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Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

---

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

---

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

---

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

NEW YORK (Reuters Health) - Dabigatran and warfarin offer similar stroke-prevention efficacy in patients with atrial fibrillation (AF), but their side effect profiles differ, according to a systematic review and meta-analysis of real-world clinical practice.

"There could be many reasons for the differences in our findings, such as differences in the quality of evidence of observational studies and randomized controlled trials (RCTs) or differences in the included study populations between the observational studies in our review and the RE-LY trial," Dr. Robert J. Romanelli from Palo Alto Medical Foundation Research Institute, California, told Reuters Health by email.

The RE-LY trial is the only RCT to have evaluated dabigatran in stroke prevention, and RCTs are prone to selection biases less likely to be present in well designed observational studies, Dr. Romanelli and colleagues note in Circulation:Cardiovascular and Quality Outcomes, online January 26.

The team used data from seven retrospective cohort studies to compare the effectiveness and safety of dabigatran and warfarin among more than 348,750 patients with nonvalvular AF.

During an overall mean follow-up of 794 days, dabigatran 150mg or 110 mg was similar to warfarin in ischemic stroke prevention.

Both the higher and lower dabigatran doses had significantly lower hazards of intracranial bleeding compared with warfarin (pooled hazard ratio, 0.44 and 0.49, respectively). But the hazard of gastrointestinal bleeding was significantly greater for dabigatran 150 mg (but not for 110 mg) than for warfarin (pHR, 1.23). The 110 mg dose of dabigatran was only available during the trial; it's now sold in 150 mg or 75 mg capsules.

The increased risk of gastrointestinal bleeding with the higher dose of dabigatran was significant only in older populations (75 years or older).

"Data presented in this review reflect relative risk, which is not always clinically meaningful," the researchers caution. "It is important to bear in mind that event rates for the outcome of interest are low under standard treatment."

"I don't think the findings from this one reviewshould change clinical practice," Dr. Romanelli said. "If anything, this study revealed areas for future research.

 

 

 

 

 

NEW YORK (Reuters Health) - Dabigatran and warfarin offer similar stroke-prevention efficacy in patients with atrial fibrillation (AF), but their side effect profiles differ, according to a systematic review and meta-analysis of real-world clinical practice.

"There could be many reasons for the differences in our findings, such as differences in the quality of evidence of observational studies and randomized controlled trials (RCTs) or differences in the included study populations between the observational studies in our review and the RE-LY trial," Dr. Robert J. Romanelli from Palo Alto Medical Foundation Research Institute, California, told Reuters Health by email.

The RE-LY trial is the only RCT to have evaluated dabigatran in stroke prevention, and RCTs are prone to selection biases less likely to be present in well designed observational studies, Dr. Romanelli and colleagues note in Circulation:Cardiovascular and Quality Outcomes, online January 26.

The team used data from seven retrospective cohort studies to compare the effectiveness and safety of dabigatran and warfarin among more than 348,750 patients with nonvalvular AF.

During an overall mean follow-up of 794 days, dabigatran 150mg or 110 mg was similar to warfarin in ischemic stroke prevention.

Both the higher and lower dabigatran doses had significantly lower hazards of intracranial bleeding compared with warfarin (pooled hazard ratio, 0.44 and 0.49, respectively). But the hazard of gastrointestinal bleeding was significantly greater for dabigatran 150 mg (but not for 110 mg) than for warfarin (pHR, 1.23). The 110 mg dose of dabigatran was only available during the trial; it's now sold in 150 mg or 75 mg capsules.

The increased risk of gastrointestinal bleeding with the higher dose of dabigatran was significant only in older populations (75 years or older).

"Data presented in this review reflect relative risk, which is not always clinically meaningful," the researchers caution. "It is important to bear in mind that event rates for the outcome of interest are low under standard treatment."

"I don't think the findings from this one reviewshould change clinical practice," Dr. Romanelli said. "If anything, this study revealed areas for future research.

 

 

 

 

 

NEW YORK (Reuters Health) - Dabigatran and warfarin offer similar stroke-prevention efficacy in patients with atrial fibrillation (AF), but their side effect profiles differ, according to a systematic review and meta-analysis of real-world clinical practice.

"There could be many reasons for the differences in our findings, such as differences in the quality of evidence of observational studies and randomized controlled trials (RCTs) or differences in the included study populations between the observational studies in our review and the RE-LY trial," Dr. Robert J. Romanelli from Palo Alto Medical Foundation Research Institute, California, told Reuters Health by email.

The RE-LY trial is the only RCT to have evaluated dabigatran in stroke prevention, and RCTs are prone to selection biases less likely to be present in well designed observational studies, Dr. Romanelli and colleagues note in Circulation:Cardiovascular and Quality Outcomes, online January 26.

The team used data from seven retrospective cohort studies to compare the effectiveness and safety of dabigatran and warfarin among more than 348,750 patients with nonvalvular AF.

During an overall mean follow-up of 794 days, dabigatran 150mg or 110 mg was similar to warfarin in ischemic stroke prevention.

Both the higher and lower dabigatran doses had significantly lower hazards of intracranial bleeding compared with warfarin (pooled hazard ratio, 0.44 and 0.49, respectively). But the hazard of gastrointestinal bleeding was significantly greater for dabigatran 150 mg (but not for 110 mg) than for warfarin (pHR, 1.23). The 110 mg dose of dabigatran was only available during the trial; it's now sold in 150 mg or 75 mg capsules.

The increased risk of gastrointestinal bleeding with the higher dose of dabigatran was significant only in older populations (75 years or older).

"Data presented in this review reflect relative risk, which is not always clinically meaningful," the researchers caution. "It is important to bear in mind that event rates for the outcome of interest are low under standard treatment."

"I don't think the findings from this one reviewshould change clinical practice," Dr. Romanelli said. "If anything, this study revealed areas for future research.

 

 

 

 

 

Twenty years ago, Robert Wachter, MD, MHM, and Lee Goldman, MD, first coined the term “hospitalist” in the New England Journal of Medicine.1 A new medical specialty was born along with a new career path dedicated to promoting exceptional care for hospitalized patients.

This year ushers in a new era in medicine. The Society of Hospital Medicine (SHM), the professional medical society representing hospital medicine professionals, is proud to introduce 2016 as the “Year of the Hospitalist … Celebrating 20 Years of Hospital Medicine and Looking to the Future.”

At the 20th anniversary of the term “hospitalist,” SHM remains committed to its mission to transform healthcare and revolutionize patient care by providing members with evidence-based quality improvement and clinical resources, best practices for managing hospital medicine groups (HMGs), and an extensive network of professionals. SHM remains committed to empowering members to lead change, develop the best HM programs, and provide the best patient care.

Help us celebrate by:

• Posting, tweeting, and sharing your SHM and hospital medicine success stories using the hashtag #SHeMpowered on your favorite social media outlets. Express how you are making an impact on patient care via hospital medicine in the YOTH and beyond.
• Visiting and sharing the Future of Hospital Medicine website (futureofhospitalmedicine.org) to learn about the wide variety of resources SHM offers to help medical students and residents navigate and understand hospital medicine and the career options available in the field.

Stay tuned throughout 2016 for regular updates on how SHM is making a difference in healthcare today, how it has changed the face of the specialty, and how you can join in the YOTH celebrations. TH

---

Brett Radler is SHM’s communications coordinator.

Reference

Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514-517. doi: 10.1056/NEJM199608153350713

Twenty years ago, Robert Wachter, MD, MHM, and Lee Goldman, MD, first coined the term “hospitalist” in the New England Journal of Medicine.1 A new medical specialty was born along with a new career path dedicated to promoting exceptional care for hospitalized patients.

This year ushers in a new era in medicine. The Society of Hospital Medicine (SHM), the professional medical society representing hospital medicine professionals, is proud to introduce 2016 as the “Year of the Hospitalist … Celebrating 20 Years of Hospital Medicine and Looking to the Future.”

At the 20th anniversary of the term “hospitalist,” SHM remains committed to its mission to transform healthcare and revolutionize patient care by providing members with evidence-based quality improvement and clinical resources, best practices for managing hospital medicine groups (HMGs), and an extensive network of professionals. SHM remains committed to empowering members to lead change, develop the best HM programs, and provide the best patient care.

Help us celebrate by:

• Posting, tweeting, and sharing your SHM and hospital medicine success stories using the hashtag #SHeMpowered on your favorite social media outlets. Express how you are making an impact on patient care via hospital medicine in the YOTH and beyond.
• Visiting and sharing the Future of Hospital Medicine website (futureofhospitalmedicine.org) to learn about the wide variety of resources SHM offers to help medical students and residents navigate and understand hospital medicine and the career options available in the field.

Stay tuned throughout 2016 for regular updates on how SHM is making a difference in healthcare today, how it has changed the face of the specialty, and how you can join in the YOTH celebrations. TH

---

Brett Radler is SHM’s communications coordinator.

Reference

Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514-517. doi: 10.1056/NEJM199608153350713

Twenty years ago, Robert Wachter, MD, MHM, and Lee Goldman, MD, first coined the term “hospitalist” in the New England Journal of Medicine.1 A new medical specialty was born along with a new career path dedicated to promoting exceptional care for hospitalized patients.

This year ushers in a new era in medicine. The Society of Hospital Medicine (SHM), the professional medical society representing hospital medicine professionals, is proud to introduce 2016 as the “Year of the Hospitalist … Celebrating 20 Years of Hospital Medicine and Looking to the Future.”

At the 20th anniversary of the term “hospitalist,” SHM remains committed to its mission to transform healthcare and revolutionize patient care by providing members with evidence-based quality improvement and clinical resources, best practices for managing hospital medicine groups (HMGs), and an extensive network of professionals. SHM remains committed to empowering members to lead change, develop the best HM programs, and provide the best patient care.

Help us celebrate by:

• Posting, tweeting, and sharing your SHM and hospital medicine success stories using the hashtag #SHeMpowered on your favorite social media outlets. Express how you are making an impact on patient care via hospital medicine in the YOTH and beyond.
• Visiting and sharing the Future of Hospital Medicine website (futureofhospitalmedicine.org) to learn about the wide variety of resources SHM offers to help medical students and residents navigate and understand hospital medicine and the career options available in the field.

Stay tuned throughout 2016 for regular updates on how SHM is making a difference in healthcare today, how it has changed the face of the specialty, and how you can join in the YOTH celebrations. TH

---

Brett Radler is SHM’s communications coordinator.

Reference

Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514-517. doi: 10.1056/NEJM199608153350713

NEW YORK (Reuters Health) - Type 2 diabetes risk appears to be increased in youth who are treated with antipsychotics, according to new research.

"We believe that clinicians should take away from our study that type 2 diabetes is a risk when treating youth with antipsychotics, especially long-term," said senior author Dr. Christoff U. Correll of Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York.

"Therefore, antipsychotics should be used judiciously and for as short a period as necessary and possible," he told Reuters Health by email. "Importantly, clinicians should routinely and proactively monitor the efficacy and need for ongoing antipsychotic treatment as well as the potential emergence of adverse effects. Specifically, clinicians and patients, as well as parents, should monitor weight change monthly, and fasting blood work for blood sugar and blood lipids

should be obtained before starting an antipsychotic, three months later, and every six months thereafter."

Dr. Correll and colleagues conducted a systematic review of studies reporting on type 2 diabetes incidence in youth up to 24 years old who were exposed to antipsychotics for at least three months. They did a meta-analysis of thirteen studies involving more than 185,000 youth exposed to antipsychotics, representing some 310,000 patient-years.

Seven studies included psychiatric controls and eight studies included healthy controls.

During a mean follow-up of 1.7 years, the cumulative type 2 diabetes risk was 5.72 per 1,000 patient-years (p<0.001). The overall incidence rate was 3.09 cases per 1,000 patient-years (p<0.001), according to an article online January 20 in JAMA Psychiatry.

Compared with healthy controls, antipsychotic-exposed youth had significantly higher cumulative type 2 diabetes risk (odds ratio, 2.58; p<0.0001) and incidence rate ratio (IRR, 3.02; p<0.0001). Compared with psychiatric controls, they had significantly higher risks (OR 2.09, p<0.0001, IRR 1.79,p<0.0001).

In multivariate regression analysis of 10 studies, diabetes was associated with longer follow-up, use of olanzapine, and male sex. Greater diabetes incidence was tied to use of second-generation antipsychotics, while it was inversely related to diagnosis of autism spectrum disorder.

"Although our findings cannot comment on the individual risk with any specific antipsychotic other than the significantly higher risk associated with olanzapine, other studies equally suggest the much increased cardiovascular risk associates with olanzapine than with other antipsychotics in youth. Based on all of these data, I personally believe that olanzapine should not be used first- or second-line in youth, but likely be reserved or treatment-resistant patients who cannot benefit sufficiently from antipsychotics with lower cardiometabolic risk," Dr. Correll told Reuters Health.

"Clearly, additional research is needed to identify the specific mechanisms of antipsychotic-related weight gain and development of diabetes in order to either counter these effects or develop medications that do not adversely affect cardiometabolic health," he added. "Moreover, research is needed seeking to identify patients who are at particularly high risk for weight gain and diabetes and those who seem to be protected against these antipsychotic-related side effects to help individualize treatment selection."

"Finally," he concluded, "research is required that tests lower-risk pharmacologic and nonpharmacologic interventions that may be used effectively before or instead of an antipsychotic when treating nonpsychotic conditions. This need pertains especially to youth presenting with severe mood or behavioral dysregulation, irritability, and aggression for whom antipsychotics are used a lot, often without even providing psychosocial treatments."

 

 

 

 

 

 

 

NEW YORK (Reuters Health) - Type 2 diabetes risk appears to be increased in youth who are treated with antipsychotics, according to new research.

"We believe that clinicians should take away from our study that type 2 diabetes is a risk when treating youth with antipsychotics, especially long-term," said senior author Dr. Christoff U. Correll of Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York.

"Therefore, antipsychotics should be used judiciously and for as short a period as necessary and possible," he told Reuters Health by email. "Importantly, clinicians should routinely and proactively monitor the efficacy and need for ongoing antipsychotic treatment as well as the potential emergence of adverse effects. Specifically, clinicians and patients, as well as parents, should monitor weight change monthly, and fasting blood work for blood sugar and blood lipids

should be obtained before starting an antipsychotic, three months later, and every six months thereafter."

Dr. Correll and colleagues conducted a systematic review of studies reporting on type 2 diabetes incidence in youth up to 24 years old who were exposed to antipsychotics for at least three months. They did a meta-analysis of thirteen studies involving more than 185,000 youth exposed to antipsychotics, representing some 310,000 patient-years.

Seven studies included psychiatric controls and eight studies included healthy controls.

During a mean follow-up of 1.7 years, the cumulative type 2 diabetes risk was 5.72 per 1,000 patient-years (p<0.001). The overall incidence rate was 3.09 cases per 1,000 patient-years (p<0.001), according to an article online January 20 in JAMA Psychiatry.

Compared with healthy controls, antipsychotic-exposed youth had significantly higher cumulative type 2 diabetes risk (odds ratio, 2.58; p<0.0001) and incidence rate ratio (IRR, 3.02; p<0.0001). Compared with psychiatric controls, they had significantly higher risks (OR 2.09, p<0.0001, IRR 1.79,p<0.0001).

In multivariate regression analysis of 10 studies, diabetes was associated with longer follow-up, use of olanzapine, and male sex. Greater diabetes incidence was tied to use of second-generation antipsychotics, while it was inversely related to diagnosis of autism spectrum disorder.

"Although our findings cannot comment on the individual risk with any specific antipsychotic other than the significantly higher risk associated with olanzapine, other studies equally suggest the much increased cardiovascular risk associates with olanzapine than with other antipsychotics in youth. Based on all of these data, I personally believe that olanzapine should not be used first- or second-line in youth, but likely be reserved or treatment-resistant patients who cannot benefit sufficiently from antipsychotics with lower cardiometabolic risk," Dr. Correll told Reuters Health.

"Clearly, additional research is needed to identify the specific mechanisms of antipsychotic-related weight gain and development of diabetes in order to either counter these effects or develop medications that do not adversely affect cardiometabolic health," he added. "Moreover, research is needed seeking to identify patients who are at particularly high risk for weight gain and diabetes and those who seem to be protected against these antipsychotic-related side effects to help individualize treatment selection."

"Finally," he concluded, "research is required that tests lower-risk pharmacologic and nonpharmacologic interventions that may be used effectively before or instead of an antipsychotic when treating nonpsychotic conditions. This need pertains especially to youth presenting with severe mood or behavioral dysregulation, irritability, and aggression for whom antipsychotics are used a lot, often without even providing psychosocial treatments."

 

 

 

 

 

 

 

NEW YORK (Reuters Health) - Type 2 diabetes risk appears to be increased in youth who are treated with antipsychotics, according to new research.

"We believe that clinicians should take away from our study that type 2 diabetes is a risk when treating youth with antipsychotics, especially long-term," said senior author Dr. Christoff U. Correll of Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York.

"Therefore, antipsychotics should be used judiciously and for as short a period as necessary and possible," he told Reuters Health by email. "Importantly, clinicians should routinely and proactively monitor the efficacy and need for ongoing antipsychotic treatment as well as the potential emergence of adverse effects. Specifically, clinicians and patients, as well as parents, should monitor weight change monthly, and fasting blood work for blood sugar and blood lipids

should be obtained before starting an antipsychotic, three months later, and every six months thereafter."

Dr. Correll and colleagues conducted a systematic review of studies reporting on type 2 diabetes incidence in youth up to 24 years old who were exposed to antipsychotics for at least three months. They did a meta-analysis of thirteen studies involving more than 185,000 youth exposed to antipsychotics, representing some 310,000 patient-years.

Seven studies included psychiatric controls and eight studies included healthy controls.

During a mean follow-up of 1.7 years, the cumulative type 2 diabetes risk was 5.72 per 1,000 patient-years (p<0.001). The overall incidence rate was 3.09 cases per 1,000 patient-years (p<0.001), according to an article online January 20 in JAMA Psychiatry.

Compared with healthy controls, antipsychotic-exposed youth had significantly higher cumulative type 2 diabetes risk (odds ratio, 2.58; p<0.0001) and incidence rate ratio (IRR, 3.02; p<0.0001). Compared with psychiatric controls, they had significantly higher risks (OR 2.09, p<0.0001, IRR 1.79,p<0.0001).

In multivariate regression analysis of 10 studies, diabetes was associated with longer follow-up, use of olanzapine, and male sex. Greater diabetes incidence was tied to use of second-generation antipsychotics, while it was inversely related to diagnosis of autism spectrum disorder.

"Although our findings cannot comment on the individual risk with any specific antipsychotic other than the significantly higher risk associated with olanzapine, other studies equally suggest the much increased cardiovascular risk associates with olanzapine than with other antipsychotics in youth. Based on all of these data, I personally believe that olanzapine should not be used first- or second-line in youth, but likely be reserved or treatment-resistant patients who cannot benefit sufficiently from antipsychotics with lower cardiometabolic risk," Dr. Correll told Reuters Health.

"Clearly, additional research is needed to identify the specific mechanisms of antipsychotic-related weight gain and development of diabetes in order to either counter these effects or develop medications that do not adversely affect cardiometabolic health," he added. "Moreover, research is needed seeking to identify patients who are at particularly high risk for weight gain and diabetes and those who seem to be protected against these antipsychotic-related side effects to help individualize treatment selection."

"Finally," he concluded, "research is required that tests lower-risk pharmacologic and nonpharmacologic interventions that may be used effectively before or instead of an antipsychotic when treating nonpsychotic conditions. This need pertains especially to youth presenting with severe mood or behavioral dysregulation, irritability, and aggression for whom antipsychotics are used a lot, often without even providing psychosocial treatments."

 

 

 

 

 

 

 

NEW YORK (Reuters Health) - Bisphosphonate use is associated with better survival in patients admitted to the intensive care unit (ICU), according to Australian researchers.

As Dr. Paul Lee told Reuters Health by email, "Bone loss in critical illness may have wider effects on the body beyond bone itself, and bisphosphonates, by reducing bone loss, may attenuate these potentially adverse effects on the body."

Increased bone resorption is known to predict mortality in the community setting, Dr. Lee of the Gavan Institute of Medical Research in Sydney and colleagues note in the Journal of Clinical Endocrinology and Metabolism, online January 18. The team theorized that mortality would be lower among patients treated with bisphosphonates prior to their acute illness.

To investigate, they examined data on more than 7,800 patients admitted to the ICU between 2003 and 2014; 245 had received bisphosphonates before admission.

The bisphosphonate users were older and had more co-morbidities, yet their in-hospital mortality rate was significantly lower than that of non-users(mortality rate ratio, 0.41; p<0.01). The difference remained significant after adjusting for factors including age, sex, and principal diagnosis.

Bisphosphonate-associated survival benefit was independent of vitamin D use, but bisphosphonate and vitamin D co-use was associated with a further reduction in mortality (MRR, 0.38).

A substudy involving CT scans of 37 patients with preadmission bisphosphonate use and 74 matched patients without such use found that baseline bone density was significantly lower among bisphosphonate users. However, all users survived admission whereas six of the non-users died.

The researchers speculate that the apparent benefits of bisphosphonate "may be partly related to modulation of systemic inflammation through antibone resorption."

However, Dr. Lee made it clear that "causality is not proven in the study, and prospective intervention trials are required to evaluate effects of bisphosphonates in critical illness."

 

 

 

NEW YORK (Reuters Health) - Bisphosphonate use is associated with better survival in patients admitted to the intensive care unit (ICU), according to Australian researchers.

As Dr. Paul Lee told Reuters Health by email, "Bone loss in critical illness may have wider effects on the body beyond bone itself, and bisphosphonates, by reducing bone loss, may attenuate these potentially adverse effects on the body."

Increased bone resorption is known to predict mortality in the community setting, Dr. Lee of the Gavan Institute of Medical Research in Sydney and colleagues note in the Journal of Clinical Endocrinology and Metabolism, online January 18. The team theorized that mortality would be lower among patients treated with bisphosphonates prior to their acute illness.

To investigate, they examined data on more than 7,800 patients admitted to the ICU between 2003 and 2014; 245 had received bisphosphonates before admission.

The bisphosphonate users were older and had more co-morbidities, yet their in-hospital mortality rate was significantly lower than that of non-users(mortality rate ratio, 0.41; p<0.01). The difference remained significant after adjusting for factors including age, sex, and principal diagnosis.

Bisphosphonate-associated survival benefit was independent of vitamin D use, but bisphosphonate and vitamin D co-use was associated with a further reduction in mortality (MRR, 0.38).

A substudy involving CT scans of 37 patients with preadmission bisphosphonate use and 74 matched patients without such use found that baseline bone density was significantly lower among bisphosphonate users. However, all users survived admission whereas six of the non-users died.

The researchers speculate that the apparent benefits of bisphosphonate "may be partly related to modulation of systemic inflammation through antibone resorption."

However, Dr. Lee made it clear that "causality is not proven in the study, and prospective intervention trials are required to evaluate effects of bisphosphonates in critical illness."

 

 

 

NEW YORK (Reuters Health) - Bisphosphonate use is associated with better survival in patients admitted to the intensive care unit (ICU), according to Australian researchers.

As Dr. Paul Lee told Reuters Health by email, "Bone loss in critical illness may have wider effects on the body beyond bone itself, and bisphosphonates, by reducing bone loss, may attenuate these potentially adverse effects on the body."

Increased bone resorption is known to predict mortality in the community setting, Dr. Lee of the Gavan Institute of Medical Research in Sydney and colleagues note in the Journal of Clinical Endocrinology and Metabolism, online January 18. The team theorized that mortality would be lower among patients treated with bisphosphonates prior to their acute illness.

To investigate, they examined data on more than 7,800 patients admitted to the ICU between 2003 and 2014; 245 had received bisphosphonates before admission.

The bisphosphonate users were older and had more co-morbidities, yet their in-hospital mortality rate was significantly lower than that of non-users(mortality rate ratio, 0.41; p<0.01). The difference remained significant after adjusting for factors including age, sex, and principal diagnosis.

Bisphosphonate-associated survival benefit was independent of vitamin D use, but bisphosphonate and vitamin D co-use was associated with a further reduction in mortality (MRR, 0.38).

A substudy involving CT scans of 37 patients with preadmission bisphosphonate use and 74 matched patients without such use found that baseline bone density was significantly lower among bisphosphonate users. However, all users survived admission whereas six of the non-users died.

The researchers speculate that the apparent benefits of bisphosphonate "may be partly related to modulation of systemic inflammation through antibone resorption."

However, Dr. Lee made it clear that "causality is not proven in the study, and prospective intervention trials are required to evaluate effects of bisphosphonates in critical illness."

 

 

 

Dear Dr. Hospitalist:

We have several physicians in our large academic group whom I hate to follow when picking up teams. There have only been a few situations when I thought there was a clear knowledge deficit, but the most irritating problem is that they don’t discharge patients. I’ve only been in the group for several years, so I don’t want to come across as a complainer. However, I am concerned about poor patient care and the work left to me to discharge patients. How can I help these physicians improve without damaging my relationship with them?

Dr. Frustrated

Dr. Hospitalist responds:

You bring up a problem that I’m certain many of us in hospital medicine have experienced at some point in our career. Since the “practice” of medicine can often be done with much variability, there are many gray areas that occur during the care of patients. However, we all know it is the transitioning of patients into and out of the hospital that is the most labor-intensive period of their care. If at all possible, the discharge process is best performed by the person with the most longitudinal knowledge of the patient’s hospital course.

Your leadership team has the responsibility to assess the quality and quantity of work of all team members. The periodic assessment of a clinician’s skill and aptitude, as well as the safety of care delivered to patients, can be done in several ways. Typically, the initial assessment is done by focused professional practice evaluations (FPPEs) and later by ongoing professional practice evaluations (OPPEs). The Joint Commission created these tools in 2007 to help determine if the quality of care by clinicians fell below an acceptable level.

FPPEs, as defined by the commission, are “the time limited evaluation of practitioner competence in performing a specific privilege.” They are usually done three to six months after the initial credentialing period, when a new or additional privilege is requested after the initial appointment, or when a condition or issue affecting the delivery of safe and high-quality care is identified.

OPPEs, as the name suggests, are typically done on an ongoing basis (usually annually). These practitioner-specific reports are best utilized as screening tools, and when unusual or aberrant tendencies are observed, a more detailed analysis typically is required.

Although these formal evaluations are carried out by chart review and analysis of data collected by the hospital, they should always be supported by discreet and candid conversations with other frontline team members. It is during these sessions that individuals should take the opportunity to express their opinions regarding the care delivered by their colleagues. From my experience, because of the shared care of patients in hospital medicine, if there is a problem with an individual’s professionalism or clinical abilities, it is usually well-known by others in the group.

If for some reason group leaders are not performing these mandated evaluations (and thus risking regulatory sanctions) or don’t have a formal mechanism in place, I would encourage them to establish one. In the interim, I would discreetly address the individuals and share your concerns. Many times, the problems you mention can be resolved with awareness, mentoring, and/or proctoring, but like any needed corrective actions, they must first be acknowledged.

Good luck! TH

Dear Dr. Hospitalist:

We have several physicians in our large academic group whom I hate to follow when picking up teams. There have only been a few situations when I thought there was a clear knowledge deficit, but the most irritating problem is that they don’t discharge patients. I’ve only been in the group for several years, so I don’t want to come across as a complainer. However, I am concerned about poor patient care and the work left to me to discharge patients. How can I help these physicians improve without damaging my relationship with them?

Dr. Frustrated

Dr. Hospitalist responds:

You bring up a problem that I’m certain many of us in hospital medicine have experienced at some point in our career. Since the “practice” of medicine can often be done with much variability, there are many gray areas that occur during the care of patients. However, we all know it is the transitioning of patients into and out of the hospital that is the most labor-intensive period of their care. If at all possible, the discharge process is best performed by the person with the most longitudinal knowledge of the patient’s hospital course.

Your leadership team has the responsibility to assess the quality and quantity of work of all team members. The periodic assessment of a clinician’s skill and aptitude, as well as the safety of care delivered to patients, can be done in several ways. Typically, the initial assessment is done by focused professional practice evaluations (FPPEs) and later by ongoing professional practice evaluations (OPPEs). The Joint Commission created these tools in 2007 to help determine if the quality of care by clinicians fell below an acceptable level.

FPPEs, as defined by the commission, are “the time limited evaluation of practitioner competence in performing a specific privilege.” They are usually done three to six months after the initial credentialing period, when a new or additional privilege is requested after the initial appointment, or when a condition or issue affecting the delivery of safe and high-quality care is identified.

OPPEs, as the name suggests, are typically done on an ongoing basis (usually annually). These practitioner-specific reports are best utilized as screening tools, and when unusual or aberrant tendencies are observed, a more detailed analysis typically is required.

Although these formal evaluations are carried out by chart review and analysis of data collected by the hospital, they should always be supported by discreet and candid conversations with other frontline team members. It is during these sessions that individuals should take the opportunity to express their opinions regarding the care delivered by their colleagues. From my experience, because of the shared care of patients in hospital medicine, if there is a problem with an individual’s professionalism or clinical abilities, it is usually well-known by others in the group.

If for some reason group leaders are not performing these mandated evaluations (and thus risking regulatory sanctions) or don’t have a formal mechanism in place, I would encourage them to establish one. In the interim, I would discreetly address the individuals and share your concerns. Many times, the problems you mention can be resolved with awareness, mentoring, and/or proctoring, but like any needed corrective actions, they must first be acknowledged.

Good luck! TH

Dear Dr. Hospitalist:

We have several physicians in our large academic group whom I hate to follow when picking up teams. There have only been a few situations when I thought there was a clear knowledge deficit, but the most irritating problem is that they don’t discharge patients. I’ve only been in the group for several years, so I don’t want to come across as a complainer. However, I am concerned about poor patient care and the work left to me to discharge patients. How can I help these physicians improve without damaging my relationship with them?

Dr. Frustrated

Dr. Hospitalist responds:

You bring up a problem that I’m certain many of us in hospital medicine have experienced at some point in our career. Since the “practice” of medicine can often be done with much variability, there are many gray areas that occur during the care of patients. However, we all know it is the transitioning of patients into and out of the hospital that is the most labor-intensive period of their care. If at all possible, the discharge process is best performed by the person with the most longitudinal knowledge of the patient’s hospital course.

Your leadership team has the responsibility to assess the quality and quantity of work of all team members. The periodic assessment of a clinician’s skill and aptitude, as well as the safety of care delivered to patients, can be done in several ways. Typically, the initial assessment is done by focused professional practice evaluations (FPPEs) and later by ongoing professional practice evaluations (OPPEs). The Joint Commission created these tools in 2007 to help determine if the quality of care by clinicians fell below an acceptable level.

FPPEs, as defined by the commission, are “the time limited evaluation of practitioner competence in performing a specific privilege.” They are usually done three to six months after the initial credentialing period, when a new or additional privilege is requested after the initial appointment, or when a condition or issue affecting the delivery of safe and high-quality care is identified.

OPPEs, as the name suggests, are typically done on an ongoing basis (usually annually). These practitioner-specific reports are best utilized as screening tools, and when unusual or aberrant tendencies are observed, a more detailed analysis typically is required.

Although these formal evaluations are carried out by chart review and analysis of data collected by the hospital, they should always be supported by discreet and candid conversations with other frontline team members. It is during these sessions that individuals should take the opportunity to express their opinions regarding the care delivered by their colleagues. From my experience, because of the shared care of patients in hospital medicine, if there is a problem with an individual’s professionalism or clinical abilities, it is usually well-known by others in the group.

If for some reason group leaders are not performing these mandated evaluations (and thus risking regulatory sanctions) or don’t have a formal mechanism in place, I would encourage them to establish one. In the interim, I would discreetly address the individuals and share your concerns. Many times, the problems you mention can be resolved with awareness, mentoring, and/or proctoring, but like any needed corrective actions, they must first be acknowledged.

Good luck! TH

NEW YORK (Reuters Health) - Myocardial infarction (MI) patients who are transferred to another hospital for care are less likely to be followed up and more likely to be readmitted to the hospital, new findings show.

"This group of patients may represent a vulnerable population and we really need to come up with specific strategies to make their post-discharge transition back to their local community as seamless as possible," corresponding author Dr. Amit Vora, of Duke University in Durham, North Carolina, told Reuters Health.

Many patients admitted to their local hospital for acute MI must be transferred to another hospital for care, for example, to receive revascularization, Dr. Vora and his team note in their report, to be published online in Circulation: Cardiovascular Quality and outcomes. Logistical factors may lead to poor communication and coordination when it's time for the patient to be transferred back to their community, they add, which could be particularly problematic for older patients who may have more comorbidity and require closer follow-up after discharge.

To investigate, the researchers looked at outcomes for 39,136 acute MI patients 65 and older who were treated between 2007 and 2010 at 451 hospitals participating in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.

Thirty-six percent of patients were transferred to another hospital for acute MI care, traveling a median of 43 miles.Within 30 days of discharge, 69.9% of the transferred patients had received outpatient follow-up, versus 78.2% of direct-arrival patients.

The adjusted risk of readmission for any cause was 14.5% for transferred patients versus 14% for direct-admit patients, while the risk of readmission for cardiovascular causes was 9.5% for

transferred patients and 9.1% for the direct-admit patients.However, the risk adjusted 30-day mortality was 1.6% for each group.

"Post-discharge care for acute MI patients is a performance measure, and we do track how often these patients are admitted

to the hospital following their discharge," Dr. Vora said. "A big focus of quality improvement is identifying strategies to reduce rehospitalization."

The next step in the research will be to identify the specific barriers to receiving follow-up care for transferred patients, he added, and then "define clear pathways and clear plans following discharge to ensure that these patients receive the care and the follow-up that they need."

The Agency for Healthcare Research and Quality funded this research. Three coauthors reported relevant relationships.

 

 

NEW YORK (Reuters Health) - Myocardial infarction (MI) patients who are transferred to another hospital for care are less likely to be followed up and more likely to be readmitted to the hospital, new findings show.

"This group of patients may represent a vulnerable population and we really need to come up with specific strategies to make their post-discharge transition back to their local community as seamless as possible," corresponding author Dr. Amit Vora, of Duke University in Durham, North Carolina, told Reuters Health.

Many patients admitted to their local hospital for acute MI must be transferred to another hospital for care, for example, to receive revascularization, Dr. Vora and his team note in their report, to be published online in Circulation: Cardiovascular Quality and outcomes. Logistical factors may lead to poor communication and coordination when it's time for the patient to be transferred back to their community, they add, which could be particularly problematic for older patients who may have more comorbidity and require closer follow-up after discharge.

To investigate, the researchers looked at outcomes for 39,136 acute MI patients 65 and older who were treated between 2007 and 2010 at 451 hospitals participating in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.

Thirty-six percent of patients were transferred to another hospital for acute MI care, traveling a median of 43 miles.Within 30 days of discharge, 69.9% of the transferred patients had received outpatient follow-up, versus 78.2% of direct-arrival patients.

The adjusted risk of readmission for any cause was 14.5% for transferred patients versus 14% for direct-admit patients, while the risk of readmission for cardiovascular causes was 9.5% for

transferred patients and 9.1% for the direct-admit patients.However, the risk adjusted 30-day mortality was 1.6% for each group.

"Post-discharge care for acute MI patients is a performance measure, and we do track how often these patients are admitted

to the hospital following their discharge," Dr. Vora said. "A big focus of quality improvement is identifying strategies to reduce rehospitalization."

The next step in the research will be to identify the specific barriers to receiving follow-up care for transferred patients, he added, and then "define clear pathways and clear plans following discharge to ensure that these patients receive the care and the follow-up that they need."

The Agency for Healthcare Research and Quality funded this research. Three coauthors reported relevant relationships.

 

 

NEW YORK (Reuters Health) - Myocardial infarction (MI) patients who are transferred to another hospital for care are less likely to be followed up and more likely to be readmitted to the hospital, new findings show.

"This group of patients may represent a vulnerable population and we really need to come up with specific strategies to make their post-discharge transition back to their local community as seamless as possible," corresponding author Dr. Amit Vora, of Duke University in Durham, North Carolina, told Reuters Health.

Many patients admitted to their local hospital for acute MI must be transferred to another hospital for care, for example, to receive revascularization, Dr. Vora and his team note in their report, to be published online in Circulation: Cardiovascular Quality and outcomes. Logistical factors may lead to poor communication and coordination when it's time for the patient to be transferred back to their community, they add, which could be particularly problematic for older patients who may have more comorbidity and require closer follow-up after discharge.

To investigate, the researchers looked at outcomes for 39,136 acute MI patients 65 and older who were treated between 2007 and 2010 at 451 hospitals participating in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.

Thirty-six percent of patients were transferred to another hospital for acute MI care, traveling a median of 43 miles.Within 30 days of discharge, 69.9% of the transferred patients had received outpatient follow-up, versus 78.2% of direct-arrival patients.

The adjusted risk of readmission for any cause was 14.5% for transferred patients versus 14% for direct-admit patients, while the risk of readmission for cardiovascular causes was 9.5% for

transferred patients and 9.1% for the direct-admit patients.However, the risk adjusted 30-day mortality was 1.6% for each group.

"Post-discharge care for acute MI patients is a performance measure, and we do track how often these patients are admitted

to the hospital following their discharge," Dr. Vora said. "A big focus of quality improvement is identifying strategies to reduce rehospitalization."

The next step in the research will be to identify the specific barriers to receiving follow-up care for transferred patients, he added, and then "define clear pathways and clear plans following discharge to ensure that these patients receive the care and the follow-up that they need."

The Agency for Healthcare Research and Quality funded this research. Three coauthors reported relevant relationships.

 

 

The Society of Hospital Medicine (SHM) proudly names Robert E. Burke, MD, MS, assistant chief of hospital medicine at Denver VA Medical Center, as the recipient of the 2016 Junior Investigator Award. He will receive the award at HM16 in San Diego.

Dr. Burke’s research focuses on improving transitional care outcomes for older adults. An academic hospitalist and health services researcher, Dr. Burke is working toward becoming a nationally recognized outcomes researcher and implementation scientist working in hospitals and post-acute-care (PAC) facilities.

In addition to this award, Dr. Burke also received the 2015 Career Development Award from SHM, the Alliance for Academic Internal Medicine, and the Association of Specialty Professors in support of the Grants for Early Medical/Surgical Subspecialists’ Transition to Aging Research Program (GEMSSTAR).

The Junior Investigator Award recognizes talented early-stage investigators in the first five years of a faculty position. Criteria for selection include the impact the research may have on hospital medicine, career achievements and milestones (e.g., abstracts, peer-reviewed publications, intra- and extramural grant funding), and engagement with SHM. TH

Brett Radler is SHM’s communications coordinator.

The Society of Hospital Medicine (SHM) proudly names Robert E. Burke, MD, MS, assistant chief of hospital medicine at Denver VA Medical Center, as the recipient of the 2016 Junior Investigator Award. He will receive the award at HM16 in San Diego.

Dr. Burke’s research focuses on improving transitional care outcomes for older adults. An academic hospitalist and health services researcher, Dr. Burke is working toward becoming a nationally recognized outcomes researcher and implementation scientist working in hospitals and post-acute-care (PAC) facilities.

In addition to this award, Dr. Burke also received the 2015 Career Development Award from SHM, the Alliance for Academic Internal Medicine, and the Association of Specialty Professors in support of the Grants for Early Medical/Surgical Subspecialists’ Transition to Aging Research Program (GEMSSTAR).

The Junior Investigator Award recognizes talented early-stage investigators in the first five years of a faculty position. Criteria for selection include the impact the research may have on hospital medicine, career achievements and milestones (e.g., abstracts, peer-reviewed publications, intra- and extramural grant funding), and engagement with SHM. TH

Brett Radler is SHM’s communications coordinator.

The Society of Hospital Medicine (SHM) proudly names Robert E. Burke, MD, MS, assistant chief of hospital medicine at Denver VA Medical Center, as the recipient of the 2016 Junior Investigator Award. He will receive the award at HM16 in San Diego.

Dr. Burke’s research focuses on improving transitional care outcomes for older adults. An academic hospitalist and health services researcher, Dr. Burke is working toward becoming a nationally recognized outcomes researcher and implementation scientist working in hospitals and post-acute-care (PAC) facilities.

In addition to this award, Dr. Burke also received the 2015 Career Development Award from SHM, the Alliance for Academic Internal Medicine, and the Association of Specialty Professors in support of the Grants for Early Medical/Surgical Subspecialists’ Transition to Aging Research Program (GEMSSTAR).

The Junior Investigator Award recognizes talented early-stage investigators in the first five years of a faculty position. Criteria for selection include the impact the research may have on hospital medicine, career achievements and milestones (e.g., abstracts, peer-reviewed publications, intra- and extramural grant funding), and engagement with SHM. TH

Brett Radler is SHM’s communications coordinator.

NEW YORK (Reuters Health) - Hospital differences in pain management are tied to different patient-reported pain scores after colorectal resection, according to a study from the Michigan Surgical Quality Collaborative (MSQC).

"The best-performing hospitals achieved superior pain control through the use of analgesia regimens that more often used local anesthesia blocks in the operating room,non-steroidal anti-inflammatory drugs, and patient-controlled analgesia rather than intermittent narcotics," said Dr. Scott E. Regenbogen from the University of Michigan, Ann Arbor.

"This suggests that efforts to implement multimodal analgesia regimens may improve pain control in the immediate postoperative period," he told Reuters Health by email.

Despite increasing attention to postoperative pain management, most patients continue to experience severe pain after major surgery, Dr. Regenbogen and colleagues note in Annals of Surgery, online January 7.

The researchers used MSQC data from 52 hospitals to evaluate the extent to which multimodal pain management practices are used after major surgery and how hospitals' perioperative practices might affect patient-reported pain levels in real-world surgical practice. Their study included 7,221 patients who underwent colorectal resection between 2012 and 2014.

Nine hospitals had average adjusted pain scores significantly worse and eight hospitals had average adjusted pain scores significantly better than the overall average. The "best" hospitals were somewhat larger and had higher annual volumes of colorectal resection than the "worst" hospitals.

Patients in hospitals with best pain scores were significantly more likely to receive local anesthesia and epidural anesthesia during the operation and to have patient-controlled analgesia (PCA), nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of PCA and NSAIDs and significantly less likely to receive intermittent postoperative narcotics, compared with patients in hospitals with worst pain scores.

Hospitals with the lowest pain scores had a significantly higher proportion of operations with a minimally invasive approach than did hospitals with the highest pain scores.

Patients whose operations took place in hospitals in the lowest quartile of pain scores had significantly shorter mean postoperative length of stay and were significantly less likely to have a postoperative complication, emergency department visit, or readmission.

Patient factors contributing to worse pain scores included being younger than 50 (versus age over 75), a woman, black (versus white), a smoker, and uninsured or insured by Medicaid (versus Medicare or privately insured).

"Most likely," the researchers note, "both pain scores and clinical outcomes reflect more global features of the quality of care in hospitals' surgical performance. Thus, hospitals with the most streamlined, high-quality perioperative care pathways experience the best pain scores, as well as improved clinical outcomes."

"Early postoperative analgesia regimens are an essential component of efforts to improve the efficiency and quality of postoperative recovery," Dr. Regenbogen said."Effective pain control, even in the first postoperative day, is associated with reduced postoperative length of stay and fewer major complications and readmissions. Thus, effective multimodal analgesia is an essential component of high-value perioperative care around colorectal surgery."

"This study is hopefully just one example of a growing emphasis on patient-reported outcomes in surgery," Dr.Regenbogen said. "Within a statewide quality collaborative, we have begun to prioritize engagement of patients, in addition to our partnering surgeons, hospitals, and mayors, in efforts to improve surgical care in Michigan. In this study, we used patient-reported pain measures to evaluate quality of care. In the near future, we will elicit patient-reported measures of functional recovery, psychosocial support, and other outcomes to validate the perioperative outcomes we have relied on traditionally. We hope this study will serve as a model for those novel areas of investigation."

Dr. Antoni Sabate from Hospital Universitari de Bellvitge in Barcelona, Spain, who has researched postoperative analgesia told Reuters Health by email, "Pain is largely influenced by magnitude of the surgical procedure, surgical technique (minimally invasive), analgesia protocol (the use of local anesthetic infiltration in open and laparoscopic, the use of epidural in open procedures, implementation of PCA and NSAID in both laparoscopic and open procedures."

 

NEW YORK (Reuters Health) - Hospital differences in pain management are tied to different patient-reported pain scores after colorectal resection, according to a study from the Michigan Surgical Quality Collaborative (MSQC).

"The best-performing hospitals achieved superior pain control through the use of analgesia regimens that more often used local anesthesia blocks in the operating room,non-steroidal anti-inflammatory drugs, and patient-controlled analgesia rather than intermittent narcotics," said Dr. Scott E. Regenbogen from the University of Michigan, Ann Arbor.

"This suggests that efforts to implement multimodal analgesia regimens may improve pain control in the immediate postoperative period," he told Reuters Health by email.

Despite increasing attention to postoperative pain management, most patients continue to experience severe pain after major surgery, Dr. Regenbogen and colleagues note in Annals of Surgery, online January 7.

The researchers used MSQC data from 52 hospitals to evaluate the extent to which multimodal pain management practices are used after major surgery and how hospitals' perioperative practices might affect patient-reported pain levels in real-world surgical practice. Their study included 7,221 patients who underwent colorectal resection between 2012 and 2014.

Nine hospitals had average adjusted pain scores significantly worse and eight hospitals had average adjusted pain scores significantly better than the overall average. The "best" hospitals were somewhat larger and had higher annual volumes of colorectal resection than the "worst" hospitals.

Patients in hospitals with best pain scores were significantly more likely to receive local anesthesia and epidural anesthesia during the operation and to have patient-controlled analgesia (PCA), nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of PCA and NSAIDs and significantly less likely to receive intermittent postoperative narcotics, compared with patients in hospitals with worst pain scores.

Hospitals with the lowest pain scores had a significantly higher proportion of operations with a minimally invasive approach than did hospitals with the highest pain scores.

Patients whose operations took place in hospitals in the lowest quartile of pain scores had significantly shorter mean postoperative length of stay and were significantly less likely to have a postoperative complication, emergency department visit, or readmission.

Patient factors contributing to worse pain scores included being younger than 50 (versus age over 75), a woman, black (versus white), a smoker, and uninsured or insured by Medicaid (versus Medicare or privately insured).

"Most likely," the researchers note, "both pain scores and clinical outcomes reflect more global features of the quality of care in hospitals' surgical performance. Thus, hospitals with the most streamlined, high-quality perioperative care pathways experience the best pain scores, as well as improved clinical outcomes."

"Early postoperative analgesia regimens are an essential component of efforts to improve the efficiency and quality of postoperative recovery," Dr. Regenbogen said."Effective pain control, even in the first postoperative day, is associated with reduced postoperative length of stay and fewer major complications and readmissions. Thus, effective multimodal analgesia is an essential component of high-value perioperative care around colorectal surgery."

"This study is hopefully just one example of a growing emphasis on patient-reported outcomes in surgery," Dr.Regenbogen said. "Within a statewide quality collaborative, we have begun to prioritize engagement of patients, in addition to our partnering surgeons, hospitals, and mayors, in efforts to improve surgical care in Michigan. In this study, we used patient-reported pain measures to evaluate quality of care. In the near future, we will elicit patient-reported measures of functional recovery, psychosocial support, and other outcomes to validate the perioperative outcomes we have relied on traditionally. We hope this study will serve as a model for those novel areas of investigation."

Dr. Antoni Sabate from Hospital Universitari de Bellvitge in Barcelona, Spain, who has researched postoperative analgesia told Reuters Health by email, "Pain is largely influenced by magnitude of the surgical procedure, surgical technique (minimally invasive), analgesia protocol (the use of local anesthetic infiltration in open and laparoscopic, the use of epidural in open procedures, implementation of PCA and NSAID in both laparoscopic and open procedures."

 

NEW YORK (Reuters Health) - Hospital differences in pain management are tied to different patient-reported pain scores after colorectal resection, according to a study from the Michigan Surgical Quality Collaborative (MSQC).

"The best-performing hospitals achieved superior pain control through the use of analgesia regimens that more often used local anesthesia blocks in the operating room,non-steroidal anti-inflammatory drugs, and patient-controlled analgesia rather than intermittent narcotics," said Dr. Scott E. Regenbogen from the University of Michigan, Ann Arbor.

"This suggests that efforts to implement multimodal analgesia regimens may improve pain control in the immediate postoperative period," he told Reuters Health by email.

Despite increasing attention to postoperative pain management, most patients continue to experience severe pain after major surgery, Dr. Regenbogen and colleagues note in Annals of Surgery, online January 7.

The researchers used MSQC data from 52 hospitals to evaluate the extent to which multimodal pain management practices are used after major surgery and how hospitals' perioperative practices might affect patient-reported pain levels in real-world surgical practice. Their study included 7,221 patients who underwent colorectal resection between 2012 and 2014.

Nine hospitals had average adjusted pain scores significantly worse and eight hospitals had average adjusted pain scores significantly better than the overall average. The "best" hospitals were somewhat larger and had higher annual volumes of colorectal resection than the "worst" hospitals.

Patients in hospitals with best pain scores were significantly more likely to receive local anesthesia and epidural anesthesia during the operation and to have patient-controlled analgesia (PCA), nonsteroidal anti-inflammatory drugs (NSAIDs), or a combination of PCA and NSAIDs and significantly less likely to receive intermittent postoperative narcotics, compared with patients in hospitals with worst pain scores.

Hospitals with the lowest pain scores had a significantly higher proportion of operations with a minimally invasive approach than did hospitals with the highest pain scores.

Patients whose operations took place in hospitals in the lowest quartile of pain scores had significantly shorter mean postoperative length of stay and were significantly less likely to have a postoperative complication, emergency department visit, or readmission.

Patient factors contributing to worse pain scores included being younger than 50 (versus age over 75), a woman, black (versus white), a smoker, and uninsured or insured by Medicaid (versus Medicare or privately insured).

"Most likely," the researchers note, "both pain scores and clinical outcomes reflect more global features of the quality of care in hospitals' surgical performance. Thus, hospitals with the most streamlined, high-quality perioperative care pathways experience the best pain scores, as well as improved clinical outcomes."

"Early postoperative analgesia regimens are an essential component of efforts to improve the efficiency and quality of postoperative recovery," Dr. Regenbogen said."Effective pain control, even in the first postoperative day, is associated with reduced postoperative length of stay and fewer major complications and readmissions. Thus, effective multimodal analgesia is an essential component of high-value perioperative care around colorectal surgery."

"This study is hopefully just one example of a growing emphasis on patient-reported outcomes in surgery," Dr.Regenbogen said. "Within a statewide quality collaborative, we have begun to prioritize engagement of patients, in addition to our partnering surgeons, hospitals, and mayors, in efforts to improve surgical care in Michigan. In this study, we used patient-reported pain measures to evaluate quality of care. In the near future, we will elicit patient-reported measures of functional recovery, psychosocial support, and other outcomes to validate the perioperative outcomes we have relied on traditionally. We hope this study will serve as a model for those novel areas of investigation."

Dr. Antoni Sabate from Hospital Universitari de Bellvitge in Barcelona, Spain, who has researched postoperative analgesia told Reuters Health by email, "Pain is largely influenced by magnitude of the surgical procedure, surgical technique (minimally invasive), analgesia protocol (the use of local anesthetic infiltration in open and laparoscopic, the use of epidural in open procedures, implementation of PCA and NSAID in both laparoscopic and open procedures."

 

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."

 

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."

 

NEW YORK (Reuters Health) - Women with atrial fibrillation (AF) are at somewhat higher risk of death and cardiovascular disease (CVD) than men with the condition, a new systematic review and meta-analysis confirms.

"Physicians should be aware of this and they should also make sure they treat women as aggressively as men," Connor Emdin, a doctoral student at The George Institute for Global Health at the University of Oxford, U.K., told Reuters Health. "On average, women should probably be treated moreaggressively."

Smoking and diabetes are known to increase coronary heart disease risk more sharply for women than for men, Emdin and his team write in their report, online January 19 in The BMJ. Some studies have found that AF is more strongly associated with stroke and death in women than in men, but other studies have not, they add.

To better understand the relationship, the researchers looked at 30 studies including more than 4.3 million individuals. The ratio of relative risk for women compared to men with AF for all-cause mortality was 1.12. For stroke, the ratio was 1.99, while it was 1.93 for cardiovascular mortality, 1.55 for cardiac events, and 1.16 for heart failure. All increases were statistically significant.

While the CHADS2 score for estimating stroke risk in AF does not include female sex as a risk factor for stroke, Emdin noted, a more recent version, the CHA2DS2-VASc score, does. "Our results would support using risk scores which include female sex," he said.

AF is less prevalent among women than men, but thefindings confirm that it is more severe for them as well, Dr. Elsayed Soliman, director of the Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center in Wake Forest, North Carolina, told Reuters Health. Dr. Soliman was not involved in the new study.

"The article adds to this evidence that really women are different from men when it comes to cardiovascular disease and they need to be managed differently," Dr. Soliman said. He added that "we need to do more work to see what could bridge the gap in outcomes associated with atrial fibrillation."