ACP Hospitalist will return in January

ACP Hospitalist will be back with more Medical News of the Obvious and the rest of our regular coverage in January. Enjoy your holiday season.

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posted by Ryan DuBosar at 5:00 PM   0 Comments

Is less really more?

If there's one thing that health reformers have agreed on, it's that hospitals should follow the lead of low-cost, high-quality centers like the Mayo Clinic. Everybody knows that other health systems are wasting lots of money on futile care in the last few months of patients' lives.

Or are they? An article in today's New York Times throws these assumptions into question. Experts from some University of California hospitals claim that their high-cost interventions for very sick patients actually preserve life and health a good percentage of the time. They say that the typically cited cost studies fail to account for the patients who turn out not to have been at the end of their lives.

Of course, the UC experts agree that some care is unnecessary. But their argument and data seem like to seriously complicate the decision-making about which care is a waste of money and which provides real benefit. Just what health care reform needs--something new to argue about.

Labels: health care reform

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posted by Stacey Butterfield at 12:11 PM   0 Comments

How hospital medicine helps rural health care

News items constantly crop up about how small town hospitals seek to cure their physician shortages by bringing internists on-staff. Here's two more stories that caught our eye this week.

In Wilmar, Minn., hospitalist Fred Hund, ACP Member, is featured at part of Rice Memorial Hospital's plan increase the number of primary and specialty care doctors. They'll work with local practices to increase primary care, specialty and hospital positions in the community.

And, ACP members in Amarillo, Texas, are rolling out a hospitalist model to their community. Hospitalist Sheryl Williams, FACP, of Baptist St. Anthony's Health System and Alan Keister, ACP Member, of Amarillo Medical Specialists, say doctors spend too much shuttling between facilities, and not having hospitalists has hindered recruitment that would ease the shortage. They've e-mailed patients to explain the changes, which are detailed in local news coverage in the video below.

Labels: rural health care, staffing

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posted by Ryan DuBosar at 12:32 PM   0 Comments

Medical News of the Obvious

We'd like to thank the Journal of the American College of Cardiology for sponsoring this edition of MNO by providing all of our content in a single issue.

First up, making chubby kids run turns out to serve a purpose besides the pleasure of unhappy gym teachers. The sadists (um, I mean, researchers) enrolled the fattest kids in the class (97th percentile for their 6 to 11 year old age range) in mandatory 60-minute exercise programs. Not surprisingly, they found that the exercise was good for the children's cardiovascular fitness. More surprisingly, they claim that the program was "deliberately made enjoyable for the children with activities including swimming and ball games." Right. Can't you just picture the coach yelling, "Get your butt on the field! This kickball game has been deliberately made enjoyable for you"?

Meanwhile, other researchers have been torturing older obese people by feeding them less to find out that weight loss is also good for your cardiovascular health. Oh, and smoking affects your recovery from a heart attack. That last one was observational. Apparently the researchers didn't have to make people smoke in order to prove that it's bad for you.

Labels: medical news of the obvious

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posted by Stacey Butterfield at 10:10 AM   0 Comments

PCI-palooza

Several recent studies tackle the subject of best practices for PCI. Some quick summaries:

• 22.3% of dialysis patients undergoing PCI received a contraindicated antithrombotic medication, which was associated with a higher risk of major bleeding while in the hospital, a JAMA study reports. Of the patients who received contraindicated meds, 64.1% received eptifibatide, 46.7% received enoxaparin, and 10.9% received both.
• There was no difference in a composite of all-cause mortality, MI, or ischemia-driven revascularization at 48 hours after PCI for patients given IV cangrelor vs. clopidogrel, the NEJM reports. The cangrelor patients received the drug 30 minutes before PCI through 2 hours after PCI, while the other group got 600 mg of oral clopidogrel 30 minutes before PCI.
• Patients given cangrelor at the time of PCI, followed by 600 mg of clopidogrel afterwards, did no better than patients give placebo then clopidogrel, at least on a primary end point, another NEJM study found. The end point here was a composite of all-cause death, MI or ischemia-driven revascularization at 48 hours after PCI. However, the cangrelor patients did see a significant reduction on the secondary end points of stent thrombosis and any-cause death at 48 hours.
• Compared to moderate-dose statin therapy, intensive statin therapy reduces major CV events for patients undergoing PCI for acute coronary syndrome. The intensive statin group received 80 mg atorvastatin, while the moderate group got 40 mg pravastatin, daily. The study was published in JACC.
• Finally, JACC issued a white paper to help clinicians manage the medication of heart disease patients undergoing PCI who might need temporary interruption of the drugs for an elective endoscopic GI procedure.

Labels: PCI

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posted by Jessica Berthold at 11:55 AM   0 Comments

New York survey shows dire need for hospitalists, internists

The Health Care Association of New York State released its 2009 Physician Advocacy Survey, "The Doctor Can't See You Now," that says the state's doctor shortage is likely to worsen. The study shows recruitment barely offsets retirements, and there is a severe lack of physicians in internal medicine and hospitalist care, as well as specialties such as obstetrics/gynecology, general surgery and psychiatry. Survey respondents reported a lack of 1,300 physicians, with 35% of that total comprising a need for primary care/internal medicine and 7% a lack of hospitalists.

The survey found that:
--45% of hospitals lack ED coverage for certain specialists, and patients must travel to other hospitals, some time distant ones, to receive care;
--24% had to reduce or eliminate specialty services because of an inability to recruit physicians;
--66% indicated that they have to pay for on-call services; and
--75% employ locum tenens physicians.

The report not only calls for better funding of physician education from the state and the nation, but an expansion of telemedicine and an increased role for nurse practitioners and physician assistants.

Labels: medical education, recruitment, staffing

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posted by Ryan DuBosar at 9:38 AM   0 Comments

Medical News of the Obvious

The selections this week are not so much obvious as they are fruitless. Call it "Medical News that is Likely to be Ignored."

A new study "provides evidence that the average cigarette is crawling with germs, including bacteria that cause respiratory disease," HealthDay reports. Because, of course, smokers typically have shown great concern about protecting themselves from respiratory disease. This research is in its early stage and the experts expressed a "need to figure out if they [the bacteria] are impacting human health." Would that mean that cigarettes are impacting human health, too?

There's bad news for ecstasy users, too. If you're not already bleary-eyed from raving all night, sleep apnea might be impairing your rest. A comparison of 71 ecstasy users with controls found an association between the drug and sleep apnea, reported WebMD. "The scientists...say doctors should warn young people that the drug 'damages their brains' and may cause sleep apnea." Hmm, which half of that warning do you find more attention-grabbing?

Labels: medical news of the obvious

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posted by Stacey Butterfield at 9:00 AM   0 Comments

Pop Quiz: Hospital procedure costs

Guess which procedure's costs rose most rapidly at hospitals between 2004 and 2007?

A. Spinal fusion
B. Bone marrow transplant
C. Cancer chemotherapy
D. Knee surgery

(Extra points if you can guess, within 10% of accuracy, how much the costs rose. Hint: Overall hospital costs grew by $344 billion (6.3%) in this time period, inflation adjusted. )

The answer is B, according to new data from AHRQ. Hospital costs for bone marrow transplants were $1.3 billion in 2007, up 85% from 2004 (when they were $694 million).

The other big procedural cost increases were as follows:

• Open surgery for non-cancerous enlarged prostate: 69% increase, to $1 billion.
• Aortic valve resection or replacement: 38.5% increase, to $1.9 billion.
• Cancer chemotherapy: 33% increase, to $2.6 billion.
• Spinal fusion: 29.5% increase, to $8.9 billion.
• Lobectomy: 29% increase, to $1.8 billion.
• Incision and drainage of skin and other tissues: 29% increase, to $1 billion.
• Knee surgery: 27.5% increase, to $9.2 billion.
• Nephrostomy: 25% increase, to $683 million.
• Mastectomy: 24% increase, to $660 million.

Labels: hospital costs

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posted by Jessica Berthold at 10:20 AM   0 Comments

Diagnosing H1N1

The NEJM posted a good piece yesterday on its Viral Insights blog about diagnosing H1N1 in hospitalized patients, given the limitations of current diagnostic tests. It's a quick read, but here are two pearls:

"Patients with suspected influenza and negative RIDT or DFA results should (still) have appropriate respiratory specimens tested for 2009 H1N1 by real-time RT-PCR."

and

"Empirical antiviral treatment should be started as soon as possible for hospitalized patients with suspected 2009 H1N1 and not withheld, because a negative RIDT or DFA result does not exclude 2009 H1N1 virus infection. Nor should treatment be delayed until real-time RT-PCR results are available."

Labels: H1N1

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posted by Jessica Berthold at 4:10 PM   0 Comments