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Latest Posts

Are The Quality Metrics For Neurologists Reasonable?

Quality and safety metrics that will specifically affect neurologists/neurohospitalists are coming in the next few years, and neurohospitalists need to be involved in the discussion of what those metrics are, warned S. Andrew Josephson of USCF during a neurohospitalists session at the Stroke 2010 conference yesterday.

He urged the audience to consider the current metric of “time to antibiotics administration for pneumonia,” which seems like a reasonable quality metric on the surface. To get compliance rates up, many hospitals give antibiotics to anyone with a little sputum, a cough, a fever, etc., as soon as he/she arrives at the ED. Thus, resistance rates have risen along with administration rates, because people are getting the drugs when they have things like bronchitis, not just pneumonia. Read more »

*This blog post was originally published at ACP Hospitalist*

Tips To Manage Acute Intracerebral Hemorrhage

Some quick tips about medically managing patients with acute intracerebral hemorrhage, courtesy of a talk at Stroke 2010 by Craig Anderson, MD, George Institute for International Health in Sydney NSW, Australia:

–avoid excess elevation of variables like blood pressure, glucose levels and body temperature

–maintain hydration; many of these patients present dehydrated

–elevate the head

–abandon intensive insulin therapy

–In terms of lowering blood pressure, going from 220 mm Hg systolic to 140 mm Hg over one hour appears safe, but it’s still unknown whether more rapid lowering is better, or if it would be better to achieve a lower systolic level.

*This blog post was originally published at ACP Hospitalist*

Cognitive Impairment Often Goes Undocumented In Hospital Charts

A recent JHM study found that hospital staff often don’t recognize cognitive impairment in patients age 65 and older. This was especially true for patients on the younger end of the spectrum, and those with more comorbidity.

Of the 424 patients (43%) in the study who were cognitively impaired, 61% weren’t recognized as such by ICD-9 coding. Interestingly, there was no significant difference between patients with documented and undocumented cognitive impairment as far as mortality, length of stay, home discharge, readmission rates, incidence of delirium, or receipt of anticholinergics. One troubling finding: a significant number of patients with cognitive impairment received anticholinergic medication, even though it’s not recommended for patients with any type of CI. Read more »

*This blog post was originally published at ACP Hospitalist*

How To Reduce Hospital Readmission Rates In Poor Cities

The Philadelphia Inquirer had an interesting piece Monday about a successful initiative in Camden, NJ (one of the poorest cities in the U.S.) that has dramatically reduced ED visits and readmissions. Among other things, a coalition of primary care providers has banded together to get more patients to see PCPs instead of going straight to the ED. (Appropriate patients are referred from the ED to these providers, for eg). Open-access scheduling, electronic prescribing and chronic disease registries also further the goal of preventive medicine that keeps patients from getting to the point where they need to go to the ED, or need to be admitted to the hospital.

The result? Monthly ED visits down by 32%, hospital admissions–and charges–down by 56%. Read more »

*This blog post was originally published at ACP Hospitalist*

Stroke: Is Your Risk Of Death Higher On Weekends?

In early 2008, researchers at the International Stroke conference unveiled two studies showing a “weekend effect” in stroke– ie, mortality from stroke was higher on the weekends (and at night) than weekdays. We explored this topic in the June 2008 ACP Hospitalist.

Now, a new Archives of Neurology study has found no difference in stroke death rates based on weekend/weekday arrival. What’s more, stroke patients admitted on weekends were more likely to get tPA. This flies in the face of one of the main theories about the weekend effect–namely, that stroke rates may be higher on weekends because there is often a shortage of staff and resources, which leads to less aggressive treatment. Read more »

*This blog post was originally published at ACP Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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