Taking CME to the Next Level on Twitter with #JHMChat

What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… until now! On Monday, July 11th, the Journal of Hospital Medicine will be hosting its 3rd Tweetchat. For those new to Twitter or to “tweetchats”, it is a block of time (typically an hour) on Twitter during which tweeters use a hashtag to engage in a dialogue about an issue. #JHMChat uses its one hour to engage in a dialogue about a particular article in the Journal of Hospital Medicine. We often choose an article that has implications for Costs of Care or Choosing Wisely and most importantly, could be practice-changing for hospitalists. While we…

A rose by any name…not!

As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc.  Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them.  If I am speaking with someone who has had the benefit of successful collaboration with an NP or PA in hospital medicine that same interaction may take on a particular respectful reverence.  Or if the physician hospitalist has had a less than stellar experience with a NP or PA in hospital medicine there may be regret, or reluctance to connect. I often wonder, after these interactions, when I and my other NP/PA colleagues will be seen as we wish to be seen: as highly valued and productive members of the hospital medicine team.  I have been taking care of…

The rate of MI hospital stays decrease, yet total cost of care goes up?

By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system.  One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light on the issue. Out in JAMA Internal Medicine this week, Likosky and colleagues sought to determine MI cost growth in Medicare beneficiaries from 1999 to 2008.   While MI's are not representative of the system at large, for the purposes of the post, I will use the diagnosis as the canary in the healthcare system coalmine. (more…)

Statins and musculoskeletal complaints

This large retrospective cohort of patients compared musculoskeletal symptoms between statin users and non-users and found they were 19% higher in users, including a 13% higher risk of strains/sprains. These symptoms are not trivial and should be considered when starting or continuing statins in patients (abstract).

No benefit to fluid/Na restriction in acute CHF

In this small single center trial, acute CHF patients were randomized to fluid and sodium restriction (800cc and 800mg/day, respectively) or to no restriction. There were no differences between the groups in weight loss or congestion scores during the hospital stay, nor were there differences in 30 day readmission rates. The restricted group reported much more thirst. This study raises doubts as to the benefit of routinely restricting fluid and sodium in patients with acute CHF (abstract).