Converting IMPROVE bleeding and VTE risk assessment models into a fast-and-frugal decision tree for optimal hospital VTE prophylaxis.

Current hospital venous thromboembolism (VTE) prophylaxis for medical patients is characterized by both underuse and overuse. The American Society of Hematology (ASH) has endorsed the use of risk assessment models (RAMs) as an approach to individualize VTE prophylaxis by balancing overuse (excessive risk of bleeding) and underuse (risk of avoidable VTE). ASH has endorsed IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) risk assessment models, the only RAMs to assess short-term bleeding and VTE risk in acutely ill medical inpatients.

Aligning Education with Collaborative Practice by Using Student Observations to Teach Interprofessional Teamwork.

As a component of a curriculum redesign to link foundational academic interprofessional education (IPE) to practice-ready skills and knowledge, students (n=582) at a southeastern academic health sciences center participated in required interprofessional course offerings that included observation of clinical or nonclinical units. Students enrolled in Behind the Scenes observed nonclinical teams across the enterprise, while students enrolled in TeamWorks became proficient observers of team behaviors using the TeamSTEPPS framework and utilized the TeamSTEPPS Team Performance Observation tool to collect observation data. Other students were enrolled in interprofessional courses consisting of theoretical content, group work, and didactic teaching strategies.

Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others.

Achieving High Reliability Through Cultural Mindfulness.

Healthcare has enthusiastically embraced quality and safety improvement. Yet, more radical transformation is clearly needed to make a more significant impact on error reduction and to ensure consistent quality. This need for transformation is leading healthcare to examine how other industries, such as nuclear power and aviation, improve safety to achieve a high degree of reliability and avoid potential catastrophes.

Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

Background: The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes.

Association between different types of social support and medication adherence.

Objectives: To evaluate the association between social support and medication adherence.

Study Design: A search of articles published before November 2010 in peer-reviewed, healthcare-related journals was conducted using PubMed, EMBASE, and Web of Science, and search terms related to social support (social support OR friend OR family OR agency) and adherence (patient compliance OR medication adherence), yielding 5331 articles.

Methods: Articles were included if they directly measured the relationship between medication adherence and some form of social support.

Nutrition in the hospitalized patient.

Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission.

Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial.

Background: Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs).

Objective: To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge.

The impact of hospitalists on length of stay and costs: systematic review and meta-analysis.

Background: Hospital medicine has undergone remarkable growth since its creation. Most (but not all) of the published literature demonstrates better outcomes for patients cared for by hospitalists.

Purpose: We performed a systematic review and meta-analysis to estimate the magnitude of the impact of hospitalists on length of stay (LOS) and cost.

U.S. physician satisfaction: a systematic review.

Introduction: There is concern in the US about the burden and potential ramifications of dissatisfaction among physicians. The purpose of this article is to systematically review the literature on US physician satisfaction.

Methods: A MEDLINE search with the medical subject headings (MeSH) phrases: (physicians OR physician's role OR physician's women) AND (job satisfaction OR career satisfaction OR burnout), limited to humans and abstracts, with 1157 abstracts reviewed.

Diagnostic and treatment delays in recurrent Clostridium difficile-associated disease.

Background: Because Clostridium difficile-associated disease (CDAD) is primarily an inpatient issue, hospitalists are at the forefront of the timely diagnosis and treatment of patients with this disease.

Design: The study was a retrospective cohort of all inpatients with CDAD at Brigham and Women's Hospital from 1997 to 2004 in order to determine the time to diagnosis and treatment in initial and recurrent episodes of disease.

Results: The mean time to sampling, between 2.

An over-the-counter omission.

Despite the widespread use of over-the-counter (OTC) medications, their utilization is rarely ascertained at hospital admission. Presented here is an interesting case of acute renal failure and hemolytic anemia attributable to a commonly utilized OTC medication. The chronic use of phenazopyridine accounted for all of these findings.

Overcoming barriers to pneumococcal vaccination in patients with pneumonia.

Inpatient pneumococcal vaccination remains underutilized, and little data exist to guide hospital personnel in improving their performance. The authors report their experience with a stepwise program to improve vaccination assessment rates for hospitalized patients with community-acquired pneumonia. They assessed barriers to vaccination and applied a stepwise educational and intranet-based decision support implementation program for hospitalized patients with community-acquired pneumonia.

Hospitalists and improved cost savings in patients with bacterial pneumonia at a state level.

Objectives: In the hospitalist literature, most studies have focused on outcomes related to cost savings for individual hospital systems. This study sought to determine if hospitalists could improve cost savings at a state level.

Methods: This is a retrospective analysis of a statewide database for inpatients in 2002 with bacterial pneumonia.

Rapid reversal of renal failure after initiation of HAART: a case report.

HIV-associated nephropathy (HIVAN), characterized by proteinuria and progressive renal failure, is a well-known complication of HIV infection. Treatment of the condition has focused on the use of corticosteroids, angiotensin-converting enzyme inhibitors, and HAART, all of which can improve the prognosis. Although there are a few case reports of improvement of renal function after the initiation of HAART, this treatment has not been studied in a prospective fashion, and the timing of the improvement is not well documented.