A recent study in which 36% of hospitalists reported that their workload exceeds safe patient census levels at least once a week could spur serious discussions on productivity and quality of care, according to one of its authors.

Daniel Brotman, MD, FACP, FHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore and one of the study's authors, says the results highlight the delicate balance between pushing hospitalists to generate revenue and maintaining patient safety.

"It's certainly not in the best interest of our patients or our healthcare system to fix financial stress by expecting more clinical productivity of doctors year over year,” he says. "At some point, and it's self-evident—at least in my mind—quality starts to suffer when workload gets excessive."

The report, "Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists," details findings of the first study to assess perception of unsafe workloads by directly questioning physicians, according to its authors. They electronically queried 506 hospitalists enrolled in the physicians' online network and information site QuantiaMD.com.

As many as 40% of physicians reported their typical inpatient census exceeded safe levels at least once monthly, the report noted, and physicians pegged 15 as the optimal number of patients to see on a shift dedicated to clinical work.

John Nelson, MD, MHM, a principal in Nelson Flores Hospital Medicine Consultants in La Quinta, Calif., says staffing shortages are likely the most common cause of heavy workloads, and that the high number of physicians reporting overloaded censuses is evidence that hospitalists are concerned their job performance is adversely affected.

"I suspect that as belt-tightening continues to occur," Dr. Brotman adds, "we're going to see the importance of [research] like this increasing, because we're going to see more and more stressed-out, overextended doctors who are having trouble delivering the care that they know they can deliver if they had more time."

Visit our website for more information on hospital medicine workloads.

A recent study in which 36% of hospitalists reported that their workload exceeds safe patient census levels at least once a week could spur serious discussions on productivity and quality of care, according to one of its authors.

Daniel Brotman, MD, FACP, FHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore and one of the study's authors, says the results highlight the delicate balance between pushing hospitalists to generate revenue and maintaining patient safety.

"It's certainly not in the best interest of our patients or our healthcare system to fix financial stress by expecting more clinical productivity of doctors year over year,” he says. "At some point, and it's self-evident—at least in my mind—quality starts to suffer when workload gets excessive."

The report, "Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists," details findings of the first study to assess perception of unsafe workloads by directly questioning physicians, according to its authors. They electronically queried 506 hospitalists enrolled in the physicians' online network and information site QuantiaMD.com.

As many as 40% of physicians reported their typical inpatient census exceeded safe levels at least once monthly, the report noted, and physicians pegged 15 as the optimal number of patients to see on a shift dedicated to clinical work.

John Nelson, MD, MHM, a principal in Nelson Flores Hospital Medicine Consultants in La Quinta, Calif., says staffing shortages are likely the most common cause of heavy workloads, and that the high number of physicians reporting overloaded censuses is evidence that hospitalists are concerned their job performance is adversely affected.

"I suspect that as belt-tightening continues to occur," Dr. Brotman adds, "we're going to see the importance of [research] like this increasing, because we're going to see more and more stressed-out, overextended doctors who are having trouble delivering the care that they know they can deliver if they had more time."

Visit our website for more information on hospital medicine workloads.

A recent study in which 36% of hospitalists reported that their workload exceeds safe patient census levels at least once a week could spur serious discussions on productivity and quality of care, according to one of its authors.

Daniel Brotman, MD, FACP, FHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore and one of the study's authors, says the results highlight the delicate balance between pushing hospitalists to generate revenue and maintaining patient safety.

"It's certainly not in the best interest of our patients or our healthcare system to fix financial stress by expecting more clinical productivity of doctors year over year,” he says. "At some point, and it's self-evident—at least in my mind—quality starts to suffer when workload gets excessive."

The report, "Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists," details findings of the first study to assess perception of unsafe workloads by directly questioning physicians, according to its authors. They electronically queried 506 hospitalists enrolled in the physicians' online network and information site QuantiaMD.com.

As many as 40% of physicians reported their typical inpatient census exceeded safe levels at least once monthly, the report noted, and physicians pegged 15 as the optimal number of patients to see on a shift dedicated to clinical work.

John Nelson, MD, MHM, a principal in Nelson Flores Hospital Medicine Consultants in La Quinta, Calif., says staffing shortages are likely the most common cause of heavy workloads, and that the high number of physicians reporting overloaded censuses is evidence that hospitalists are concerned their job performance is adversely affected.

"I suspect that as belt-tightening continues to occur," Dr. Brotman adds, "we're going to see the importance of [research] like this increasing, because we're going to see more and more stressed-out, overextended doctors who are having trouble delivering the care that they know they can deliver if they had more time."

Visit our website for more information on hospital medicine workloads.

Patrick Cawley, MD, MBA, MHM, a past president of SHM and a recipient of its prestigious Master of Hospital Medicine award, has been named vice president for clinical operations and executive director of the Medical University Hospital Authority at the Medical University of South Carolina (MUSC) in Charleston.

"What distinguished Dr. Cawley from the rest of the field is his intimate knowledge of MUSC, his medical expertise combined with graduate education in management, and his track record of improving our performance in quality and patient safety," says Raymond S. Greenberg, MD, PhD, and president of MUSC. "Given his familiarity with the issues here, Dr. Cawley can step in quickly to assume his new responsibilities. He's already demonstrating steady and thoughtful leadership."

Dr. Cawley took his first leadership course 15 years ago. That led to other courses on such topics as marketing and finance, and that led to his earning a master’s degree in business administration from the University of Massachusetts at Amherst. "Just like medicine, you never stop learning in business or trying to do things better," he says.

Dr. Cawley says hospitalists have a leg up on other physicians when it comes to moving into hospital administration. "Being a hospitalist allowed me to get into every nook and cranny of this hospital," he says. He advises other hospitalists interested in this path to seek out progressive leadership roles. “Show what you can do,” he says, “and get that management degree.”

As Dr. Cawley's administrative responsibilities continue to expand, the time he spends in clinical practice continues to decrease. Although he plans to give up clinical work for the crucial first six months in his new position, he says he hopes to return to hospitalist practice at least 10% of the time after that.

"Any CEO worth his or her salt goes out to the front lines to see what is happening," Dr. Cawley notes. "As a physician, it is easier to get to those front lines. Once there, you get a feel for how the hospital really runs."

Visit our website for more information about executive leadership positions in hospitals.

Patrick Cawley, MD, MBA, MHM, a past president of SHM and a recipient of its prestigious Master of Hospital Medicine award, has been named vice president for clinical operations and executive director of the Medical University Hospital Authority at the Medical University of South Carolina (MUSC) in Charleston.

"What distinguished Dr. Cawley from the rest of the field is his intimate knowledge of MUSC, his medical expertise combined with graduate education in management, and his track record of improving our performance in quality and patient safety," says Raymond S. Greenberg, MD, PhD, and president of MUSC. "Given his familiarity with the issues here, Dr. Cawley can step in quickly to assume his new responsibilities. He's already demonstrating steady and thoughtful leadership."

Dr. Cawley took his first leadership course 15 years ago. That led to other courses on such topics as marketing and finance, and that led to his earning a master’s degree in business administration from the University of Massachusetts at Amherst. "Just like medicine, you never stop learning in business or trying to do things better," he says.

Dr. Cawley says hospitalists have a leg up on other physicians when it comes to moving into hospital administration. "Being a hospitalist allowed me to get into every nook and cranny of this hospital," he says. He advises other hospitalists interested in this path to seek out progressive leadership roles. “Show what you can do,” he says, “and get that management degree.”

As Dr. Cawley's administrative responsibilities continue to expand, the time he spends in clinical practice continues to decrease. Although he plans to give up clinical work for the crucial first six months in his new position, he says he hopes to return to hospitalist practice at least 10% of the time after that.

"Any CEO worth his or her salt goes out to the front lines to see what is happening," Dr. Cawley notes. "As a physician, it is easier to get to those front lines. Once there, you get a feel for how the hospital really runs."

Visit our website for more information about executive leadership positions in hospitals.

Patrick Cawley, MD, MBA, MHM, a past president of SHM and a recipient of its prestigious Master of Hospital Medicine award, has been named vice president for clinical operations and executive director of the Medical University Hospital Authority at the Medical University of South Carolina (MUSC) in Charleston.

"What distinguished Dr. Cawley from the rest of the field is his intimate knowledge of MUSC, his medical expertise combined with graduate education in management, and his track record of improving our performance in quality and patient safety," says Raymond S. Greenberg, MD, PhD, and president of MUSC. "Given his familiarity with the issues here, Dr. Cawley can step in quickly to assume his new responsibilities. He's already demonstrating steady and thoughtful leadership."

Dr. Cawley took his first leadership course 15 years ago. That led to other courses on such topics as marketing and finance, and that led to his earning a master’s degree in business administration from the University of Massachusetts at Amherst. "Just like medicine, you never stop learning in business or trying to do things better," he says.

Dr. Cawley says hospitalists have a leg up on other physicians when it comes to moving into hospital administration. "Being a hospitalist allowed me to get into every nook and cranny of this hospital," he says. He advises other hospitalists interested in this path to seek out progressive leadership roles. “Show what you can do,” he says, “and get that management degree.”

As Dr. Cawley's administrative responsibilities continue to expand, the time he spends in clinical practice continues to decrease. Although he plans to give up clinical work for the crucial first six months in his new position, he says he hopes to return to hospitalist practice at least 10% of the time after that.

"Any CEO worth his or her salt goes out to the front lines to see what is happening," Dr. Cawley notes. "As a physician, it is easier to get to those front lines. Once there, you get a feel for how the hospital really runs."

Visit our website for more information about executive leadership positions in hospitals.

Prescriptions
Credit: Steven Harbour

The US Food and Drug Administration (FDA) has granted accelerated approval for the immunomodulatory agent pomalidomide (Pomalyst) to treat patients with advanced multiple myeloma (MM).

Continued FDA approval for the drug may be contingent upon verification and description of clinical benefit in confirmatory trials.

Pomalidomide is intended for use in combination with dexamethasone to treat MM patients who have received at least 2 prior

therapies (including lenalidomide and a proteasome inhibitor) and who experienced progression within 60 days of their last treatment.

Pomalidomide has demonstrated some efficacy in this patient population in a number of studies.

In a study published in Blood last year (PG Richardson et al.), pomalidomide elicited responses in MM patients who were refractory to lenalidomide, bortezomib, or both drugs.

In a study presented at ASH 2011 (abstract 634), pomalidomide did not fare as well when given alone to patients with refractory MM. However, combining the drug with low-dose dexamethasone significantly improved responses.

A study presented at ASH 2012 (LBA-6) built upon those findings, showing that pomalidomide plus low-dose dexamethasone was superior to high-dose dexamethasone in MM patients who were refractory to lenalidomide and bortezomib.

Common side effects observed with pomalidomide include neutropenia, anemia, thrombocytopenia, fatigue, weakness, constipation, diarrhea, upper respiratory tract infections, back pain, and fever.

In addition, pomalidomide has been shown to cause venous thromboembolism, as well as severe, life-threatening birth defects in pregnant women. The drug carries a boxed warning alerting patients and healthcare professionals to both of these risks.

Because of the embryo-fetal risk, pomalidomide is available only through the Pomalyst Risk Evaluation and Mitigation Strategy (REMS) Program. Prescribers must be certified with the program by enrolling and complying with the REMS requirements.

Patients must sign a patient-physician agreement form and comply with the REMS requirements. In particular, female patients who are not pregnant but can become pregnant must comply with the pregnancy testing and contraception requirements, and males must comply with contraception requirements.

Pharmacies must be certified with the Pomalyst REMS Program, must only dispense the drug to patients who are authorized to receive it, and must comply with REMS requirements. Both lenalidomide and thalidomide have similar REMS.

Pomalidomide is marketed by Celgene, which is based in Summit, New Jersey.

Prescriptions
Credit: Steven Harbour

The US Food and Drug Administration (FDA) has granted accelerated approval for the immunomodulatory agent pomalidomide (Pomalyst) to treat patients with advanced multiple myeloma (MM).

Continued FDA approval for the drug may be contingent upon verification and description of clinical benefit in confirmatory trials.

Pomalidomide is intended for use in combination with dexamethasone to treat MM patients who have received at least 2 prior

therapies (including lenalidomide and a proteasome inhibitor) and who experienced progression within 60 days of their last treatment.

Pomalidomide has demonstrated some efficacy in this patient population in a number of studies.

In a study published in Blood last year (PG Richardson et al.), pomalidomide elicited responses in MM patients who were refractory to lenalidomide, bortezomib, or both drugs.

In a study presented at ASH 2011 (abstract 634), pomalidomide did not fare as well when given alone to patients with refractory MM. However, combining the drug with low-dose dexamethasone significantly improved responses.

A study presented at ASH 2012 (LBA-6) built upon those findings, showing that pomalidomide plus low-dose dexamethasone was superior to high-dose dexamethasone in MM patients who were refractory to lenalidomide and bortezomib.

Common side effects observed with pomalidomide include neutropenia, anemia, thrombocytopenia, fatigue, weakness, constipation, diarrhea, upper respiratory tract infections, back pain, and fever.

In addition, pomalidomide has been shown to cause venous thromboembolism, as well as severe, life-threatening birth defects in pregnant women. The drug carries a boxed warning alerting patients and healthcare professionals to both of these risks.

Because of the embryo-fetal risk, pomalidomide is available only through the Pomalyst Risk Evaluation and Mitigation Strategy (REMS) Program. Prescribers must be certified with the program by enrolling and complying with the REMS requirements.

Patients must sign a patient-physician agreement form and comply with the REMS requirements. In particular, female patients who are not pregnant but can become pregnant must comply with the pregnancy testing and contraception requirements, and males must comply with contraception requirements.

Pharmacies must be certified with the Pomalyst REMS Program, must only dispense the drug to patients who are authorized to receive it, and must comply with REMS requirements. Both lenalidomide and thalidomide have similar REMS.

Pomalidomide is marketed by Celgene, which is based in Summit, New Jersey.

Prescriptions
Credit: Steven Harbour

The US Food and Drug Administration (FDA) has granted accelerated approval for the immunomodulatory agent pomalidomide (Pomalyst) to treat patients with advanced multiple myeloma (MM).

Continued FDA approval for the drug may be contingent upon verification and description of clinical benefit in confirmatory trials.

Pomalidomide is intended for use in combination with dexamethasone to treat MM patients who have received at least 2 prior

therapies (including lenalidomide and a proteasome inhibitor) and who experienced progression within 60 days of their last treatment.

Pomalidomide has demonstrated some efficacy in this patient population in a number of studies.

In a study published in Blood last year (PG Richardson et al.), pomalidomide elicited responses in MM patients who were refractory to lenalidomide, bortezomib, or both drugs.

In a study presented at ASH 2011 (abstract 634), pomalidomide did not fare as well when given alone to patients with refractory MM. However, combining the drug with low-dose dexamethasone significantly improved responses.

A study presented at ASH 2012 (LBA-6) built upon those findings, showing that pomalidomide plus low-dose dexamethasone was superior to high-dose dexamethasone in MM patients who were refractory to lenalidomide and bortezomib.

Common side effects observed with pomalidomide include neutropenia, anemia, thrombocytopenia, fatigue, weakness, constipation, diarrhea, upper respiratory tract infections, back pain, and fever.

In addition, pomalidomide has been shown to cause venous thromboembolism, as well as severe, life-threatening birth defects in pregnant women. The drug carries a boxed warning alerting patients and healthcare professionals to both of these risks.

Because of the embryo-fetal risk, pomalidomide is available only through the Pomalyst Risk Evaluation and Mitigation Strategy (REMS) Program. Prescribers must be certified with the program by enrolling and complying with the REMS requirements.

Patients must sign a patient-physician agreement form and comply with the REMS requirements. In particular, female patients who are not pregnant but can become pregnant must comply with the pregnancy testing and contraception requirements, and males must comply with contraception requirements.

Pharmacies must be certified with the Pomalyst REMS Program, must only dispense the drug to patients who are authorized to receive it, and must comply with REMS requirements. Both lenalidomide and thalidomide have similar REMS.

Pomalidomide is marketed by Celgene, which is based in Summit, New Jersey.

U.S. hospitals in 2011 showed improvements in their rates of central line-associated bloodstream infections (CLABSI) and in some surgical-site infections, compared with 2010, but the rate essentially hit a plateau for catheter-associated urinary tract infections (CAUTI), according to a new CDC report.

“Reductions in some of the deadliest healthcare-associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” CDC director Thomas R. Frieden, MD, MPH, says. “However, the slower progress in reducing catheter-associated urinary tract infections is a call to action for hospitals to redouble their efforts to track these infections and implement control strategies we know that work.”

The report showed a 41% reduction in 2011 central-line infections compared with 2008, the baseline year for the report. In 2010, the reduction was 32% over the 2008 baseline. The improvement was seen across ICUs, general wards, and neonatal ICUs.

“I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI. No single strategy used in isolation is going to be effective.”

—Scott Flanders, MD, SFHM, professor of medicine, director of hospital medicine, University of Michigan Health System, Ann Arbor, former SHM president

The CDC also reported a 17% drop in surgical-site infections since 2008, better than the 7% reduction in 2010. The biggest reductions were seen in coronary artery bypass graft surgery and cardiac surgery; little improvement was seen in infections from hip arthroplasty and vaginal hysterectomy procedures.

The rate of infections from CAUTIs was 7%, nearly the same as the 6% rate in 2010 data. The infection rate in ICUs actually went up—a 1% drop in 2011 compared with a 3% drop from baseline in 2010.

SHM is a partner in two initiatives that aim to reduce CAUTI infections: the University HealthSystems Consortium’s Partnership for Patients project and On the CUSP: STOP CAUTI, an American Hospital Association HRET effort that’s funded by the Agency for Healthcare Research and Quality-funded project.

Gregory Maynard, MD, SFHM, director of hospital medicine at the University of San Diego Medical Center and senior vice president of SHM’s Center for Healthcare Improvement and Innovation is encouraged by the CLABSI and SSI figures. The report highlights the need for more effort on CAUTI.

“I think all the tools and information are available for improvement teams,” he says. “The CDC, the HRET On the CUSP group, and others all have great toolkits.”

He also says it was telling that the CAUTI numbers were worse in the ICU than in general wards.

“The more complex the environment, the easier it is for those things to get lost,” he says. “It just will probably take more attention to it and making it more of a priority.

“The more complex the environment, the easier it is for those things to get lost. It just will probably take more attention to it and making it more of a priority…. We’re supposed to reduce these adverse events by a very significant amount and obviously we’re not getting there based on this report. We have to do a better job. Reducing CAUTI by 40% is one of goals for the $500 million Partnerships for Patients effort. With that much money involved, it should increase the pressure to get this done.”

Click here to hear more of Dr. Maynard's interview with The Hospitalist

Scott Flanders, MD, SFHM, a former SHM president and SHM’s physician leader for STOP CAUTI, says the report shows that CAUTIs may be more difficult to prevent. In part, that is because catheters are used more broadly throughout a hospital than, say, central lines, which are most common in ICUs.

It takes a multi-disciplinary team implementing a variety of tools: critieria for putting catheters in, managing them appropriately once they are in, and developing protocols for removing them as quickly as possible, he adds.

“Having all those elements in place are critical to preventing CAUTI and I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI,” says Dr. Flanders, professor of medicine and director of hospital medicine at the University of Michigan Health System in Ann Arbor. “No single strategy used in isolation is going to be effective.”

Efforts to reduce CAUTIs have been launched more recently than efforts to reduce other infection types, he says.

“There’s been less of a drive for CAUTI,” he says. “It’s a tougher problem to tackle than some of these other issues, which is a contributing factor in the lower rate of improvement.” TH

Tom Collins is a freelance writer in South Florida.

U.S. hospitals in 2011 showed improvements in their rates of central line-associated bloodstream infections (CLABSI) and in some surgical-site infections, compared with 2010, but the rate essentially hit a plateau for catheter-associated urinary tract infections (CAUTI), according to a new CDC report.

“Reductions in some of the deadliest healthcare-associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” CDC director Thomas R. Frieden, MD, MPH, says. “However, the slower progress in reducing catheter-associated urinary tract infections is a call to action for hospitals to redouble their efforts to track these infections and implement control strategies we know that work.”

The report showed a 41% reduction in 2011 central-line infections compared with 2008, the baseline year for the report. In 2010, the reduction was 32% over the 2008 baseline. The improvement was seen across ICUs, general wards, and neonatal ICUs.

“I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI. No single strategy used in isolation is going to be effective.”

—Scott Flanders, MD, SFHM, professor of medicine, director of hospital medicine, University of Michigan Health System, Ann Arbor, former SHM president

The CDC also reported a 17% drop in surgical-site infections since 2008, better than the 7% reduction in 2010. The biggest reductions were seen in coronary artery bypass graft surgery and cardiac surgery; little improvement was seen in infections from hip arthroplasty and vaginal hysterectomy procedures.

The rate of infections from CAUTIs was 7%, nearly the same as the 6% rate in 2010 data. The infection rate in ICUs actually went up—a 1% drop in 2011 compared with a 3% drop from baseline in 2010.

SHM is a partner in two initiatives that aim to reduce CAUTI infections: the University HealthSystems Consortium’s Partnership for Patients project and On the CUSP: STOP CAUTI, an American Hospital Association HRET effort that’s funded by the Agency for Healthcare Research and Quality-funded project.

Gregory Maynard, MD, SFHM, director of hospital medicine at the University of San Diego Medical Center and senior vice president of SHM’s Center for Healthcare Improvement and Innovation is encouraged by the CLABSI and SSI figures. The report highlights the need for more effort on CAUTI.

“I think all the tools and information are available for improvement teams,” he says. “The CDC, the HRET On the CUSP group, and others all have great toolkits.”

He also says it was telling that the CAUTI numbers were worse in the ICU than in general wards.

“The more complex the environment, the easier it is for those things to get lost,” he says. “It just will probably take more attention to it and making it more of a priority.

“The more complex the environment, the easier it is for those things to get lost. It just will probably take more attention to it and making it more of a priority…. We’re supposed to reduce these adverse events by a very significant amount and obviously we’re not getting there based on this report. We have to do a better job. Reducing CAUTI by 40% is one of goals for the $500 million Partnerships for Patients effort. With that much money involved, it should increase the pressure to get this done.”

Click here to hear more of Dr. Maynard's interview with The Hospitalist

Scott Flanders, MD, SFHM, a former SHM president and SHM’s physician leader for STOP CAUTI, says the report shows that CAUTIs may be more difficult to prevent. In part, that is because catheters are used more broadly throughout a hospital than, say, central lines, which are most common in ICUs.

It takes a multi-disciplinary team implementing a variety of tools: critieria for putting catheters in, managing them appropriately once they are in, and developing protocols for removing them as quickly as possible, he adds.

“Having all those elements in place are critical to preventing CAUTI and I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI,” says Dr. Flanders, professor of medicine and director of hospital medicine at the University of Michigan Health System in Ann Arbor. “No single strategy used in isolation is going to be effective.”

Efforts to reduce CAUTIs have been launched more recently than efforts to reduce other infection types, he says.

“There’s been less of a drive for CAUTI,” he says. “It’s a tougher problem to tackle than some of these other issues, which is a contributing factor in the lower rate of improvement.” TH

Tom Collins is a freelance writer in South Florida.

U.S. hospitals in 2011 showed improvements in their rates of central line-associated bloodstream infections (CLABSI) and in some surgical-site infections, compared with 2010, but the rate essentially hit a plateau for catheter-associated urinary tract infections (CAUTI), according to a new CDC report.

“Reductions in some of the deadliest healthcare-associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” CDC director Thomas R. Frieden, MD, MPH, says. “However, the slower progress in reducing catheter-associated urinary tract infections is a call to action for hospitals to redouble their efforts to track these infections and implement control strategies we know that work.”

The report showed a 41% reduction in 2011 central-line infections compared with 2008, the baseline year for the report. In 2010, the reduction was 32% over the 2008 baseline. The improvement was seen across ICUs, general wards, and neonatal ICUs.

“I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI. No single strategy used in isolation is going to be effective.”

—Scott Flanders, MD, SFHM, professor of medicine, director of hospital medicine, University of Michigan Health System, Ann Arbor, former SHM president

The CDC also reported a 17% drop in surgical-site infections since 2008, better than the 7% reduction in 2010. The biggest reductions were seen in coronary artery bypass graft surgery and cardiac surgery; little improvement was seen in infections from hip arthroplasty and vaginal hysterectomy procedures.

The rate of infections from CAUTIs was 7%, nearly the same as the 6% rate in 2010 data. The infection rate in ICUs actually went up—a 1% drop in 2011 compared with a 3% drop from baseline in 2010.

SHM is a partner in two initiatives that aim to reduce CAUTI infections: the University HealthSystems Consortium’s Partnership for Patients project and On the CUSP: STOP CAUTI, an American Hospital Association HRET effort that’s funded by the Agency for Healthcare Research and Quality-funded project.

Gregory Maynard, MD, SFHM, director of hospital medicine at the University of San Diego Medical Center and senior vice president of SHM’s Center for Healthcare Improvement and Innovation is encouraged by the CLABSI and SSI figures. The report highlights the need for more effort on CAUTI.

“I think all the tools and information are available for improvement teams,” he says. “The CDC, the HRET On the CUSP group, and others all have great toolkits.”

He also says it was telling that the CAUTI numbers were worse in the ICU than in general wards.

“The more complex the environment, the easier it is for those things to get lost,” he says. “It just will probably take more attention to it and making it more of a priority.

“The more complex the environment, the easier it is for those things to get lost. It just will probably take more attention to it and making it more of a priority…. We’re supposed to reduce these adverse events by a very significant amount and obviously we’re not getting there based on this report. We have to do a better job. Reducing CAUTI by 40% is one of goals for the $500 million Partnerships for Patients effort. With that much money involved, it should increase the pressure to get this done.”

Click here to hear more of Dr. Maynard's interview with The Hospitalist

Scott Flanders, MD, SFHM, a former SHM president and SHM’s physician leader for STOP CAUTI, says the report shows that CAUTIs may be more difficult to prevent. In part, that is because catheters are used more broadly throughout a hospital than, say, central lines, which are most common in ICUs.

It takes a multi-disciplinary team implementing a variety of tools: critieria for putting catheters in, managing them appropriately once they are in, and developing protocols for removing them as quickly as possible, he adds.

“Having all those elements in place are critical to preventing CAUTI and I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI,” says Dr. Flanders, professor of medicine and director of hospital medicine at the University of Michigan Health System in Ann Arbor. “No single strategy used in isolation is going to be effective.”

Efforts to reduce CAUTIs have been launched more recently than efforts to reduce other infection types, he says.

“There’s been less of a drive for CAUTI,” he says. “It’s a tougher problem to tackle than some of these other issues, which is a contributing factor in the lower rate of improvement.” TH

Tom Collins is a freelance writer in South Florida.

If you’ve ever heard someone say, "I’ve been pinning for an hour. I’m addicted!" and had no idea what this person was talking about, I have one word for you: Pinterest.

Pinterest is a fabulously popular social media site that allows users to find, share, and organize images called "pins" that are displayed or "pinned" on electronic "boards." A "board" is like a digital folder that helps you organize your pins. For example, you might have boards for Healthy Recipes, Exercise, and Places I’ve Traveled. Images are uploaded from the web or from your own computer or smartphone. Since it’s social, users can "like" other people’s pins, comment on them, and "repin" or share them. They can also add friends and become part of a "pin group board," where you and selected others upload pins to the shared boards.

Why is this important for you and your medical practice? Pinterest is one of the fastest-growing social media sites in history. It launched in March 2010, and by October 2012 it had reached more than 25,000,000 active monthly users and debuted on the list of top 50 most-visited web sites in the United States.

According to the Pew Research Center, 72% of adults who are online are searching for health, and Pinterest is another social media channel you can use to reach them. If you’re thinking, "But I already do Twitter and Facebook," consider this: Approximately 80% of Pinterest users are female and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. See the connection? It’s not farfetched to posit that Pinterest may turn out to be one of the most effective social media sites for the health care industry.

Because many people are visual learners, Pinterest can be an effective tool for patient education. Several renowned institutions, including St. Jude Children’s Hospital and the Mayo Clinic, use Pinterest effectively to educate the public, share patient stories, and discuss newsworthy topics.

As physicians, you can use Pinterest similarly to build your brand and help market your practice more creatively.

You’ll find that Pinterest is very easy to learn and use. And because it’s a visual site with little to no text, it requires minimal effort on your part, or your staff’s part. A few minutes per day or every few days are sufficient to establish a presence and make connections.

There are many ways you can use Pinterest to build brand awareness and reach patients. Here are a few:

• Explain how medical or cosmetic procedures work, such as fillers and sclerotherapy.

• Explain how medical devices work, such as lasers and dermatoscopes.

• Generate awareness of medical conditions, such as psoriasis, eczema, and skin cancers. Infographics are especially effective.

• Provide inspiration. Many skin conditions are psychologically challenging. Pinning inspirational images can give patients hope.

• Share your product recommendations.

• Share uplifting patient stories and testimonials.

• Introduce and update the public to you, your staff, your office, and your services.

As for creating pin boards, the categories are endless, but here are some ideas to get you started: Patient Stories, Healthy Skin Habits, Sun Safety, Before and After, Acne Tips, Cosmetic Services, Parenting Tips, Words of Inspiration, and Meet Our Staff.

If you haven’t been on Pinterest yet, take a visit there and explore what it has to offer. And don’t be surprised if you become addicted.

Dr. Benabio is physician director at Kaiser Permanente in San Diego. Visit his consumer health blog at thedermblog.com; connect with him on Twitter @Dermdoc, and on Facebook (DermDoc).

If you’ve ever heard someone say, "I’ve been pinning for an hour. I’m addicted!" and had no idea what this person was talking about, I have one word for you: Pinterest.

Pinterest is a fabulously popular social media site that allows users to find, share, and organize images called "pins" that are displayed or "pinned" on electronic "boards." A "board" is like a digital folder that helps you organize your pins. For example, you might have boards for Healthy Recipes, Exercise, and Places I’ve Traveled. Images are uploaded from the web or from your own computer or smartphone. Since it’s social, users can "like" other people’s pins, comment on them, and "repin" or share them. They can also add friends and become part of a "pin group board," where you and selected others upload pins to the shared boards.

Why is this important for you and your medical practice? Pinterest is one of the fastest-growing social media sites in history. It launched in March 2010, and by October 2012 it had reached more than 25,000,000 active monthly users and debuted on the list of top 50 most-visited web sites in the United States.

According to the Pew Research Center, 72% of adults who are online are searching for health, and Pinterest is another social media channel you can use to reach them. If you’re thinking, "But I already do Twitter and Facebook," consider this: Approximately 80% of Pinterest users are female and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. See the connection? It’s not farfetched to posit that Pinterest may turn out to be one of the most effective social media sites for the health care industry.

Because many people are visual learners, Pinterest can be an effective tool for patient education. Several renowned institutions, including St. Jude Children’s Hospital and the Mayo Clinic, use Pinterest effectively to educate the public, share patient stories, and discuss newsworthy topics.

As physicians, you can use Pinterest similarly to build your brand and help market your practice more creatively.

You’ll find that Pinterest is very easy to learn and use. And because it’s a visual site with little to no text, it requires minimal effort on your part, or your staff’s part. A few minutes per day or every few days are sufficient to establish a presence and make connections.

There are many ways you can use Pinterest to build brand awareness and reach patients. Here are a few:

• Explain how medical or cosmetic procedures work, such as fillers and sclerotherapy.

• Explain how medical devices work, such as lasers and dermatoscopes.

• Generate awareness of medical conditions, such as psoriasis, eczema, and skin cancers. Infographics are especially effective.

• Provide inspiration. Many skin conditions are psychologically challenging. Pinning inspirational images can give patients hope.

• Share your product recommendations.

• Share uplifting patient stories and testimonials.

• Introduce and update the public to you, your staff, your office, and your services.

As for creating pin boards, the categories are endless, but here are some ideas to get you started: Patient Stories, Healthy Skin Habits, Sun Safety, Before and After, Acne Tips, Cosmetic Services, Parenting Tips, Words of Inspiration, and Meet Our Staff.

If you haven’t been on Pinterest yet, take a visit there and explore what it has to offer. And don’t be surprised if you become addicted.

Dr. Benabio is physician director at Kaiser Permanente in San Diego. Visit his consumer health blog at thedermblog.com; connect with him on Twitter @Dermdoc, and on Facebook (DermDoc).

If you’ve ever heard someone say, "I’ve been pinning for an hour. I’m addicted!" and had no idea what this person was talking about, I have one word for you: Pinterest.

Pinterest is a fabulously popular social media site that allows users to find, share, and organize images called "pins" that are displayed or "pinned" on electronic "boards." A "board" is like a digital folder that helps you organize your pins. For example, you might have boards for Healthy Recipes, Exercise, and Places I’ve Traveled. Images are uploaded from the web or from your own computer or smartphone. Since it’s social, users can "like" other people’s pins, comment on them, and "repin" or share them. They can also add friends and become part of a "pin group board," where you and selected others upload pins to the shared boards.

Why is this important for you and your medical practice? Pinterest is one of the fastest-growing social media sites in history. It launched in March 2010, and by October 2012 it had reached more than 25,000,000 active monthly users and debuted on the list of top 50 most-visited web sites in the United States.

According to the Pew Research Center, 72% of adults who are online are searching for health, and Pinterest is another social media channel you can use to reach them. If you’re thinking, "But I already do Twitter and Facebook," consider this: Approximately 80% of Pinterest users are female and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. See the connection? It’s not farfetched to posit that Pinterest may turn out to be one of the most effective social media sites for the health care industry.

Because many people are visual learners, Pinterest can be an effective tool for patient education. Several renowned institutions, including St. Jude Children’s Hospital and the Mayo Clinic, use Pinterest effectively to educate the public, share patient stories, and discuss newsworthy topics.

As physicians, you can use Pinterest similarly to build your brand and help market your practice more creatively.

You’ll find that Pinterest is very easy to learn and use. And because it’s a visual site with little to no text, it requires minimal effort on your part, or your staff’s part. A few minutes per day or every few days are sufficient to establish a presence and make connections.

There are many ways you can use Pinterest to build brand awareness and reach patients. Here are a few:

• Explain how medical or cosmetic procedures work, such as fillers and sclerotherapy.

• Explain how medical devices work, such as lasers and dermatoscopes.

• Generate awareness of medical conditions, such as psoriasis, eczema, and skin cancers. Infographics are especially effective.

• Provide inspiration. Many skin conditions are psychologically challenging. Pinning inspirational images can give patients hope.

• Share your product recommendations.

• Share uplifting patient stories and testimonials.

• Introduce and update the public to you, your staff, your office, and your services.

As for creating pin boards, the categories are endless, but here are some ideas to get you started: Patient Stories, Healthy Skin Habits, Sun Safety, Before and After, Acne Tips, Cosmetic Services, Parenting Tips, Words of Inspiration, and Meet Our Staff.

If you haven’t been on Pinterest yet, take a visit there and explore what it has to offer. And don’t be surprised if you become addicted.

Dr. Benabio is physician director at Kaiser Permanente in San Diego. Visit his consumer health blog at thedermblog.com; connect with him on Twitter @Dermdoc, and on Facebook (DermDoc).

WARSAW—Recombinant Fc fusion proteins can provide long-lasting protection from bleeding in patients with hemophilia A or B, according to data presented at the 6th Annual Congress of the European Association for Haemophilia and Allied Disorders.

Data from the phase 3 A-LONG study indicated that patients with hemophilia A could maintain low bleeding rates with once- to twice-weekly prophylactic injections of a recombinant factor VIII Fc fusion protein (rFVIIIFc, efmoroctocog alfa/Elocta, Eloctate).

Similarly, results of the phase 3 B-LONG study showed that patients with hemophilia B had low bleeding rates when they received prophylactic injections of a recombinant factor IX Fc fusion protein (rFIXFc, eftrenonacog alfa/Alprolix) every 1 to 2 weeks.

Both studies were sponsored by the companies developing these factors, Biogen Idec and Swedish Orphan Biovitrum (Sobi).

A-LONG data

In the A-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFVIIIFc in 165 male patients aged 12 years and older. The team found that 98% of bleeding episodes were controlled by 1 or 2 injections of rFVIIIFc.

The factor was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or higher) were nasopharyngitis, arthralgia, headache, and upper respiratory tract infection.

The study also showed that rFVIIIFc stays in the body for 50% longer than Advate [antihemophilic factor (recombinant), plasma/albumin-free method], the most frequently used factor VIII therapy. The terminal half-life for rFVIIIFc was 19 hours, compared to 12 hours for Advate.

Additionally, the mean time for maintaining a clotting factor activity level associated with less bleeding (time to 1%) was approximately 5 days for rFVIIIFc, compared to 3.5 days for Advate. And the average rate at which rFVIIIFc was cleared from the body was 2.0 mL/hr/kg, compared with 3.0 mL/hr/kg for Advate.

In the study’s individualized prophylaxis arm, patients received rFVIIIFc at a median dosing interval of 3.5 days and a median weekly dose of 78 IU/kg to prevent bleeding, which compares favorably to the recommended dose for the standard of care. Nearly one-third of patients were able to achieve every-5-days dosing in this arm.

The A-LONG data were presented in the late-breaking oral abstract session and in poster 104, “Phase 3 clinical study of recombinant FC fusion factor FVIII (rFVIIIFc) demonstrated safety, efficacy, and improved pharmacokinetics (A-LONG).”

B-LONG data

In the B-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFIXFc in 123 male patients aged 12 years and older. The team found that more than 90% of bleeding episodes were controlled by a single injection of rFIXFc.

rFIXFc was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or more) were nasopharyngitis, influenza, arthralgia, upper respiratory infection, hypertension, and headache.

One serious adverse event, obstructive uropathy in the setting of hematuria, may have been related to rFIXFc treatment. However, the patient continued to receive rFIXFc, and the event resolved with medical management.

The study also showed that rFIXFc stays in the body more than twice as long as BeneFIX [Coagulation Factor IX (Recombinant)], the only recombinant factor IX therapy currently approved for prophylactic use. The terminal half-life for rFIXFc was 82 hours, compared to 34 hours for BeneFIX.

In addition, the mean time for maintaining a normal clotting factor activity level (time to 1%) was 11 days for rFIXFc, compared to 5 days for BeneFIX. And the average rate at which rFIXFc was cleared from the body was 3.2 mL/hr/kg, compared with 6.3 mL/hr/kg for BeneFIX.

All patients in the individualized interval prophylaxis arm of the study were able to go at least 1 week between rFIXFc injections, and 50% could go 14 days or longer before needing another dose to prevent bleeding. The median weekly dose was 45 IU/kg, which is comparable to the recommended dose for the current standard of care.

The B-LONG data were presented in poster 115, “Safety, efficacy, and improved pharmacokinetics (PK) demonstrated in a phase 3 clinical trial of extended half-life recombinant FC fusion factor IX (B-LONG).”

WARSAW—Recombinant Fc fusion proteins can provide long-lasting protection from bleeding in patients with hemophilia A or B, according to data presented at the 6th Annual Congress of the European Association for Haemophilia and Allied Disorders.

Data from the phase 3 A-LONG study indicated that patients with hemophilia A could maintain low bleeding rates with once- to twice-weekly prophylactic injections of a recombinant factor VIII Fc fusion protein (rFVIIIFc, efmoroctocog alfa/Elocta, Eloctate).

Similarly, results of the phase 3 B-LONG study showed that patients with hemophilia B had low bleeding rates when they received prophylactic injections of a recombinant factor IX Fc fusion protein (rFIXFc, eftrenonacog alfa/Alprolix) every 1 to 2 weeks.

Both studies were sponsored by the companies developing these factors, Biogen Idec and Swedish Orphan Biovitrum (Sobi).

A-LONG data

In the A-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFVIIIFc in 165 male patients aged 12 years and older. The team found that 98% of bleeding episodes were controlled by 1 or 2 injections of rFVIIIFc.

The factor was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or higher) were nasopharyngitis, arthralgia, headache, and upper respiratory tract infection.

The study also showed that rFVIIIFc stays in the body for 50% longer than Advate [antihemophilic factor (recombinant), plasma/albumin-free method], the most frequently used factor VIII therapy. The terminal half-life for rFVIIIFc was 19 hours, compared to 12 hours for Advate.

Additionally, the mean time for maintaining a clotting factor activity level associated with less bleeding (time to 1%) was approximately 5 days for rFVIIIFc, compared to 3.5 days for Advate. And the average rate at which rFVIIIFc was cleared from the body was 2.0 mL/hr/kg, compared with 3.0 mL/hr/kg for Advate.

In the study’s individualized prophylaxis arm, patients received rFVIIIFc at a median dosing interval of 3.5 days and a median weekly dose of 78 IU/kg to prevent bleeding, which compares favorably to the recommended dose for the standard of care. Nearly one-third of patients were able to achieve every-5-days dosing in this arm.

The A-LONG data were presented in the late-breaking oral abstract session and in poster 104, “Phase 3 clinical study of recombinant FC fusion factor FVIII (rFVIIIFc) demonstrated safety, efficacy, and improved pharmacokinetics (A-LONG).”

B-LONG data

In the B-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFIXFc in 123 male patients aged 12 years and older. The team found that more than 90% of bleeding episodes were controlled by a single injection of rFIXFc.

rFIXFc was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or more) were nasopharyngitis, influenza, arthralgia, upper respiratory infection, hypertension, and headache.

One serious adverse event, obstructive uropathy in the setting of hematuria, may have been related to rFIXFc treatment. However, the patient continued to receive rFIXFc, and the event resolved with medical management.

The study also showed that rFIXFc stays in the body more than twice as long as BeneFIX [Coagulation Factor IX (Recombinant)], the only recombinant factor IX therapy currently approved for prophylactic use. The terminal half-life for rFIXFc was 82 hours, compared to 34 hours for BeneFIX.

In addition, the mean time for maintaining a normal clotting factor activity level (time to 1%) was 11 days for rFIXFc, compared to 5 days for BeneFIX. And the average rate at which rFIXFc was cleared from the body was 3.2 mL/hr/kg, compared with 6.3 mL/hr/kg for BeneFIX.

All patients in the individualized interval prophylaxis arm of the study were able to go at least 1 week between rFIXFc injections, and 50% could go 14 days or longer before needing another dose to prevent bleeding. The median weekly dose was 45 IU/kg, which is comparable to the recommended dose for the current standard of care.

The B-LONG data were presented in poster 115, “Safety, efficacy, and improved pharmacokinetics (PK) demonstrated in a phase 3 clinical trial of extended half-life recombinant FC fusion factor IX (B-LONG).”

WARSAW—Recombinant Fc fusion proteins can provide long-lasting protection from bleeding in patients with hemophilia A or B, according to data presented at the 6th Annual Congress of the European Association for Haemophilia and Allied Disorders.

Data from the phase 3 A-LONG study indicated that patients with hemophilia A could maintain low bleeding rates with once- to twice-weekly prophylactic injections of a recombinant factor VIII Fc fusion protein (rFVIIIFc, efmoroctocog alfa/Elocta, Eloctate).

Similarly, results of the phase 3 B-LONG study showed that patients with hemophilia B had low bleeding rates when they received prophylactic injections of a recombinant factor IX Fc fusion protein (rFIXFc, eftrenonacog alfa/Alprolix) every 1 to 2 weeks.

Both studies were sponsored by the companies developing these factors, Biogen Idec and Swedish Orphan Biovitrum (Sobi).

A-LONG data

In the A-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFVIIIFc in 165 male patients aged 12 years and older. The team found that 98% of bleeding episodes were controlled by 1 or 2 injections of rFVIIIFc.

The factor was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or higher) were nasopharyngitis, arthralgia, headache, and upper respiratory tract infection.

The study also showed that rFVIIIFc stays in the body for 50% longer than Advate [antihemophilic factor (recombinant), plasma/albumin-free method], the most frequently used factor VIII therapy. The terminal half-life for rFVIIIFc was 19 hours, compared to 12 hours for Advate.

Additionally, the mean time for maintaining a clotting factor activity level associated with less bleeding (time to 1%) was approximately 5 days for rFVIIIFc, compared to 3.5 days for Advate. And the average rate at which rFVIIIFc was cleared from the body was 2.0 mL/hr/kg, compared with 3.0 mL/hr/kg for Advate.

In the study’s individualized prophylaxis arm, patients received rFVIIIFc at a median dosing interval of 3.5 days and a median weekly dose of 78 IU/kg to prevent bleeding, which compares favorably to the recommended dose for the standard of care. Nearly one-third of patients were able to achieve every-5-days dosing in this arm.

The A-LONG data were presented in the late-breaking oral abstract session and in poster 104, “Phase 3 clinical study of recombinant FC fusion factor FVIII (rFVIIIFc) demonstrated safety, efficacy, and improved pharmacokinetics (A-LONG).”

B-LONG data

In the B-LONG study, researchers evaluated the efficacy, safety, and pharmacokinetics of intravenous rFIXFc in 123 male patients aged 12 years and older. The team found that more than 90% of bleeding episodes were controlled by a single injection of rFIXFc.

rFIXFc was generally well-tolerated, and no inhibitors were detected. The most common adverse events (with an incidence of 5% or more) were nasopharyngitis, influenza, arthralgia, upper respiratory infection, hypertension, and headache.

One serious adverse event, obstructive uropathy in the setting of hematuria, may have been related to rFIXFc treatment. However, the patient continued to receive rFIXFc, and the event resolved with medical management.

The study also showed that rFIXFc stays in the body more than twice as long as BeneFIX [Coagulation Factor IX (Recombinant)], the only recombinant factor IX therapy currently approved for prophylactic use. The terminal half-life for rFIXFc was 82 hours, compared to 34 hours for BeneFIX.

In addition, the mean time for maintaining a normal clotting factor activity level (time to 1%) was 11 days for rFIXFc, compared to 5 days for BeneFIX. And the average rate at which rFIXFc was cleared from the body was 3.2 mL/hr/kg, compared with 6.3 mL/hr/kg for BeneFIX.

All patients in the individualized interval prophylaxis arm of the study were able to go at least 1 week between rFIXFc injections, and 50% could go 14 days or longer before needing another dose to prevent bleeding. The median weekly dose was 45 IU/kg, which is comparable to the recommended dose for the current standard of care.

The B-LONG data were presented in poster 115, “Safety, efficacy, and improved pharmacokinetics (PK) demonstrated in a phase 3 clinical trial of extended half-life recombinant FC fusion factor IX (B-LONG).”

Chronic suppurative otitis media remains a global burden for children despite the declining incidence in industrialized countries and advances in diagnosis and management in developing countries. The World Health Organization cites chronic suppurative otitis media (CSOM) as a major cause of acquired hearing loss, primarily in developing countries and indigenous peoples.

CSOM is characterized by a persistent discharge from the middle ear lasting for a minimum of 2 weeks. In industrialized countries, the major risk factor is tympanostomy tube placement; in developing nations, the major risk factor is early bacterial colonization with Streptococcus pneumoniae and nontypable Haemophilus influenzae and early onset of acute bacterial otitis media with perforation. In both situations, biofilms are thought to underlie the pathogenesis with S. pneumoniae and nontypable H. influenzae found on mucosal biopsies using specific fluorescent in situ hybridization assays on specimens from children with chronic suppurative otitis media or recurrent acute otitis media (ROM). Dr. Ruth B. Thornton and her colleagues reported that 11 of 17 (65%) middle-ear mucosal biopsies from children with CSOM or ROM showed evidence of bacterial biofilm, and 12 (71%) demonstrated intracellular bacteria (Pediatrics 2011;11:94).

Microbiologic studies in children with otorrhea, through either a perforation or tympanostomy tube, demonstrate primarily Staphylococcus aureus, both methicillin sensitive and resistant isolates, and Pseudomonas aeruginosa. However, it is recognized that the early pathogens are S. pneumoniae and nontypable H. influenzae in these children recovered both from cultures of ear drainage and from molecular studies of middle-ear mucosal biopsies. Amanda J. Leach, Ph.D., and Peter S. Morris, Ph.D., reported that cultures from ear discharge in Aborigine children with acute perforations identified nontypable H. influenzae in 57%, S. pneumoniae in 34%, and both in 21% (Pediatr. Inf. Dis. J. 2007;26:S4-7).

The high rate of mixed infection has also been reported in Bedouin children with recurrent and persistent otitis. In children with otorrhea from a tympanostomy tube, a dichotomy in microbiology etiology was found. In young children, nasopharyngeal pathogens (S. pneumoniae and nontypable H. influenzae) dominated and in older children, external ear commensals (Staph. aureus and P. aeruginosa) predominated (Int. J. Pediatr. Otorhinolaryngol. 2003;67:1317-23).

In industrialized countries, successful treatment of young children with otorrhea through a tympanostomy tube has been reported with both oral amoxicillin/clavulanate and topical fluoroquinolones, reflecting the frequent role of S. pneumoniae and nontypable H. influenzae in young children. However, in older children, in those with foul-smelling discharge, and in those who fail amoxicillin/clavulanate, topical fluoroquinolone is the treatment of choice. Guidelines for the treatment of otorrhea through a tympanostomy tube have been published with a recommendation that topical therapy be used as the first choice when systemic signs of illness are not present (J. Otolaryngol. 2005;34[suppl. 2]:S60-3). Treatment failures are most often due to methicillin-resistant Staph. aureus (MRSA) and often require a combination of oral therapy with an agent active against MRSA such as trimethoprim/sulfamethoxazole and topical therapy with a fluoroquinolone; removal of the tympanostomy tube also may be necessary to achieve a cure.

The prevention of chronic suppurative otitis media has proven elusive. Studies of 7-valent pneumococcal conjugate (PCV7) vaccine in Dutch children with established ROM demonstrated no reduction in episodes. In fact, more episodes of AOM or otorrhea were observed in the vaccine group, despite good immunogenicity and a reduction in colonization with vaccine-type S. pneumoniae (Int. J. Pediatr. Otorhinolaryngol. 2006;70:275-85).

In studies of PCV7 administered at 2, 4, and 6 months of age to Aborigine infants, only a marginal benefit was observed when they were compared with a historical birth cohort. By 12 months of age, 89% of those vaccinated had experienced AOM; 34%, AOM with perforation; and 14%, CSOM. Although not statistically significant, this represented a 40% decrease in CSOM at 1 year of age (BMC Pediatr. 2009;9:14).

CSOM persists as an important cause of morbidity in indigenous children and in children in developing countries. It is a major cause of acquired hearing loss and impacts dramatically on the quality of life of affected children. We have made important advances in identifying the bacterial antecedents and understanding the pathogenesis of disease, yet morbidity remains substantial. Further research in the treatment and prevention of middle-ear biofilms is likely to be critical to reducing the burden of ear disease in children.

Dr. Pelton is chief of pediatric infectious disease and also is the coordinator of the maternal-child HIV program at Boston Medical Center. He disclosed that he has received honoraria and investigator-initiated research funding from Pfizer and Merck, and honoraria from GlaxoSmithKline related to pneumococcal vaccines. E-mail him at pdnews@elsevier.com.  

Chronic suppurative otitis media remains a global burden for children despite the declining incidence in industrialized countries and advances in diagnosis and management in developing countries. The World Health Organization cites chronic suppurative otitis media (CSOM) as a major cause of acquired hearing loss, primarily in developing countries and indigenous peoples.

CSOM is characterized by a persistent discharge from the middle ear lasting for a minimum of 2 weeks. In industrialized countries, the major risk factor is tympanostomy tube placement; in developing nations, the major risk factor is early bacterial colonization with Streptococcus pneumoniae and nontypable Haemophilus influenzae and early onset of acute bacterial otitis media with perforation. In both situations, biofilms are thought to underlie the pathogenesis with S. pneumoniae and nontypable H. influenzae found on mucosal biopsies using specific fluorescent in situ hybridization assays on specimens from children with chronic suppurative otitis media or recurrent acute otitis media (ROM). Dr. Ruth B. Thornton and her colleagues reported that 11 of 17 (65%) middle-ear mucosal biopsies from children with CSOM or ROM showed evidence of bacterial biofilm, and 12 (71%) demonstrated intracellular bacteria (Pediatrics 2011;11:94).

Microbiologic studies in children with otorrhea, through either a perforation or tympanostomy tube, demonstrate primarily Staphylococcus aureus, both methicillin sensitive and resistant isolates, and Pseudomonas aeruginosa. However, it is recognized that the early pathogens are S. pneumoniae and nontypable H. influenzae in these children recovered both from cultures of ear drainage and from molecular studies of middle-ear mucosal biopsies. Amanda J. Leach, Ph.D., and Peter S. Morris, Ph.D., reported that cultures from ear discharge in Aborigine children with acute perforations identified nontypable H. influenzae in 57%, S. pneumoniae in 34%, and both in 21% (Pediatr. Inf. Dis. J. 2007;26:S4-7).

The high rate of mixed infection has also been reported in Bedouin children with recurrent and persistent otitis. In children with otorrhea from a tympanostomy tube, a dichotomy in microbiology etiology was found. In young children, nasopharyngeal pathogens (S. pneumoniae and nontypable H. influenzae) dominated and in older children, external ear commensals (Staph. aureus and P. aeruginosa) predominated (Int. J. Pediatr. Otorhinolaryngol. 2003;67:1317-23).

In industrialized countries, successful treatment of young children with otorrhea through a tympanostomy tube has been reported with both oral amoxicillin/clavulanate and topical fluoroquinolones, reflecting the frequent role of S. pneumoniae and nontypable H. influenzae in young children. However, in older children, in those with foul-smelling discharge, and in those who fail amoxicillin/clavulanate, topical fluoroquinolone is the treatment of choice. Guidelines for the treatment of otorrhea through a tympanostomy tube have been published with a recommendation that topical therapy be used as the first choice when systemic signs of illness are not present (J. Otolaryngol. 2005;34[suppl. 2]:S60-3). Treatment failures are most often due to methicillin-resistant Staph. aureus (MRSA) and often require a combination of oral therapy with an agent active against MRSA such as trimethoprim/sulfamethoxazole and topical therapy with a fluoroquinolone; removal of the tympanostomy tube also may be necessary to achieve a cure.

The prevention of chronic suppurative otitis media has proven elusive. Studies of 7-valent pneumococcal conjugate (PCV7) vaccine in Dutch children with established ROM demonstrated no reduction in episodes. In fact, more episodes of AOM or otorrhea were observed in the vaccine group, despite good immunogenicity and a reduction in colonization with vaccine-type S. pneumoniae (Int. J. Pediatr. Otorhinolaryngol. 2006;70:275-85).

In studies of PCV7 administered at 2, 4, and 6 months of age to Aborigine infants, only a marginal benefit was observed when they were compared with a historical birth cohort. By 12 months of age, 89% of those vaccinated had experienced AOM; 34%, AOM with perforation; and 14%, CSOM. Although not statistically significant, this represented a 40% decrease in CSOM at 1 year of age (BMC Pediatr. 2009;9:14).

CSOM persists as an important cause of morbidity in indigenous children and in children in developing countries. It is a major cause of acquired hearing loss and impacts dramatically on the quality of life of affected children. We have made important advances in identifying the bacterial antecedents and understanding the pathogenesis of disease, yet morbidity remains substantial. Further research in the treatment and prevention of middle-ear biofilms is likely to be critical to reducing the burden of ear disease in children.

Dr. Pelton is chief of pediatric infectious disease and also is the coordinator of the maternal-child HIV program at Boston Medical Center. He disclosed that he has received honoraria and investigator-initiated research funding from Pfizer and Merck, and honoraria from GlaxoSmithKline related to pneumococcal vaccines. E-mail him at pdnews@elsevier.com.  

Chronic suppurative otitis media remains a global burden for children despite the declining incidence in industrialized countries and advances in diagnosis and management in developing countries. The World Health Organization cites chronic suppurative otitis media (CSOM) as a major cause of acquired hearing loss, primarily in developing countries and indigenous peoples.

CSOM is characterized by a persistent discharge from the middle ear lasting for a minimum of 2 weeks. In industrialized countries, the major risk factor is tympanostomy tube placement; in developing nations, the major risk factor is early bacterial colonization with Streptococcus pneumoniae and nontypable Haemophilus influenzae and early onset of acute bacterial otitis media with perforation. In both situations, biofilms are thought to underlie the pathogenesis with S. pneumoniae and nontypable H. influenzae found on mucosal biopsies using specific fluorescent in situ hybridization assays on specimens from children with chronic suppurative otitis media or recurrent acute otitis media (ROM). Dr. Ruth B. Thornton and her colleagues reported that 11 of 17 (65%) middle-ear mucosal biopsies from children with CSOM or ROM showed evidence of bacterial biofilm, and 12 (71%) demonstrated intracellular bacteria (Pediatrics 2011;11:94).

Microbiologic studies in children with otorrhea, through either a perforation or tympanostomy tube, demonstrate primarily Staphylococcus aureus, both methicillin sensitive and resistant isolates, and Pseudomonas aeruginosa. However, it is recognized that the early pathogens are S. pneumoniae and nontypable H. influenzae in these children recovered both from cultures of ear drainage and from molecular studies of middle-ear mucosal biopsies. Amanda J. Leach, Ph.D., and Peter S. Morris, Ph.D., reported that cultures from ear discharge in Aborigine children with acute perforations identified nontypable H. influenzae in 57%, S. pneumoniae in 34%, and both in 21% (Pediatr. Inf. Dis. J. 2007;26:S4-7).

The high rate of mixed infection has also been reported in Bedouin children with recurrent and persistent otitis. In children with otorrhea from a tympanostomy tube, a dichotomy in microbiology etiology was found. In young children, nasopharyngeal pathogens (S. pneumoniae and nontypable H. influenzae) dominated and in older children, external ear commensals (Staph. aureus and P. aeruginosa) predominated (Int. J. Pediatr. Otorhinolaryngol. 2003;67:1317-23).

In industrialized countries, successful treatment of young children with otorrhea through a tympanostomy tube has been reported with both oral amoxicillin/clavulanate and topical fluoroquinolones, reflecting the frequent role of S. pneumoniae and nontypable H. influenzae in young children. However, in older children, in those with foul-smelling discharge, and in those who fail amoxicillin/clavulanate, topical fluoroquinolone is the treatment of choice. Guidelines for the treatment of otorrhea through a tympanostomy tube have been published with a recommendation that topical therapy be used as the first choice when systemic signs of illness are not present (J. Otolaryngol. 2005;34[suppl. 2]:S60-3). Treatment failures are most often due to methicillin-resistant Staph. aureus (MRSA) and often require a combination of oral therapy with an agent active against MRSA such as trimethoprim/sulfamethoxazole and topical therapy with a fluoroquinolone; removal of the tympanostomy tube also may be necessary to achieve a cure.

The prevention of chronic suppurative otitis media has proven elusive. Studies of 7-valent pneumococcal conjugate (PCV7) vaccine in Dutch children with established ROM demonstrated no reduction in episodes. In fact, more episodes of AOM or otorrhea were observed in the vaccine group, despite good immunogenicity and a reduction in colonization with vaccine-type S. pneumoniae (Int. J. Pediatr. Otorhinolaryngol. 2006;70:275-85).

In studies of PCV7 administered at 2, 4, and 6 months of age to Aborigine infants, only a marginal benefit was observed when they were compared with a historical birth cohort. By 12 months of age, 89% of those vaccinated had experienced AOM; 34%, AOM with perforation; and 14%, CSOM. Although not statistically significant, this represented a 40% decrease in CSOM at 1 year of age (BMC Pediatr. 2009;9:14).

CSOM persists as an important cause of morbidity in indigenous children and in children in developing countries. It is a major cause of acquired hearing loss and impacts dramatically on the quality of life of affected children. We have made important advances in identifying the bacterial antecedents and understanding the pathogenesis of disease, yet morbidity remains substantial. Further research in the treatment and prevention of middle-ear biofilms is likely to be critical to reducing the burden of ear disease in children.

Dr. Pelton is chief of pediatric infectious disease and also is the coordinator of the maternal-child HIV program at Boston Medical Center. He disclosed that he has received honoraria and investigator-initiated research funding from Pfizer and Merck, and honoraria from GlaxoSmithKline related to pneumococcal vaccines. E-mail him at pdnews@elsevier.com.