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In The News

INPATIENT MORTALITY
Does practice make perfect for hospitals?
While the conventional wisdom has long held that high volume hospitals have a significant edge when it comes to surgery and invasive procedures, a new study finds that experience and volume may also play a role with all types of care. Researchers in the New England Journal of Medicine found that patients treated at high-volume hospitals for AMI, heart failure and pneumonia had lower 30-day mortality rates. Risk-adjusted mortality dropped 11% for AMI, 9% for heart failure and 5% for pneumonia. The study noted that while volume alone can’t be used as a proxy for outcomes, researchers should determine what high-volume hospitals are doing well.

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Posted on 03-25-2010 at 9:33 AM


EOL CARE
The impact of EOL planning, surrogates on care
Helping patients with end-of-life care planning not only increases the likelihood that their final wishes are respected, but makes death less traumatic for family members. A study published on the Web site of the British Medical Journal found that when patients over 80 were given help documenting their EOL wishes and designated a surrogate, they were three times more likely to receive the care they specified. The study also found that family members of those patients reported significantly less stress, and that patient and family satisfaction scores were higher than for patients who didn’t receive help with EOL care planning.

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Posted on 03-25-2010 at 9:33 AM


PNEUMONIA
A look at therapies for nursing home pneumonia
A study in the March issue of the Journal of Hospital Medicine examines an area that hasn’t received much attention: prescribing patterns for nursing home-acquired pneumonia. Researchers found that the most commonly used therapies were fluoroquinolones (51.4%), ceftriaxone (45.0%), and azithromycin (42.1%). A single agent was prescribed 57% of the time, with fluoroquinolones used alone in about 80% of those cases. Sicker patients were more likely to receive a combination of vancomycin plus piperacillin/tazobactam.

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Posted on 03-25-2010 at 9:33 AM


MRSA STRATEGIES
How French hospitals reduced MRSA incidence
French researchers have found that fairly simple strategies to combat MRSA can be effective—if they are used consistently and for a long enough period of time. According to an article in the Archives of Internal Medicine, researchers started a 15-year program to combat the infection began in 1993 after data showed MRSA incidence had reached 35% in French hospitals. Successful strategies included more proactively identifying MRSA patients, placing them in single-bed rooms, using barrier precautions, and promoting hand hygiene. Researchers were able to reduce the incidence of MRSA from 0.86 per thousand hospitals days to 0.56.

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Posted on 03-24-2010 at 11:30 AM


STATIN ALERT
FDA: 80 mg of simvastatin increases myopathy
You might think twice before boosting your patients’ prescription for simvastatin (Zocor). The FDA has released an alert that increasing simvastatin to 80 mg a day increases the risk of myopathy. The alert found that 0.9% of patients taking the 80 mg dose of simvastatin developed myopathy compared to 0.2% of patients taking a 20 mg dose. Physicians often prescribe higher doses of simvastatin to achieve similar potency levels as other statins because simvastatin, a generic, is on the formularies of large payers, including the VA.

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Posted on 03-24-2010 at 11:30 AM


HOSPITAL REVENUE
How much do you earn for your hospital?
Survey results released this week find that internal medicine physicians generate $1.68 million in revenue for hospitals. The survey, conducted by Merritt Hawkins, found that the average annual net hospital revenue being generated by 17 specialties is $1.54 million, a 3% decrease over 2007 survey figures and a 19% decrease over net revenue generated by all specialties in 2004.

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Posted on 03-24-2010 at 11:29 AM


HEALTH CARE REFORM
Will reform help or hurt hospitals’ bottom line?
With the passage of health care reform, some analysts are predicting that hospitals may stand to gain financially from expanding the number of Americans with health insurance. A story in the New York Times says that the health reform bill will likely mean 32 million more paying customers for the health care industry. It also notes that many of those patients will be covered by Medicaid, which typically pays less than hospitals’ costs.

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Posted on 03-23-2010 at 10:19 AM


GUIDELINE UPDATE
C. diff guidelines offer new recommendations
New guidelines call for using metronidazole as the front line treatment for patients with first episodes of mild-to-moderate C. diff infection. The guidelines, which were released by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America, call for administering 500 mg orally three times a day for 10–14 days. For first recurrences of C. diff, the guidelines recommend repeating the initial treatment regimen. For additional recurrences, the guidelines advise using vancomycin instead of metronidazole because of the risk for neurotoxicity. The guidelines, which were last updated in 1995, appear on the Infection Control and Hospital Epidemiology Web site.

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Posted on 03-23-2010 at 10:19 AM


HEART FAILURE
BNP-guided therapy reduces mortality
According to a new meta-analysis, B-type natriuretic peptide (BNP) guided therapy led to a decrease in all-cause mortality in chronic heart failure patients. The survival benefit, researchers wrote, was particularly clear in patients younger than 75. However, BNP-guided therapy was not found to reduce all-cause hospitalization rates.

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Posted on 03-23-2010 at 10:19 AM


THE MATCH
Match day: same plateau for primary care
The number of U.S. medical school seniors choosing internal medicine in last week's Match crept up from figures in 2009--but not in any significant percentage. There was a 3.4% increase in matching seniors to internal medicine residencies (2,722), up from 2,632 the previous year. Currently, 54% of those go on to an internal medicine subspecialty, compared to only between 20% and 25% in 1998.

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Posted on 03-22-2010 at 11:55 AM


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