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.

Hospitalists and the quality of care in hospitals.

Background: Little is known about the link between hospitalists and performance on hospital-level quality indicators.

Methods: From October 1, 2005, through September 31, 2006, we linked the Hospital Quality Alliance (HQA) data to the American Hospital Association data on the presence of hospitalists. Main outcome measures included composite measurements of hospital-level quality of care for 3 conditions (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) and 2 dimensions of care (treatment and diagnosis, as well as counseling and prevention).

Once daily enoxaparin for outpatient treatment of acute venous thromboembolism: a case-control study.

We studied the efficacy and safety of an investigational enoxaparin regimen, 1.5 mg/kg once daily, as a bridge to warfarin for the outpatient treatment of acute venous thromboembolism. We undertook a case-control design.

Implementation of a physician assistant/hospitalist service in an academic medical center: impact on efficiency and patient outcomes.

Background: Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions have led to the widespread implementation of non-house staff services in academic medical centers, yet little is known about the quality and efficiency of patient care on such services.

Objective: To evaluate the quality and efficiency of patient care on a physician assistant/hospitalist service compared with that of traditional house staff services.

Design: Retrospective cohort study.

Prevention of venous thromboembolism in the cancer surgery patient.

Cancer patients, especially those undergoing surgery for cancer, are at extremely high risk for developing venous thromboembolism (VTE), even with appropriate thromboprophylaxis. Anticoagulant prophylaxis in cancer surgery patients has reduced the incidence of VTE events by approximately one-half in placebo-controlled trials, and extended prophylaxis (for up to 1 month) has also significantly reduced out-of-hospital VTE events in clinical trials in this population. Clinical trials show no difference between low-molecular-weight heparin (LMWH) and unfractionated heparin in VTE prophylaxis efficacy or bleeding risk in this population, although the incidence of heparin-induced thrombocytopenia is lower with LMWH.

Prevention of venous thromboembolism in the orthopedic surgery patient.

Patients undergoing major orthopedic surgery--hip or knee arthroplasty, or hip fracture repair--are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review.

Prevention of venous thromboembolism in the hospitalized medical patient.

Hospitalized acutely ill medical patients are at high risk for venous thromboembolism (VTE), and clinical trials clearly demonstrate that pharmacologic prophylaxis of VTE for up to 14 days significantly reduces the incidence of VTE in this population. Guidelines recommend use of low-molecular-weight heparin (LMWH) or unfractionated heparin (5,000 U three times daily) for VTE prophylaxis in hospitalized medical patients with risk factors for VTE; in patients with contraindications to anticoagulants, mechanical prophylaxis is recommended. All hospitalized medical patients should be assessed for their risk of VTE at admission and daily thereafter, and those with reduced mobility and one or more other VTE risk factors are candidates for aggressive VTE prophylaxis.

How to use the core competencies in hospital medicine: a framework for curriculum development.

Background: The seminal article that coined the term hospitalist, published in 1996, attributed the role of the hospitalist to enhancing throughput and cost reduction, primarily through reduction in length of stay, accomplished by having a dedicated clinician on site in the hospital. Since that time the role of the hospitalist has evolved, and hospitalists are being called upon to demonstrate that they actually improve quality of care and the education of the next generation of physicians. A companion article in this issue describes in detail the rationale for the development of the Core Competencies document and the methods by which it was created.

Core competencies in hospital medicine: development and methodology.

Background: The hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of hospital medicine. Training and developing curricula specific to hospital medicine are the next step in the evolution of the field.

Curriculum development: the venous thromboembolism quality improvement resource room.

Background: The role of the hospitalist has evolved over the last decade, with hospitalists increasingly being asked to lead systems-based initiatives to improve the quality of inpatient care. The educational strategy of the Society of Hospital Medicine (SHM) includes development of practice-based resources to support hospitalist-led improvement in clinically important measures of hospital care quality.

Objective: To develop a resource at the SHM Web site to present quality improvement (QI) principles for systems-based care in the hospital and to help individual hospitalists improve specific patient outcomes.

How to use The Core Competencies in Hospital Medicine: a framework for curriculum development.

Background: The seminal article that coined the term hospitalist, published in 1996, attributed the role of the hospitalist to enhancing throughput and cost reduction, primarily through reduction in length of stay, accomplished by having a dedicated clinician on site in the hospital. Since that time the role of the hospitalist has evolved, and hospitalists are being called upon to demonstrate that they actually improve quality of care and the education of the next generation of physicians. A companion article in this issue describes in detail the rationale for the development of the Core Competencies document and the methods by which it was created.

Core competencies in hospital medicine: development and methodology.

Background: The hospitalist model of inpatient care has been rapidly expanding over the last decade, with significant growth related to the quality and efficiency of care provision. This growth and development have stimulated a need to better define and characterize the field of hospital medicine. Training and developing curricula specific to hospital medicine are the next step in the evolution of the field.

Comparison of a single end point to determine optimal initial warfarin dosing (5 mg versus 10 mg) for venous thromboembolism.

There remains considerable controversy regarding optimal initial warfarin dosing in patients with acute venous thromboembolism. Therefore, an open-label, randomized trial comparing 2 warfarin initiation nomograms (5 vs 10 mg) was conducted in patients with acute venous thromboembolism. All participants received fondaparinux for > or = 5 days as a "bridge" to warfarin.

Role of pharmacist counseling in preventing adverse drug events after hospitalization.

Background: Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs.

Methods: We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital.

Extended enoxaparin monotherapy for acute symptomatic pulmonary embolism.

We investigated the efficacy and safety of extended enoxaparin monotherapy in symptomatic patients with acute pulmonary embolism (PE). We randomized 40 patients in a 1:1 allocation to enoxaparin monotherapy (1 mg/kg twice daily for 10-18 days, and then 1.5mg/kg once daily until day 90) (n = 20) or to enoxaparin 1.