Consent for organ donation depends on how you ask

A systematic review published online last week by BMJ looked at whether rates of consent for organ donation could be improved by changing the way the issue is addressed with family members. Families were more likely to consent if they understood the organ donation process and the concept of brain death, and if their loved one was getting high-quality care. Next-of-kin who were asked about organ donation privately and by trained, experienced staff were also more likely to say yes. Last, the study found that it was most helpful to notify family members of death or brain death first, then ask for organs in a separate conversation. None of this seems particularly ground-breaking; most of these "modifiable factors" just seem like common sense. And that appeared to be one of the points the study authors were making: "Targeting these factors might have a greater and more immediate effect on the number of organs for donation than legislative or other long term strategies," they concluded. In other words: no need to reinvent the wheel.

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posted by Jennifer Kearney-Strouse at 10:42 AM   0 Comments

Hospitals becoming more like hotels

Pennsylvania Hospital is opening eight private rooms featuring five-star amenities, chef-prepared foods, fine linens and concierge service for $400 more a day. (No word on whether patients get their own hospitalists.)

Citing word like "choice" and "control," the press release went a long way to spin the announcement, saying that the concierge service stems from patient requests and even funds programs for the less fortunate.

Internists in outpatient medicine often decry "concierge" practices, in which doctors close their doors to a limited patient panel that pays a flat fee for care. The complaint is that this creates an increased burden on other practices in the community. To apply this perception to luxury hospital suites (Penn's have a secured entryway, DVD players, boutique toiletries, daily newspapers, an in-room safe and a Family Business Center) we'd have to consider whether these upgraded rooms take away resources needed in other areas of health care, or whether this is purely extra, creating new positions where none would have existed before. (Still no word on whether they're taking applications from hospitalists to staff those suites.)

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posted by Ryan DuBosar at 9:24 AM   0 Comments

Highlights from Internal Medicine 2009

At a Thursday afternoon session, Jason Persoff, MD, reminded his audience of the high stakes involved when dealing with cardiac resuscitation. Even when CPR is done perfectly, he noted during "Shocking Developments in Resuscitation: Cold Compressions and Clinical Updates," it yields only one-third of the normal cardiac output, 10% to 15% of normal cerebral blood flow, and 1% to 5% of normal cardiac blood flow. And perfect CPR is rare: Dr. Persoff cited a study showing that chest compressions are too shallow about 63% of the time and too slow about 72% of the time. As for defibrillation, it's often not done quickly enough, Dr. Persoff said. He advised attendees to shock first, ask questions about rhythm later.

On Friday, Dennis G. Maki, MACP, delivered a lecture on "Emerging Infectious Diseases" that focused in part on C. difficile-associated disease (CDAD). Rates of CDAD are increasing "precipitously," he noted, because of more variable strains and an older, more susceptible population. He also pointed to another possible culprit: alcohol-based handrubs. Because spores can't be killed by alcohol gels, Dr. Maki recommends good old-fashioned handwashing instead.

Finally, at a Saturday afternoon session on "Pain Management in the Hospitalized Patient," Eva H. Chittenden, FACP, offered attendees a thorough review of best practices, including appropriate use of opioids and other medications. Although completely relieving pain isn't always possible, Dr. Chittenden said, clinicians can focus on reducing it to a level that's tolerable for the patient. "We have to believe our patients when they say they have pain," she said, "because they're the only ones who can tell us."

For more in-depth coverage of Internal Medicine 2009 sessions, check out the June issue of ACP Hospitalist.

Labels: cardiology, infectious diseases, Internal Medicine 2009, pain management, palliative care

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posted by Jennifer Kearney-Strouse at 12:23 PM   1 Comments

Saturday's hospital medicine sessions

8:15 a.m. Fundamentals of Critical Care, Room 204B
9:30 a.m. Update in Hospital Medicine, Ballroom B
11:15 a.m. Consult Talk, Marriott Salon H
2:15 p.m. Pain Management in the Hospitalized Patient, Room 201A
4:00 p.m. Developing Systems to Teach and Operationalize Quality in the Hospital, Room 204A

Labels: Internal Medicine 2009

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posted by Jennifer Kearney-Strouse at 9:12 AM   1 Comments

Friday's hospital medicine sessions

7:00 a.m. Pulmonary Embolism: What's New in Diagnosis and Management?, Room 202
8:15 a.m. Delirium in Older Hospitalized Patients, Room 201C
9:30 a.m. Management of Blood Glucose in the Hospitalized Patient, Marriott Salon AB
11:15 a.m. Common Errors in the Management of Patients with Atrial Fibrillation and Flutter, Marriott Salon AB
2:15 p.m. New Approaches to Control of Hospital-Acquired Infections, Room 204C
4:30 p.m. Improving Your Skills at Bedside Teaching, Marriott Salon G

Labels: Internal Medicine 2009

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posted by Jennifer Kearney-Strouse at 9:05 AM   0 Comments

Thursday's hospital medicine sessions

For those at the meeting, here's a look at the hospital medicine sessions happening today:

• 7:00 a.m. The Preoperative Evaluation: An Evidence-Based Approach, Room 201C
• 8:15 a.m. Optimal Management of Chronic Heart Failure, Marriott Salon E
• Prevention and Management of Hyperkalemia, Room 201C
• 11:15 a.m. Prophylaxis and Management of Venous Thromboembolism, Room 204B
• 2:15 p.m. Evaluation and Management of Pancreaticobiliary Disease, Room 203
• 4:30 p.m. Shocking Developments in Resuscitation: Cold Compressions and Clinical Updates, Room 204C

Labels: Internal Medicine 2009

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posted by Jennifer Kearney-Strouse at 9:35 AM   0 Comments

Internal Medicine 2009

This week, Philadelphia hosts Internal Medicine 2009, the premier meeting in internal medicine, and the ACP Hospitalist team will be on site to cover it. Watch this space for updates!

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posted by Jennifer Kearney-Strouse at 5:00 PM   0 Comments