2011 September

Mentorship, Productivity, and Promotion Among Academic Hospitalists.

Sep 292011

Mentorship, Productivity, and Promotion Among Academic Hospitalists.

J Gen Intern Med. 2011 Sep 28;

Authors: Reid MB, Misky GJ, Harrison RA, Sharpe B, Auerbach A, Glasheen JJ

Abstract
BACKGROUND: United States academic hospitals have rapidly adopted the hospitalist model of care. Academic hospitalists have taken on much of the clinical and teaching responsibilities at many institutions, yet little is known about their academic productivity and promotion. OBJECTIVE: We sought to discover the attitudes and attributes of academic hospitalists regarding mentorship, productivity, and promotion. DESIGN: We performed a web-based email survey of academic hospitalists consisting of 61 questions. PARTICIPANTS: Four hundred and twenty academic hospitalists. MAIN MEASURES: Demographic details, scholarly production, presence of mentorship and attitudes towards mentor, academic rank KEY RESULTS: Two hundred and sixty-six (63%) of hospitalists responded. The majority were under 41 (80%) and had been working as hospitalists for <5 years (62%). Only 42% of academic hospitalists had a mentor. Forty-four percent of hospitalists had not presented a poster or abstract at national meeting; 51% had not been first author on a peer-reviewed publication. Factors positively associated with publication of a peer-reviewed first author paper included: 1) male gender, AOR?=?2.38 (95% CI 1.30, 4.33), 2) >20% "protected" time, AOR?=?1.92 (95% CI 1.00, 3.69), and 3) a better-than-average understanding of the criteria for promotion, AOR?=?3.66 (95% CI 1.76, 7.62). A lack of mentorship was negatively associated with producing any peer-reviewed first author publications AOR?=?0.43 (95% CI 0.23, 0.81); any non-peer reviewed publications AOR?=?0.45 (95% CI 0.24, 0.83), and leading a teaching session at a national meeting AOR?=?0.41 (95% CI 0.19, 0.88). Most hospitalists promoted to the level of associate professor had been first author on four to six peer-reviewed publications. CONCLUSIONS: Most academic hospitalists had not presented a poster at a national meeting, authored an academic publication, or presented grand rounds at their institution. Many academic hospitalists lacked mentorship and this was associated with a failure to produce scholarly activity. Mentorship may improve academic productivity among hospitalists.

PMID: 21953327 [PubMed - as supplied by publisher]

Link to Article at PubMed

Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit.

J Hosp Med Start a Discussion »

Sep 292011

Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit.

J Hosp Med. 2011 Sep 26;

Authors: Szecket N, Wong HJ, Wu RC, Berman HD, Morra D

Abstract
BACKGROUND: Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a "bolus" system to a "drip" system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year. METHODS: We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6-month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods. RESULTS: There were a total of 2734 discharges, 1446 occurring in the pre-change period, and 1288 in the post-change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post-change period (P = 0.0065). CONCLUSIONS: Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

PMID: 21954169 [PubMed - as supplied by publisher]

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Procalcitonin-guided therapy in respiratory tract infections: a meta-analysis and systematic review.

Antimicrob Agents Chemother Start a Discussion »

Sep 292011

Procalcitonin-guided therapy in respiratory tract infections: a meta-analysis and systematic review.

Antimicrob Agents Chemother. 2011 Sep 26;

Authors: Li H, Luo YF, Blackwell TS, Xie CM

Abstract
Circulating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996-2010), IS Web of knowledge (1996-2010), and OVID. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, ICU admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.

PMID: 21947386 [PubMed - as supplied by publisher]

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The Relationship Between Vancomycin Trough Concentrations and Nephrotoxicty: A Prospective, Multi-center Trial.

Antimicrob Agents Chemother Start a Discussion »

Sep 292011

The Relationship Between Vancomycin Trough Concentrations and Nephrotoxicty: A Prospective, Multi-center Trial.

Antimicrob Agents Chemother. 2011 Sep 26;

Authors: Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, Mauldin PD

Abstract
Several single center studies have suggested that higher doses of vancomycin, aimed at producing trough concentrations > 15 mg/L, are associated with increased risk of nephrotoxicity. We prospectively assessed the relative incidence of nephrotoxicity in relation to trough concentration in patients with documented MRSA infections at 7 hospitals throughout South Carolina. Adult patients receiving vancomycin for at least 72 hr with at least one vancomycin trough concentration determined under steady-state conditions were prospectively studied. The relationship between vancomycin trough concentrations > 15 mg/mL and occurrence of nephrotoxicity was assessed using univariate and multivariate analyses, controlling for age, gender, race, dose, length of therapy, use of other nephrotoxins (including contrast media), ICU residence, episodes of hypotension, and comorbidities. Nephrotoxicity was defined as an increase in serum creatinine of 0.5 mg/dL or ? 50% increase from baseline for two consecutive measurements. Minimum inhibitory concentrations of vancomycin for the MRSA isolates were also determined. 288 patients were studied between February 2008 and June 2010 with approximately one-half having initial trough concentrations ? 15 mg/mL. Nephrotoxicity was observed in 42 patients (29.6%) with trough concentrations > 15 mg/mL and in 13 (8.9%) with troughs ? 15 mg/mL. Multivariate analysis revealed vancomycin troughs > 15 mg/mL and race (Black) as risk factors for nephrotoxicity in this population. Vancomycin trough concentrations > 15 mg/mL appear to be associated with a 3-fold increased risk of nephrotoxicity.

PMID: 21947388 [PubMed - as supplied by publisher]

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Rapid Detection of Coronary Artery Stenoses with Real Time Perfusion Echocardiography During Regadenoson Stress.

Circ Cardiovasc Imaging Start a Discussion »

Sep 292011

Rapid Detection of Coronary Artery Stenoses with Real Time Perfusion Echocardiography During Regadenoson Stress.

Circ Cardiovasc Imaging. 2011 Sep 23;

Authors: Porter TR, Adolphson M, High RR, Smith LM, Olson J, Erdkamp M, Xie F, O'Leary E, Wong BF, Eifert-Rain S, Hagen ME, Abdelmoneim SS, Mulvagh SL

Abstract
BACKGROUND: -Real time myocardial contrast echocardiography (RTMCE) permits the detection of myocardial perfusion abnormalities during stress echocardiography that may improve the accuracy of the test in detecting coronary artery stenoses (CAD). We hypothesized that this technique could be utilized following a bolus injection of the selective A2A receptor agonist regadenoson (Astellas Pharma) to rapidly and safely detect CAD. METHODS AND RESULTS: -In 100 patients referred for quantitative coronary angiography (QCA), RTMCE was performed during a continuous intravenous infusion of 3% Definity (Lantheus Medical Imaging) at baseline and at two minute intervals for up to six minutes following a regadenoson bolus injection (400 ug). Myocardial perfusion was assessed by examining myocardial contrast replenishment (MCR) following brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in MCR in two contiguous segments. Wall motion (WM) was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, while for WM analysis it was 60%/72%/66% (p<0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first two minutes following regadenoson bolus (p<0.001 compared to wall motion), while wall motion sensitivity was highest at the 4-6 minute period following the bolus.No significant side effects occurred following regadenoson bolus injection. CONCLUSIONS: -Regadenoson RTMCE appears to be a feasible, safe, and rapid non-invasive method for the detection of significant coronary artery stenoses. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0087369.

PMID: 21946702 [PubMed - as supplied by publisher]

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Comparison of Measured GFR, Serum Creatinine, Cystatin C, and Beta-Trace Protein to Predict ESRD in African Americans With Hypertensive CKD.

Am J Kidney Dis Start a Discussion »

Sep 292011

Comparison of Measured GFR, Serum Creatinine, Cystatin C, and Beta-Trace Protein to Predict ESRD in African Americans With Hypertensive CKD.

Am J Kidney Dis. 2011 Sep 21;

Authors: Bhavsar NA, Appel LJ, Kusek JW, Contreras G, Bakris G, Coresh J, Astor BC,

Abstract
BACKGROUND: Identification of persons with chronic kidney disease (CKD) who are at highest risk to progress to end-stage renal disease (ESRD) is necessary to reduce the burden of kidney failure. The relative utility of traditional markers of kidney function, including estimated glomerular filtration rate (eGFR) and serum creatinine level, and emerging markers of kidney function, including cystatin C and beta-trace protein (BTP) levels, to predict ESRD and mortality has yet to be established. STUDY DESIGN: Randomized clinical trial followed by an observational cohort study. SETTING & PARTICIPANTS: 865 African American individuals with hypertensive CKD enrolled in a clinical trial of 2 levels of blood pressure control and 3 different antihypertensive drugs as initial therapy and subsequently followed by an observational cohort study. PREDICTORS: Quintile of measured GFR (mGFR) by iothalamate clearance, serum creatinine, serum creatinine-based eGFR, cystatin C, and BTP values. OUTCOMES & MEASUREMENTS: Incidence of ESRD and mortality. RESULTS: 246 participants reached ESRD during a median follow-up of 102 months. The incidence rate of ESRD was higher with higher quintiles of each marker. The association between higher BTP level and ESRD was stronger than those for the other markers, including mGFR. All markers remained significantly associated with ESRD after adjustment for mGFR and relevant covariates (all P < 0.05), with BTP level retaining the strongest association (HR for highest vs lowest quintile, 5.7; 95% CI, 2.2-14.9). Associations with the combined end point of ESRD or mortality (n = 390) were weaker, but remained significant for cystatin C (P = 0.05) and BTP levels (P = 0.004). LIMITATIONS: The ability of these markers to predict ESRD and mortality in other racial and ethnic groups and in individuals with CKD due to other causes is unknown. CONCLUSIONS: Plasma BTP and cystatin C levels may be useful adjuncts to serum creatinine level and mGFR in evaluating risk of progression of kidney disease.

PMID: 21944667 [PubMed - as supplied by publisher]

Link to Article at PubMed

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