to work on a study of the effectiveness of PCT in a community hospital setting.

"If everything else fits, it's another piece of information that's important to the puzzle," Dr. Amin says. "No single test in isolation is going to give you everything you want … but this can help."

The use of a procalcitonin (PCT) algorithm reduced the usage of antibiotics in patients with lower-respiratory-tract infections (LTRI), according to a recent study that may highlight a new way for hospitalists to reduce costs.

The study found the mean duration of antibiotics exposure in the PCT group was lower than in a control group (5.7 days vs. 8.7 days). The researchers, who studied 1,359 patients at six tertiary-care hospitals in Switzerland, also reported less-frequent antibiotic-associated adverse effects, such as nausea, rashes or diarrhea, in the PCT group (JAMA. 2009;302(10):1059-1066).

Scott Flanders, MD, FHM, SHM president and director of the hospitalist program at the University of Michigan Health System in Ann Arbor, says if further review were to show more statistical impacts on costs savings, PCT usage would become more common.

"If you can reduce length-of-stay by half through treatment intervention, then this will easily pay for itself," says Dr. Flanders, who adds, "Hospitalists need to know and have at their fingertips the best avenues of treatment."

Devendra Amin, MD, director of critical-care services at Morton Plant Hospital in Clearwater, Fla., was one of the first physicians to use PCT tests after the Food and Drug Administration (FDA) approved wider usage last year. He says the overuse of antibiotics is a needless cost overrun that hospitalists using PCT tests could better control—and then tout as an example of their ability to reduce costs. Dr. Amin plans to team with a half-dozen of his health system's hospitalists next year to work on a study of the effectiveness of PCT in a community hospital setting.

"If everything else fits, it's another piece of information that's important to the puzzle," Dr. Amin says. "No single test in isolation is going to give you everything you want … but this can help."

The use of a procalcitonin (PCT) algorithm reduced the usage of antibiotics in patients with lower-respiratory-tract infections (LTRI), according to a recent study that may highlight a new way for hospitalists to reduce costs.

The study found the mean duration of antibiotics exposure in the PCT group was lower than in a control group (5.7 days vs. 8.7 days). The researchers, who studied 1,359 patients at six tertiary-care hospitals in Switzerland, also reported less-frequent antibiotic-associated adverse effects, such as nausea, rashes or diarrhea, in the PCT group (JAMA. 2009;302(10):1059-1066).

Scott Flanders, MD, FHM, SHM president and director of the hospitalist program at the University of Michigan Health System in Ann Arbor, says if further review were to show more statistical impacts on costs savings, PCT usage would become more common.

"If you can reduce length-of-stay by half through treatment intervention, then this will easily pay for itself," says Dr. Flanders, who adds, "Hospitalists need to know and have at their fingertips the best avenues of treatment."

Devendra Amin, MD, director of critical-care services at Morton Plant Hospital in Clearwater, Fla., was one of the first physicians to use PCT tests after the Food and Drug Administration (FDA) approved wider usage last year. He says the overuse of antibiotics is a needless cost overrun that hospitalists using PCT tests could better control—and then tout as an example of their ability to reduce costs. Dr. Amin plans to team with a half-dozen of his health system's hospitalists next year to work on a study of the effectiveness of PCT in a community hospital setting.

"If everything else fits, it's another piece of information that's important to the puzzle," Dr. Amin says. "No single test in isolation is going to give you everything you want … but this can help."