The Nuance of C-Suite Vocabulary

I have just become the leader of our hospitalist group and had the most amazing meeting with the hospital administrators. They seem to be speaking English, but I didn’t understand a thing. Can you help?

—B.N.L., Bellingham, Wash.

Dr. Hospitalist responds:

Ah, congrats on your first exposure to corporate jargon—otherwise known as admino-babble. Having survived numerous boardroom encounters with members of the corporate tribe to which you refer, I am, sad to say, now fluent in this most obtuse way of communicating. Herewith, a glossary that is gloriously non-alphabetical. Please note, I have heard all of these terms in person; this is not just some list I parroted off the Web:

Circle back: We don’t have any answers, but this meeting has gone on too long, so let’s talk about it next time.

Close the loop: Finish what you were thinking.

Failure of messaging: Things did not get explained very well. Formerly known as: It’s not you, it’s me.

Low-hanging fruit: The easy victories. Otherwise known as the stuff you already did for the hospital but never thought to get contractually paid for.

Value-add: Something that adds value. Hmm.

Corner case: An argument for something that isn’t likely to happen anyway. Otherwise known as “a long run for a short slide.”

Ping me offline: Send me an email/text after the meeting. LOL.

Straw man: An example that is thrown together just for the sake of discussion, and is not expected to stand up to scrutiny. Cousin to “laying down a marker.”

Cascading failures: Major, major problems. Example: “Our census just increased 50%, which means we don’t have time to get the discharges done, which means the census will stay high, which means ... ”

Granularity: The details.

Drill down: No, thanks, I just got granularity on that.

Deep dive: How cool is this? We now have three ways of saying the same thing.

Brand refresh: Marketing-speak for “The CEO doesn’t like our logo.”

Bandwidth: The capacity to take on more work. Old saying: “Yeah, I can do that.”

Contextualize: To add meaning to a discussion. (Is this actually a word?)

Deliverable: Those things in the contract that you said you would do, only now in writing.

Open the kimono: Umm, I’m afraid to say anything here. Use the Internet at your peril.

Visibility: The ability to not only recognize a problem, but understand it as well. “We don’t have visibility on that process.”

SWOT analysis: Strengths, Weaknesses, Opportunities, Threats—a way to characterize the current state of your hospitalist group.

30,000-foot view: Opposite of granular. The view the upper management likes to have. Apparently it’s not enough, because there is now even a “50,000-foot view.”

Win-win: Where everybody is happy. Somehow used often in negotiations, when in actuality the hallmark of a good negotiation is that both sides think they could have gotten a little bit more.

Deck, or slide deck: One of those interminable PowerPoint presentations.

Elevator test: An idea or concept that can be explained to someone important during the course of a brief elevator ride.

Pushback: Disagreement. “We’re likely to get some pushback from the ED docs if you want them to write admission orders.”

Right-size the organization: Everybody is going to get fired. Update your resume.

Off-path: When things aren’t going your way.

Off-budget: For you, it means losing money; for them, it just means not making enough.

Opportunities and synergies: Things that might happen but rarely do.

Boil the ocean: Do the impossible. “Let’s not try to boil the ocean here, maybe just harvest the low-hanging fruit.”

Amazingly, there are many more terms available. Please do remember all this in your new role. And here’s one more definition for good measure:

The consultant: Someone who takes a subject you understand and makes it sound confusing, and for these efforts is paid fantastically well.

Best of luck out there!

The Nuance of C-Suite Vocabulary

I have just become the leader of our hospitalist group and had the most amazing meeting with the hospital administrators. They seem to be speaking English, but I didn’t understand a thing. Can you help?

—B.N.L., Bellingham, Wash.

Dr. Hospitalist responds:

Ah, congrats on your first exposure to corporate jargon—otherwise known as admino-babble. Having survived numerous boardroom encounters with members of the corporate tribe to which you refer, I am, sad to say, now fluent in this most obtuse way of communicating. Herewith, a glossary that is gloriously non-alphabetical. Please note, I have heard all of these terms in person; this is not just some list I parroted off the Web:

Circle back: We don’t have any answers, but this meeting has gone on too long, so let’s talk about it next time.

Close the loop: Finish what you were thinking.

Failure of messaging: Things did not get explained very well. Formerly known as: It’s not you, it’s me.

Low-hanging fruit: The easy victories. Otherwise known as the stuff you already did for the hospital but never thought to get contractually paid for.

Value-add: Something that adds value. Hmm.

Corner case: An argument for something that isn’t likely to happen anyway. Otherwise known as “a long run for a short slide.”

Ping me offline: Send me an email/text after the meeting. LOL.

Straw man: An example that is thrown together just for the sake of discussion, and is not expected to stand up to scrutiny. Cousin to “laying down a marker.”

Cascading failures: Major, major problems. Example: “Our census just increased 50%, which means we don’t have time to get the discharges done, which means the census will stay high, which means ... ”

Granularity: The details.

Drill down: No, thanks, I just got granularity on that.

Deep dive: How cool is this? We now have three ways of saying the same thing.

Brand refresh: Marketing-speak for “The CEO doesn’t like our logo.”

Bandwidth: The capacity to take on more work. Old saying: “Yeah, I can do that.”

Contextualize: To add meaning to a discussion. (Is this actually a word?)

Deliverable: Those things in the contract that you said you would do, only now in writing.

Open the kimono: Umm, I’m afraid to say anything here. Use the Internet at your peril.

Visibility: The ability to not only recognize a problem, but understand it as well. “We don’t have visibility on that process.”

SWOT analysis: Strengths, Weaknesses, Opportunities, Threats—a way to characterize the current state of your hospitalist group.

30,000-foot view: Opposite of granular. The view the upper management likes to have. Apparently it’s not enough, because there is now even a “50,000-foot view.”

Win-win: Where everybody is happy. Somehow used often in negotiations, when in actuality the hallmark of a good negotiation is that both sides think they could have gotten a little bit more.

Deck, or slide deck: One of those interminable PowerPoint presentations.

Elevator test: An idea or concept that can be explained to someone important during the course of a brief elevator ride.

Pushback: Disagreement. “We’re likely to get some pushback from the ED docs if you want them to write admission orders.”

Right-size the organization: Everybody is going to get fired. Update your resume.

Off-path: When things aren’t going your way.

Off-budget: For you, it means losing money; for them, it just means not making enough.

Opportunities and synergies: Things that might happen but rarely do.

Boil the ocean: Do the impossible. “Let’s not try to boil the ocean here, maybe just harvest the low-hanging fruit.”

Amazingly, there are many more terms available. Please do remember all this in your new role. And here’s one more definition for good measure:

The consultant: Someone who takes a subject you understand and makes it sound confusing, and for these efforts is paid fantastically well.

Best of luck out there!

The Nuance of C-Suite Vocabulary

I have just become the leader of our hospitalist group and had the most amazing meeting with the hospital administrators. They seem to be speaking English, but I didn’t understand a thing. Can you help?

—B.N.L., Bellingham, Wash.

Dr. Hospitalist responds:

Ah, congrats on your first exposure to corporate jargon—otherwise known as admino-babble. Having survived numerous boardroom encounters with members of the corporate tribe to which you refer, I am, sad to say, now fluent in this most obtuse way of communicating. Herewith, a glossary that is gloriously non-alphabetical. Please note, I have heard all of these terms in person; this is not just some list I parroted off the Web:

Circle back: We don’t have any answers, but this meeting has gone on too long, so let’s talk about it next time.

Close the loop: Finish what you were thinking.

Failure of messaging: Things did not get explained very well. Formerly known as: It’s not you, it’s me.

Low-hanging fruit: The easy victories. Otherwise known as the stuff you already did for the hospital but never thought to get contractually paid for.

Value-add: Something that adds value. Hmm.

Corner case: An argument for something that isn’t likely to happen anyway. Otherwise known as “a long run for a short slide.”

Ping me offline: Send me an email/text after the meeting. LOL.

Straw man: An example that is thrown together just for the sake of discussion, and is not expected to stand up to scrutiny. Cousin to “laying down a marker.”

Cascading failures: Major, major problems. Example: “Our census just increased 50%, which means we don’t have time to get the discharges done, which means the census will stay high, which means ... ”

Granularity: The details.

Drill down: No, thanks, I just got granularity on that.

Deep dive: How cool is this? We now have three ways of saying the same thing.

Brand refresh: Marketing-speak for “The CEO doesn’t like our logo.”

Bandwidth: The capacity to take on more work. Old saying: “Yeah, I can do that.”

Contextualize: To add meaning to a discussion. (Is this actually a word?)

Deliverable: Those things in the contract that you said you would do, only now in writing.

Open the kimono: Umm, I’m afraid to say anything here. Use the Internet at your peril.

Visibility: The ability to not only recognize a problem, but understand it as well. “We don’t have visibility on that process.”

SWOT analysis: Strengths, Weaknesses, Opportunities, Threats—a way to characterize the current state of your hospitalist group.

30,000-foot view: Opposite of granular. The view the upper management likes to have. Apparently it’s not enough, because there is now even a “50,000-foot view.”

Win-win: Where everybody is happy. Somehow used often in negotiations, when in actuality the hallmark of a good negotiation is that both sides think they could have gotten a little bit more.

Deck, or slide deck: One of those interminable PowerPoint presentations.

Elevator test: An idea or concept that can be explained to someone important during the course of a brief elevator ride.

Pushback: Disagreement. “We’re likely to get some pushback from the ED docs if you want them to write admission orders.”

Right-size the organization: Everybody is going to get fired. Update your resume.

Off-path: When things aren’t going your way.

Off-budget: For you, it means losing money; for them, it just means not making enough.

Opportunities and synergies: Things that might happen but rarely do.

Boil the ocean: Do the impossible. “Let’s not try to boil the ocean here, maybe just harvest the low-hanging fruit.”

Amazingly, there are many more terms available. Please do remember all this in your new role. And here’s one more definition for good measure:

The consultant: Someone who takes a subject you understand and makes it sound confusing, and for these efforts is paid fantastically well.

Best of luck out there!

Hospitalists routinely have to handle infection cases, but how well trained are they to do so, and how well prepared are the hospitals they work in to support them on difficult cases?

It depends on training and the institution, but both areas have room for improvement, says a physician who has had feet on both sides of the fence.

Leland Allen, MD, says there is no easy answer on whether hospitalists have enough baseline training.

“What I see locally in Birmingham is that there is a wide variation in the training,” he says. “The hospitalists that I see that are family-practice-trained, just as the nature of the family practice training [goes], have a whole lot of outpatient experience. And so these people don’t have nearly the inpatient experience in their training that people trained in internal medicine do.”

A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution.

—Leland Allen, MD, infectious-disease physician, Shelby Baptist Medical Center, Birmingham, Ala.

Some hospitalists, Dr. Allen says, are as proficient in dealing with inpatient ID cases as he is. Others are clueless, he says. “It really just depends on the training. It would be nice if there was some standardization of training, rather than just kind of catch-as-catch-can.”

As for ID resources available at hospitals, Dr. Allen says, “there is potential in any hospital to have an excellent backbone program of infection control.” But that depends on the availability of ID experts and the willingness of hospital administration to invest in the program.

“A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution,” Dr. Allen explains. “It really pays off down the road for the hospital with reduced infection rates, and also physicians who are practicing in the hospital, in terms of making their life a little bit easier.”

And with changes in Medicare reimbursement for hospital-acquired infections, he says, “it really behooves a hospital to spend some money up front.”

Hospitalists routinely have to handle infection cases, but how well trained are they to do so, and how well prepared are the hospitals they work in to support them on difficult cases?

It depends on training and the institution, but both areas have room for improvement, says a physician who has had feet on both sides of the fence.

Leland Allen, MD, says there is no easy answer on whether hospitalists have enough baseline training.

“What I see locally in Birmingham is that there is a wide variation in the training,” he says. “The hospitalists that I see that are family-practice-trained, just as the nature of the family practice training [goes], have a whole lot of outpatient experience. And so these people don’t have nearly the inpatient experience in their training that people trained in internal medicine do.”

A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution.

—Leland Allen, MD, infectious-disease physician, Shelby Baptist Medical Center, Birmingham, Ala.

Some hospitalists, Dr. Allen says, are as proficient in dealing with inpatient ID cases as he is. Others are clueless, he says. “It really just depends on the training. It would be nice if there was some standardization of training, rather than just kind of catch-as-catch-can.”

As for ID resources available at hospitals, Dr. Allen says, “there is potential in any hospital to have an excellent backbone program of infection control.” But that depends on the availability of ID experts and the willingness of hospital administration to invest in the program.

“A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution,” Dr. Allen explains. “It really pays off down the road for the hospital with reduced infection rates, and also physicians who are practicing in the hospital, in terms of making their life a little bit easier.”

And with changes in Medicare reimbursement for hospital-acquired infections, he says, “it really behooves a hospital to spend some money up front.”

Hospitalists routinely have to handle infection cases, but how well trained are they to do so, and how well prepared are the hospitals they work in to support them on difficult cases?

It depends on training and the institution, but both areas have room for improvement, says a physician who has had feet on both sides of the fence.

Leland Allen, MD, says there is no easy answer on whether hospitalists have enough baseline training.

“What I see locally in Birmingham is that there is a wide variation in the training,” he says. “The hospitalists that I see that are family-practice-trained, just as the nature of the family practice training [goes], have a whole lot of outpatient experience. And so these people don’t have nearly the inpatient experience in their training that people trained in internal medicine do.”

A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution.

—Leland Allen, MD, infectious-disease physician, Shelby Baptist Medical Center, Birmingham, Ala.

Some hospitalists, Dr. Allen says, are as proficient in dealing with inpatient ID cases as he is. Others are clueless, he says. “It really just depends on the training. It would be nice if there was some standardization of training, rather than just kind of catch-as-catch-can.”

As for ID resources available at hospitals, Dr. Allen says, “there is potential in any hospital to have an excellent backbone program of infection control.” But that depends on the availability of ID experts and the willingness of hospital administration to invest in the program.

“A well-developed, well-maintained infection-control program, with a good infection-control nurse, can really help a hospitalist to understand the types of infections that they’re up against in that particular institution,” Dr. Allen explains. “It really pays off down the road for the hospital with reduced infection rates, and also physicians who are practicing in the hospital, in terms of making their life a little bit easier.”

And with changes in Medicare reimbursement for hospital-acquired infections, he says, “it really behooves a hospital to spend some money up front.”

It might seem basic, but ID experts say it’s too important not to repeat it over and over again: Hospitalists have to take care to narrowly tailor patients’ antibiotic treatments.

Starting a patient on broad-spectrum therapies might be necessary, but once the culprit is identified, the therapy should be honed, they say.

“I think frequently people who get started on antibiotics empirically in the emergency room, they’ll come into the hospital and they’ll kind of stay on them because folks are sometimes afraid to stop them,” Dr. Chansolme says. “But don’t be afraid to do that, particularly in this era of multi-drug resistance.”

Dr. Allen says scaling down treatment might not be easy in the middle of a busy day, but that it must be done.

“The path of least resistance is always to do nothing,” he says. “Even sometimes when you’re 100% certain [about the precise bug requiring

treatment], there’s this little voice in the back of your head going, ‘Yeah, but what if?’ It really does take some thought, and [courage], to stop antibiotics when the patient’s getting better on the current therapy.”

Dr. Gupta of the CDC says HM programs are in prime position to influence a hospital’s practices. “It’s important to remember appropriate use of antimicrobials and treatment and prevention of hospital-acquired infections when they are practicing that they’re often influencing physicians and training,” he says.

The experts raise a few red flags and offer tips that, if followed, should help hospitalists improve their antimicrobial stewardship:

Dr. Chansolme cautions that “not all fluoroquinolones are created equal” and are not interchangeable. In particular, he notes, moxifloxacin is not good for pseudomonas and doesn’t cover UTIs.

• Dr. Allen says that metronidazole does not have to be given if you’re already giving Zosyn or a carbapenem—it doesn’t add anything to the treatment.
• Dr. Allen also says it’s important to remember that cellulitis is almost always just a gram-positive infection, and does not require a very broad-spectrum antibiotic, a mistake he often sees.
• Dr. Orenstein says hospitalists should be on the lookout for the procalcitonin test, a laboratory study based on a prohormone that tends to be elevated in the setting of bacterial infections. The test can be used to possibly shorten the length of time a patient is given an antibiotic in certain cases.

“If elevated and you followed it, you could use it as a marker for when you could stop your antibiotics,” Dr. Orenstein said.

He says the test generally has been shown to allow doctors to shorten the course of antibiotics by one or two days, which can save on cost and length of stay.

“People need to be aware of it,” he says, “as I think a lot of places will be using it. It’s not quite ready for prime time.”

It might seem basic, but ID experts say it’s too important not to repeat it over and over again: Hospitalists have to take care to narrowly tailor patients’ antibiotic treatments.

Starting a patient on broad-spectrum therapies might be necessary, but once the culprit is identified, the therapy should be honed, they say.

“I think frequently people who get started on antibiotics empirically in the emergency room, they’ll come into the hospital and they’ll kind of stay on them because folks are sometimes afraid to stop them,” Dr. Chansolme says. “But don’t be afraid to do that, particularly in this era of multi-drug resistance.”

Dr. Allen says scaling down treatment might not be easy in the middle of a busy day, but that it must be done.

“The path of least resistance is always to do nothing,” he says. “Even sometimes when you’re 100% certain [about the precise bug requiring

treatment], there’s this little voice in the back of your head going, ‘Yeah, but what if?’ It really does take some thought, and [courage], to stop antibiotics when the patient’s getting better on the current therapy.”

Dr. Gupta of the CDC says HM programs are in prime position to influence a hospital’s practices. “It’s important to remember appropriate use of antimicrobials and treatment and prevention of hospital-acquired infections when they are practicing that they’re often influencing physicians and training,” he says.

The experts raise a few red flags and offer tips that, if followed, should help hospitalists improve their antimicrobial stewardship:

Dr. Chansolme cautions that “not all fluoroquinolones are created equal” and are not interchangeable. In particular, he notes, moxifloxacin is not good for pseudomonas and doesn’t cover UTIs.

• Dr. Allen says that metronidazole does not have to be given if you’re already giving Zosyn or a carbapenem—it doesn’t add anything to the treatment.
• Dr. Allen also says it’s important to remember that cellulitis is almost always just a gram-positive infection, and does not require a very broad-spectrum antibiotic, a mistake he often sees.
• Dr. Orenstein says hospitalists should be on the lookout for the procalcitonin test, a laboratory study based on a prohormone that tends to be elevated in the setting of bacterial infections. The test can be used to possibly shorten the length of time a patient is given an antibiotic in certain cases.

“If elevated and you followed it, you could use it as a marker for when you could stop your antibiotics,” Dr. Orenstein said.

He says the test generally has been shown to allow doctors to shorten the course of antibiotics by one or two days, which can save on cost and length of stay.

“People need to be aware of it,” he says, “as I think a lot of places will be using it. It’s not quite ready for prime time.”

It might seem basic, but ID experts say it’s too important not to repeat it over and over again: Hospitalists have to take care to narrowly tailor patients’ antibiotic treatments.

Starting a patient on broad-spectrum therapies might be necessary, but once the culprit is identified, the therapy should be honed, they say.

“I think frequently people who get started on antibiotics empirically in the emergency room, they’ll come into the hospital and they’ll kind of stay on them because folks are sometimes afraid to stop them,” Dr. Chansolme says. “But don’t be afraid to do that, particularly in this era of multi-drug resistance.”

Dr. Allen says scaling down treatment might not be easy in the middle of a busy day, but that it must be done.

“The path of least resistance is always to do nothing,” he says. “Even sometimes when you’re 100% certain [about the precise bug requiring

treatment], there’s this little voice in the back of your head going, ‘Yeah, but what if?’ It really does take some thought, and [courage], to stop antibiotics when the patient’s getting better on the current therapy.”

Dr. Gupta of the CDC says HM programs are in prime position to influence a hospital’s practices. “It’s important to remember appropriate use of antimicrobials and treatment and prevention of hospital-acquired infections when they are practicing that they’re often influencing physicians and training,” he says.

The experts raise a few red flags and offer tips that, if followed, should help hospitalists improve their antimicrobial stewardship:

Dr. Chansolme cautions that “not all fluoroquinolones are created equal” and are not interchangeable. In particular, he notes, moxifloxacin is not good for pseudomonas and doesn’t cover UTIs.

• Dr. Allen says that metronidazole does not have to be given if you’re already giving Zosyn or a carbapenem—it doesn’t add anything to the treatment.
• Dr. Allen also says it’s important to remember that cellulitis is almost always just a gram-positive infection, and does not require a very broad-spectrum antibiotic, a mistake he often sees.
• Dr. Orenstein says hospitalists should be on the lookout for the procalcitonin test, a laboratory study based on a prohormone that tends to be elevated in the setting of bacterial infections. The test can be used to possibly shorten the length of time a patient is given an antibiotic in certain cases.

“If elevated and you followed it, you could use it as a marker for when you could stop your antibiotics,” Dr. Orenstein said.

He says the test generally has been shown to allow doctors to shorten the course of antibiotics by one or two days, which can save on cost and length of stay.

“People need to be aware of it,” he says, “as I think a lot of places will be using it. It’s not quite ready for prime time.”

• Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
• Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
• Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
• Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
• Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
• Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
• Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
• Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
• Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
• Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”

• Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
• Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
• Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
• Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
• Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
• Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
• Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
• Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
• Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
• Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”

• Command of Clinical Care. “First and foremost, you have to be a good hospitalist,” Dr. George says. “You cannot lead a group of physicians unless they respect the quality of your medical care.”
• Transformational leadership. “This is inspiring members of an organization toward a common vision and getting workers to invest energies beyond their own self-interest,” Dr. Carnes says. “That includes things like mentoring your subordinates and taking a personal interest in trying to form a community.”
• Vision/strategic thinking. “You need to understand where your organization is today and envision what the threats to the organization could be or the opportunities for the organization,” Dr. Gorman says. “If a leader doesn’t have an idea of the direction they should go, then they can’t really lead anywhere.”
• Communication. “You have to be able to communicate with a large, diverse audience that includes your colleagues, the administration of the hospital, providers in the community, and your supervisor or direct report,” Dr. Bell says.
• Active listening. “This is really being able to listen to what an individual is saying and what they’re not saying, and to set aside your own preconceived notions, opinions, filters, and judgments, so that you’re truly hearing what the other person has to say,” Cannon says.
• Consensus-building. “A good leader has the ability to work with others, break down barriers, and get that buy-in,” Dr. Ammann says. “The more people you can bring into a project to work on it together, the better.”
• Determination. “If you have a goal, you have to really be steadfast in achieving it,” Dr. Satpathy says. “You’re going to have so many pitfalls along the way that you can’t ever just say, ‘This isn’t going to work.’”
• Open-mindedness. “You have to be able to be unbiased─i.e., try to evaluate whatever the circumstance is from more than one perspective,” Dr. Bell says. “When an issue or problem is brought to you, you really need to hear both sides of the story before you reach a conclusion.”
• Willingness to seek advice. “If you have a view of where you want to go and you’re not getting there, find the right people who can give you some thoughts on how you can approach the issue,” Dr. Gorman says.
• Managerial competence. “If the practice is not financially viable, then the practice will cease to exist,” Dr. Bell says. “So you have to understand the balance between the financial realities and clinical needs of the practice.”

Click here to listen to Dr. Allen

Click here to listen to Dr. Allen

Click here to listen to Dr. Allen

NEW YORK – The prevalence of gout has increased by 40% over almost 2 decades, judging from recent data discussed by Dr. Michael Pillinger at a rheumatology meeting sponsored by New York University. At the same time, other research has shown that there is greater recognition of its ill effects, including increased risk of osteoarthritis, heart failure, and death.

"Gout continues to be on the rise," according to Dr. Pillinger, citing the results of a recently published analysis of gout prevalence based on two large nationally representative samples (Arthritis Rheum. 2011;63:3136-41). By comparing data from 5,707 participants of the National Health and Nutrition Examination Survey (NHANES, 2007-2008) to 18,825 participants in NHANES-III (1988-1994), the researchers found that the prevalence of gout increased by 1.2%, from 2.7% to 3.9%. The rise was greater for men than women, with an increase of 2.1% for men and 0.4% for women. The most striking gain was found in those over the age of 80 years old (men and women), which saw an increase of 6.7% (from 5.9% to 12.6%).

"Something very significant is going on," says Dr. Pillinger, suggesting that factors such as longer life span, kidney disease, increased diuretic use, diet, and obesity may all be contributing to the findings.

While few patients die as a result of a gout attack, just having the disease shortens survival by 10% to 15%, says Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

An examination of the National Death Registry of Taiwan of 6,631 people who were diagnosed with gout in 2000 and followed for 8 years (representing 53,048 person-years of follow-up) showed that crude mortality for men and women combined was 21.3 per 1,000 patient-years, which was significantly higher than that of the national population (Joint Bone Spine 2011;78:577-80). The all-cause standardized mortality ratio was 1.29 for men and 1.70 for women, with higher mortality ratios due to death from kidney diseases, endocrine and metabolic, and cardiovascular diseases in both sexes.

Gout is often accompanied by several serious comorbidities. Results from the New York Veterans Affairs Gout Cohort, a database analysis of 575 people with gout in the VA system, found that the average gout patient has four or five comorbidities. In their sample, nearly 90% were found to have hypertension, 60% hyperlipidemia, and 40-50% chronic kidney disease, diabetes, and coronary artery disease (Am. J. Med. 2011;124:155-63). The presence of comorbidities result in a high frequency of contraindications to approved gout medication, so these patients can be difficult to treat, says Dr. Pillinger, a coauthor of the study.

Now heart failure can be added to the list of gout-related comorbidities. In a post-hoc, longitudinal and cross-sectional analysis of 4,989 patients enrolled in the Framingham Offspring Study (BMJ Open 2012 Feb. 15 [doi: 10.1136/bmjopen-2011-000282]), the researchers found that those with gout (n = 228) had two to three times higher incidence of clinical heart failure compared with those without. Examining the cardiac characteristics of patients with and without gout (2,326 had echocardiograms), those with gout were four times more likely to have systolic dysfunction (P less than .001) and three times more likely to have low ejection fraction (P less than .001).

The study began in 1971 and patients were examined approximately every 4 years, with the last data collection in 2008. Longitudinal analysis showed that the risk of clinical heart failure did not become apparent until after the patients had gout for 10 or 12 years. These findings suggest that while clinical heart failure is not a problem when patients with gout are first seen when they are younger, the risk of clinical heart failure as patients age should be something to be cognizant of for possible early intervention, says Dr. Pillinger.

Participants with gout had greater mortality than those without (adjusted hazard ratio, 1.58; 95% confidence interval, 1.40 to 1.78). In those with heart failure, those with gout were more likely to die than those without the disease (adjusted HR, 1.50; 95% CI, 1.3 to 1.73). "This study adds to the growing body of evidence suggesting that gout has major consequences on the cardiovascular system," according to Dr. Krishnan.

Gout appears to also increase the prevalence and severity of osteoarthritis (OA). Using both ACR clinical and radiographic criteria, the prevalence of OA in both knees was significantly higher in those with gout compared to normal controls or those with asymptomatic hyperuricemia (68% vs. 28%, P less than or equal to .05), according to data presented at the 2011 annual meeting of the American College of Rheumatology. The severity of osteoarthritis was also higher in those with gout compared to normal controls using both Kellgren-Lawrence and Western Ontario and McMaster Universities Arthritis Index scores, but differences between groups did not reach statistical significance.

"If you have gout in an older person, you better look for OA," says Dr. Pillinger, a coauthor. He attributed the lack of statistical significance to the small size of the study (25 in each group of gout, normal controls, and those with asymptomatic hyperuricemia, age greater than 60 years).

Dr. Pillinger reported financial relationships with Takeda and URL Pharma.

NEW YORK – The prevalence of gout has increased by 40% over almost 2 decades, judging from recent data discussed by Dr. Michael Pillinger at a rheumatology meeting sponsored by New York University. At the same time, other research has shown that there is greater recognition of its ill effects, including increased risk of osteoarthritis, heart failure, and death.

"Gout continues to be on the rise," according to Dr. Pillinger, citing the results of a recently published analysis of gout prevalence based on two large nationally representative samples (Arthritis Rheum. 2011;63:3136-41). By comparing data from 5,707 participants of the National Health and Nutrition Examination Survey (NHANES, 2007-2008) to 18,825 participants in NHANES-III (1988-1994), the researchers found that the prevalence of gout increased by 1.2%, from 2.7% to 3.9%. The rise was greater for men than women, with an increase of 2.1% for men and 0.4% for women. The most striking gain was found in those over the age of 80 years old (men and women), which saw an increase of 6.7% (from 5.9% to 12.6%).

"Something very significant is going on," says Dr. Pillinger, suggesting that factors such as longer life span, kidney disease, increased diuretic use, diet, and obesity may all be contributing to the findings.

While few patients die as a result of a gout attack, just having the disease shortens survival by 10% to 15%, says Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

An examination of the National Death Registry of Taiwan of 6,631 people who were diagnosed with gout in 2000 and followed for 8 years (representing 53,048 person-years of follow-up) showed that crude mortality for men and women combined was 21.3 per 1,000 patient-years, which was significantly higher than that of the national population (Joint Bone Spine 2011;78:577-80). The all-cause standardized mortality ratio was 1.29 for men and 1.70 for women, with higher mortality ratios due to death from kidney diseases, endocrine and metabolic, and cardiovascular diseases in both sexes.

Gout is often accompanied by several serious comorbidities. Results from the New York Veterans Affairs Gout Cohort, a database analysis of 575 people with gout in the VA system, found that the average gout patient has four or five comorbidities. In their sample, nearly 90% were found to have hypertension, 60% hyperlipidemia, and 40-50% chronic kidney disease, diabetes, and coronary artery disease (Am. J. Med. 2011;124:155-63). The presence of comorbidities result in a high frequency of contraindications to approved gout medication, so these patients can be difficult to treat, says Dr. Pillinger, a coauthor of the study.

Now heart failure can be added to the list of gout-related comorbidities. In a post-hoc, longitudinal and cross-sectional analysis of 4,989 patients enrolled in the Framingham Offspring Study (BMJ Open 2012 Feb. 15 [doi: 10.1136/bmjopen-2011-000282]), the researchers found that those with gout (n = 228) had two to three times higher incidence of clinical heart failure compared with those without. Examining the cardiac characteristics of patients with and without gout (2,326 had echocardiograms), those with gout were four times more likely to have systolic dysfunction (P less than .001) and three times more likely to have low ejection fraction (P less than .001).

The study began in 1971 and patients were examined approximately every 4 years, with the last data collection in 2008. Longitudinal analysis showed that the risk of clinical heart failure did not become apparent until after the patients had gout for 10 or 12 years. These findings suggest that while clinical heart failure is not a problem when patients with gout are first seen when they are younger, the risk of clinical heart failure as patients age should be something to be cognizant of for possible early intervention, says Dr. Pillinger.

Participants with gout had greater mortality than those without (adjusted hazard ratio, 1.58; 95% confidence interval, 1.40 to 1.78). In those with heart failure, those with gout were more likely to die than those without the disease (adjusted HR, 1.50; 95% CI, 1.3 to 1.73). "This study adds to the growing body of evidence suggesting that gout has major consequences on the cardiovascular system," according to Dr. Krishnan.

Gout appears to also increase the prevalence and severity of osteoarthritis (OA). Using both ACR clinical and radiographic criteria, the prevalence of OA in both knees was significantly higher in those with gout compared to normal controls or those with asymptomatic hyperuricemia (68% vs. 28%, P less than or equal to .05), according to data presented at the 2011 annual meeting of the American College of Rheumatology. The severity of osteoarthritis was also higher in those with gout compared to normal controls using both Kellgren-Lawrence and Western Ontario and McMaster Universities Arthritis Index scores, but differences between groups did not reach statistical significance.

"If you have gout in an older person, you better look for OA," says Dr. Pillinger, a coauthor. He attributed the lack of statistical significance to the small size of the study (25 in each group of gout, normal controls, and those with asymptomatic hyperuricemia, age greater than 60 years).

Dr. Pillinger reported financial relationships with Takeda and URL Pharma.

NEW YORK – The prevalence of gout has increased by 40% over almost 2 decades, judging from recent data discussed by Dr. Michael Pillinger at a rheumatology meeting sponsored by New York University. At the same time, other research has shown that there is greater recognition of its ill effects, including increased risk of osteoarthritis, heart failure, and death.

"Gout continues to be on the rise," according to Dr. Pillinger, citing the results of a recently published analysis of gout prevalence based on two large nationally representative samples (Arthritis Rheum. 2011;63:3136-41). By comparing data from 5,707 participants of the National Health and Nutrition Examination Survey (NHANES, 2007-2008) to 18,825 participants in NHANES-III (1988-1994), the researchers found that the prevalence of gout increased by 1.2%, from 2.7% to 3.9%. The rise was greater for men than women, with an increase of 2.1% for men and 0.4% for women. The most striking gain was found in those over the age of 80 years old (men and women), which saw an increase of 6.7% (from 5.9% to 12.6%).

"Something very significant is going on," says Dr. Pillinger, suggesting that factors such as longer life span, kidney disease, increased diuretic use, diet, and obesity may all be contributing to the findings.

While few patients die as a result of a gout attack, just having the disease shortens survival by 10% to 15%, says Dr. Pillinger, director of the rheumatology fellowship program at New York University and director of rheumatology at the Manhattan campus of the VA New York Harbor Healthcare System.

An examination of the National Death Registry of Taiwan of 6,631 people who were diagnosed with gout in 2000 and followed for 8 years (representing 53,048 person-years of follow-up) showed that crude mortality for men and women combined was 21.3 per 1,000 patient-years, which was significantly higher than that of the national population (Joint Bone Spine 2011;78:577-80). The all-cause standardized mortality ratio was 1.29 for men and 1.70 for women, with higher mortality ratios due to death from kidney diseases, endocrine and metabolic, and cardiovascular diseases in both sexes.

Gout is often accompanied by several serious comorbidities. Results from the New York Veterans Affairs Gout Cohort, a database analysis of 575 people with gout in the VA system, found that the average gout patient has four or five comorbidities. In their sample, nearly 90% were found to have hypertension, 60% hyperlipidemia, and 40-50% chronic kidney disease, diabetes, and coronary artery disease (Am. J. Med. 2011;124:155-63). The presence of comorbidities result in a high frequency of contraindications to approved gout medication, so these patients can be difficult to treat, says Dr. Pillinger, a coauthor of the study.

Now heart failure can be added to the list of gout-related comorbidities. In a post-hoc, longitudinal and cross-sectional analysis of 4,989 patients enrolled in the Framingham Offspring Study (BMJ Open 2012 Feb. 15 [doi: 10.1136/bmjopen-2011-000282]), the researchers found that those with gout (n = 228) had two to three times higher incidence of clinical heart failure compared with those without. Examining the cardiac characteristics of patients with and without gout (2,326 had echocardiograms), those with gout were four times more likely to have systolic dysfunction (P less than .001) and three times more likely to have low ejection fraction (P less than .001).

The study began in 1971 and patients were examined approximately every 4 years, with the last data collection in 2008. Longitudinal analysis showed that the risk of clinical heart failure did not become apparent until after the patients had gout for 10 or 12 years. These findings suggest that while clinical heart failure is not a problem when patients with gout are first seen when they are younger, the risk of clinical heart failure as patients age should be something to be cognizant of for possible early intervention, says Dr. Pillinger.

Participants with gout had greater mortality than those without (adjusted hazard ratio, 1.58; 95% confidence interval, 1.40 to 1.78). In those with heart failure, those with gout were more likely to die than those without the disease (adjusted HR, 1.50; 95% CI, 1.3 to 1.73). "This study adds to the growing body of evidence suggesting that gout has major consequences on the cardiovascular system," according to Dr. Krishnan.

Gout appears to also increase the prevalence and severity of osteoarthritis (OA). Using both ACR clinical and radiographic criteria, the prevalence of OA in both knees was significantly higher in those with gout compared to normal controls or those with asymptomatic hyperuricemia (68% vs. 28%, P less than or equal to .05), according to data presented at the 2011 annual meeting of the American College of Rheumatology. The severity of osteoarthritis was also higher in those with gout compared to normal controls using both Kellgren-Lawrence and Western Ontario and McMaster Universities Arthritis Index scores, but differences between groups did not reach statistical significance.

"If you have gout in an older person, you better look for OA," says Dr. Pillinger, a coauthor. He attributed the lack of statistical significance to the small size of the study (25 in each group of gout, normal controls, and those with asymptomatic hyperuricemia, age greater than 60 years).

Dr. Pillinger reported financial relationships with Takeda and URL Pharma.

A new class of 141 Fellows of Hospital Medicine (FHM), SHM’s designation for recognizing professional leadership by hospitalists, will be introduced Tuesday morning at HM12 in San Diego. This is the fourth class of fellows, a program that began in 2009 with more than 500 inductees. Also honored this year are 54 new Senior Fellows of Hospital Medicine (SFHM) and three Masters of Hospital Medicine (MHM).

“SHM’s Fellows, Senior Fellows, and Masters in Hospital Medicine embody the core ideals of hospital medicine: high-value care delivery, teamwork to integrate health systems, and effective leadership to guide our systems,” says Shaun Frost, MD, SFHM, FACP, who will be inaugurated as SHM’s president this week. “As the vanguard of HM, they challenge our healthcare community to think critically about how care is provided in the hospital.”

For new Fellow Gregory Misky, MD, FHM, a hospitalist at the University of Colorado Denver, the designation represents national recognition and validation for his years of hospitalist work, including work in nonclinical realms such as teaching and hospital committee assignments.

“It also conveys a kind of credibility, both within my institution and my hospital group and among peers elsewhere—like a badge of honor. It feels like arriving as a well-rounded hospitalist and belonging to something bigger,” Dr. Misky says.

Mangla Gulati, MD, FHM, academic hospitalist at the University of Maryland at Baltimore, says that being named a fellow acknowledges the work she has done in areas such as quality, patient satisfaction, and teaching. “Hospitalists all over the country are doing things to make a difference," she says. "This honor encourages us to continue.” Increasingly, says Dr. Gulati, all hospitalists will need to do more than just clinical work; they will need to show what they can do to improve quality of care, patient satisfaction, and efficiency.

The Fellow designation is for physicians who have devoted their careers to HM and whose personal and professional behavior embodies the mission and goals of SHM.

A new class of 141 Fellows of Hospital Medicine (FHM), SHM’s designation for recognizing professional leadership by hospitalists, will be introduced Tuesday morning at HM12 in San Diego. This is the fourth class of fellows, a program that began in 2009 with more than 500 inductees. Also honored this year are 54 new Senior Fellows of Hospital Medicine (SFHM) and three Masters of Hospital Medicine (MHM).

“SHM’s Fellows, Senior Fellows, and Masters in Hospital Medicine embody the core ideals of hospital medicine: high-value care delivery, teamwork to integrate health systems, and effective leadership to guide our systems,” says Shaun Frost, MD, SFHM, FACP, who will be inaugurated as SHM’s president this week. “As the vanguard of HM, they challenge our healthcare community to think critically about how care is provided in the hospital.”

For new Fellow Gregory Misky, MD, FHM, a hospitalist at the University of Colorado Denver, the designation represents national recognition and validation for his years of hospitalist work, including work in nonclinical realms such as teaching and hospital committee assignments.

“It also conveys a kind of credibility, both within my institution and my hospital group and among peers elsewhere—like a badge of honor. It feels like arriving as a well-rounded hospitalist and belonging to something bigger,” Dr. Misky says.

Mangla Gulati, MD, FHM, academic hospitalist at the University of Maryland at Baltimore, says that being named a fellow acknowledges the work she has done in areas such as quality, patient satisfaction, and teaching. “Hospitalists all over the country are doing things to make a difference," she says. "This honor encourages us to continue.” Increasingly, says Dr. Gulati, all hospitalists will need to do more than just clinical work; they will need to show what they can do to improve quality of care, patient satisfaction, and efficiency.

The Fellow designation is for physicians who have devoted their careers to HM and whose personal and professional behavior embodies the mission and goals of SHM.

A new class of 141 Fellows of Hospital Medicine (FHM), SHM’s designation for recognizing professional leadership by hospitalists, will be introduced Tuesday morning at HM12 in San Diego. This is the fourth class of fellows, a program that began in 2009 with more than 500 inductees. Also honored this year are 54 new Senior Fellows of Hospital Medicine (SFHM) and three Masters of Hospital Medicine (MHM).

“SHM’s Fellows, Senior Fellows, and Masters in Hospital Medicine embody the core ideals of hospital medicine: high-value care delivery, teamwork to integrate health systems, and effective leadership to guide our systems,” says Shaun Frost, MD, SFHM, FACP, who will be inaugurated as SHM’s president this week. “As the vanguard of HM, they challenge our healthcare community to think critically about how care is provided in the hospital.”

For new Fellow Gregory Misky, MD, FHM, a hospitalist at the University of Colorado Denver, the designation represents national recognition and validation for his years of hospitalist work, including work in nonclinical realms such as teaching and hospital committee assignments.

“It also conveys a kind of credibility, both within my institution and my hospital group and among peers elsewhere—like a badge of honor. It feels like arriving as a well-rounded hospitalist and belonging to something bigger,” Dr. Misky says.

Mangla Gulati, MD, FHM, academic hospitalist at the University of Maryland at Baltimore, says that being named a fellow acknowledges the work she has done in areas such as quality, patient satisfaction, and teaching. “Hospitalists all over the country are doing things to make a difference," she says. "This honor encourages us to continue.” Increasingly, says Dr. Gulati, all hospitalists will need to do more than just clinical work; they will need to show what they can do to improve quality of care, patient satisfaction, and efficiency.

The Fellow designation is for physicians who have devoted their careers to HM and whose personal and professional behavior embodies the mission and goals of SHM.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ferring Pharmaceuticals.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Definition & Diagnosis
• Tranexamic Acid for the Treatment of HMB
• Conclusion

Faculty/Faculty Disclosure

Lee Shulman, MD, FACOG, FACMG
The Anna Ross Lapham Professor in Obstetrics and Gynecology
Feinberg School of Medicine of Northwestern University
Chicago, Illinois

Dr Shulman is a consultant to Ferring Pharmaceuticals, Inc.

Matt T. Rosenberg, MD
Family Physician
Mid-Michigan Health Centers
Jackson, Michigan

Dr Rosenberg is a consultant to Ferring Pharmaceuticals, Inc.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ferring Pharmaceuticals.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Definition & Diagnosis
• Tranexamic Acid for the Treatment of HMB
• Conclusion

Faculty/Faculty Disclosure

Lee Shulman, MD, FACOG, FACMG
The Anna Ross Lapham Professor in Obstetrics and Gynecology
Feinberg School of Medicine of Northwestern University
Chicago, Illinois

Dr Shulman is a consultant to Ferring Pharmaceuticals, Inc.

Matt T. Rosenberg, MD
Family Physician
Mid-Michigan Health Centers
Jackson, Michigan

Dr Rosenberg is a consultant to Ferring Pharmaceuticals, Inc.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News. This supplement was sponsored by Ferring Pharmaceuticals.

•Topics
•Faculty/Faculty Disclosure

To view the supplement, click the image above.

• Introduction
• Definition & Diagnosis
• Tranexamic Acid for the Treatment of HMB
• Conclusion

Faculty/Faculty Disclosure

Lee Shulman, MD, FACOG, FACMG
The Anna Ross Lapham Professor in Obstetrics and Gynecology
Feinberg School of Medicine of Northwestern University
Chicago, Illinois

Dr Shulman is a consultant to Ferring Pharmaceuticals, Inc.

Matt T. Rosenberg, MD
Family Physician
Mid-Michigan Health Centers
Jackson, Michigan

Dr Rosenberg is a consultant to Ferring Pharmaceuticals, Inc.

Copyright © 2011 by Elsevier Inc.

A supplement to Ob.Gyn. News.
This supplement was sponsored by ETHICON Women's Health & Urology.

•Topic Highlights
•Faculty

To view the supplement, click the image above.

• The Evolution of Thermal Balloon Therapy

• Understanding the Mechanism of Action for Thermal Balloon Therapy

• Menorrhagia-Associated Dysmenorrhea

• Importance of endometrial Cavitary Coverage

• A Review of Research on Clinical Efficacy

• Thermal Balloon Ablation After Cesarean Section

• Should Thermal Balloon Therapy Be Performed in the Office?
Faculty/Faculty Disclosures

Hector O. Chapa, MD
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Methodist Medical Center
Department of Obstetrics and Gynecology Residency ProgramDallas, TX
Dr. Chapa is a medical consultant for ETHICON Women's Health & Urology and has coauthored its Professional Education Content for ThermaChoice Balloon Ablation.

Lowell L. McCauley, MD, PC
Obstetrician/Gynecologist
Knoxville, TN
Dr. McCauley is a medical consultant for ETHICON Women's Health & Urology. To date, he has successfully completed more than 400 Thermachoice III endometrial ablations and serves as a physician educator and trainer for the procedure.

A supplement to Ob.Gyn. News.
This supplement was sponsored by ETHICON Women's Health & Urology.

•Topic Highlights
•Faculty

To view the supplement, click the image above.

• The Evolution of Thermal Balloon Therapy

• Understanding the Mechanism of Action for Thermal Balloon Therapy

• Menorrhagia-Associated Dysmenorrhea

• Importance of endometrial Cavitary Coverage

• A Review of Research on Clinical Efficacy

• Thermal Balloon Ablation After Cesarean Section

• Should Thermal Balloon Therapy Be Performed in the Office?
Faculty/Faculty Disclosures

Hector O. Chapa, MD
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Methodist Medical Center
Department of Obstetrics and Gynecology Residency ProgramDallas, TX
Dr. Chapa is a medical consultant for ETHICON Women's Health & Urology and has coauthored its Professional Education Content for ThermaChoice Balloon Ablation.

Lowell L. McCauley, MD, PC
Obstetrician/Gynecologist
Knoxville, TN
Dr. McCauley is a medical consultant for ETHICON Women's Health & Urology. To date, he has successfully completed more than 400 Thermachoice III endometrial ablations and serves as a physician educator and trainer for the procedure.

A supplement to Ob.Gyn. News.
This supplement was sponsored by ETHICON Women's Health & Urology.

•Topic Highlights
•Faculty

To view the supplement, click the image above.

• The Evolution of Thermal Balloon Therapy

• Understanding the Mechanism of Action for Thermal Balloon Therapy

• Menorrhagia-Associated Dysmenorrhea

• Importance of endometrial Cavitary Coverage

• A Review of Research on Clinical Efficacy

• Thermal Balloon Ablation After Cesarean Section

• Should Thermal Balloon Therapy Be Performed in the Office?
Faculty/Faculty Disclosures

Hector O. Chapa, MD
Medical Director and Outreach Coordinator
Women's Specialty Center
Clinical Faculty
Methodist Medical Center
Department of Obstetrics and Gynecology Residency ProgramDallas, TX
Dr. Chapa is a medical consultant for ETHICON Women's Health & Urology and has coauthored its Professional Education Content for ThermaChoice Balloon Ablation.

Lowell L. McCauley, MD, PC
Obstetrician/Gynecologist
Knoxville, TN
Dr. McCauley is a medical consultant for ETHICON Women's Health & Urology. To date, he has successfully completed more than 400 Thermachoice III endometrial ablations and serves as a physician educator and trainer for the procedure.

A Centers for Disease Control report on Clostridium difficile infections offers encouragement for hospitalists that prevention is possible, but also offers further evidence that more work is needed to prevent the potentially deadly infections.

The report examines three sets of data on C. diff infections. According to an analysis of the CDC’s Emerging Infections Program, 94% of the more than 10,000 infections identified were related to the receipt of healthcare. Also, 75% of the infections had their onset in patients who were not hospitalized at the time.

An analysis of National Healthcare Safety Network data of present-at-admission and hospital-onset C. diff infections found that 52% of the cases involved patients already infected at admission, although they were largely healthcare-related.

And an analysis of data from three state-administered CDI-prevention projects in Illinois, Massachusetts, and New York found that, cumulatively, C. diff infections were reduced by 20%, showing that prevention efforts can pay off.

The heavy involvement of healthcare settings in infections shows that more should be done, says Clifford McDonald, MD, chief of prevention and response in CDC’s Division of Healthcare Quality and Promotion in Atlanta. He took aim specifically at careful use of antibiotics, as broad-spectrum antibiotics kill off bacteria that can help keep C. diff at bay.

“Certainly in the area of antibiotic stewardship, hospitals can do a lot more,” he told The Hospitalist. “A lot of the most potent antibiotics are being prescribed in the hospital. … If they’re necessary, that’s the way it is. It’s necessary and people are put at increased risk because they had to get those antibiotics. But if they weren’t necessary, it’s all the more critical that greater judiciousness be applied to the use of those antibiotics.”

Since many of the cases had their onset outside the hospital, hospitals must emphasize quick evaluation of admitted patients, including asking them an uncomfortable question: “Have you had diarrhea recently?” Three unformed stools in the previous 24 hours, along with antibiotic use in the previous 12 weeks—particularly the previous four to eight weeks—means a C. diff infection is a distinct possibility.

“We don’t think to ask, and patients may not bring it up because they are embarrassed by it,” Dr. McDonald says. Patients suspected of having C. diff infections must be isolated right away, he adds. (Click here to listen to more of Dr. McDonald's interview.)

The success in lowering the infection rate within the three state initiatives is encouraging, Dr. McDonald says, particularly because almost the entire emphasis in those programs was infection control; only the Massachusetts program included antibiotic stewardship, and only as a minor component.

“It does appear that prevention’s possible,” he notes. “Even more can be done if more tools are brought to bear and brought to bear across settings.”

Ketino Kobaidze, MD, PhD, assistant professor at the Emory University School of Medicine in Atlanta and a member of the antimicrobial stewardship and infectious-disease-control committees at Emory’s Hospital Midtown, says that while hospitalists have long been aware of C. diff infections in community settings, she was surprised to learn that 75% of cases were found in patients not currently in the hospital.

“This information will make all hospital-based doctors be more alert when a patient comes with diarrhea—and include CDI in their differential,” she says. “We need to change our approach and make appropriate recommendations on how to screen and prevent further spread.

“What this data tells us is that we need to educate our doctors to prescribe antibiotics more carefully; ask patients about diarrhea even if they are coming in for another disease; and order diagnostic tests if [they report it].”

SHM presid

He also says that while it’s widely accepted that antibiotics are overprescribed, the use of antibiotics in agriculture─in the poultry and cattle industries, for example─is an area that should be explored.

“One of the things to think about is the amount of antibiotics that are used for non- healthcare reasons,” he says, “and that also is a very large contributor to the problem.”

Thomas R. Collins is a freelance medical writer in South Florida.

A Centers for Disease Control report on Clostridium difficile infections offers encouragement for hospitalists that prevention is possible, but also offers further evidence that more work is needed to prevent the potentially deadly infections.

The report examines three sets of data on C. diff infections. According to an analysis of the CDC’s Emerging Infections Program, 94% of the more than 10,000 infections identified were related to the receipt of healthcare. Also, 75% of the infections had their onset in patients who were not hospitalized at the time.

An analysis of National Healthcare Safety Network data of present-at-admission and hospital-onset C. diff infections found that 52% of the cases involved patients already infected at admission, although they were largely healthcare-related.

And an analysis of data from three state-administered CDI-prevention projects in Illinois, Massachusetts, and New York found that, cumulatively, C. diff infections were reduced by 20%, showing that prevention efforts can pay off.

The heavy involvement of healthcare settings in infections shows that more should be done, says Clifford McDonald, MD, chief of prevention and response in CDC’s Division of Healthcare Quality and Promotion in Atlanta. He took aim specifically at careful use of antibiotics, as broad-spectrum antibiotics kill off bacteria that can help keep C. diff at bay.

“Certainly in the area of antibiotic stewardship, hospitals can do a lot more,” he told The Hospitalist. “A lot of the most potent antibiotics are being prescribed in the hospital. … If they’re necessary, that’s the way it is. It’s necessary and people are put at increased risk because they had to get those antibiotics. But if they weren’t necessary, it’s all the more critical that greater judiciousness be applied to the use of those antibiotics.”

Since many of the cases had their onset outside the hospital, hospitals must emphasize quick evaluation of admitted patients, including asking them an uncomfortable question: “Have you had diarrhea recently?” Three unformed stools in the previous 24 hours, along with antibiotic use in the previous 12 weeks—particularly the previous four to eight weeks—means a C. diff infection is a distinct possibility.

“We don’t think to ask, and patients may not bring it up because they are embarrassed by it,” Dr. McDonald says. Patients suspected of having C. diff infections must be isolated right away, he adds. (Click here to listen to more of Dr. McDonald's interview.)

The success in lowering the infection rate within the three state initiatives is encouraging, Dr. McDonald says, particularly because almost the entire emphasis in those programs was infection control; only the Massachusetts program included antibiotic stewardship, and only as a minor component.

“It does appear that prevention’s possible,” he notes. “Even more can be done if more tools are brought to bear and brought to bear across settings.”

Ketino Kobaidze, MD, PhD, assistant professor at the Emory University School of Medicine in Atlanta and a member of the antimicrobial stewardship and infectious-disease-control committees at Emory’s Hospital Midtown, says that while hospitalists have long been aware of C. diff infections in community settings, she was surprised to learn that 75% of cases were found in patients not currently in the hospital.

“This information will make all hospital-based doctors be more alert when a patient comes with diarrhea—and include CDI in their differential,” she says. “We need to change our approach and make appropriate recommendations on how to screen and prevent further spread.

“What this data tells us is that we need to educate our doctors to prescribe antibiotics more carefully; ask patients about diarrhea even if they are coming in for another disease; and order diagnostic tests if [they report it].”

SHM presid

He also says that while it’s widely accepted that antibiotics are overprescribed, the use of antibiotics in agriculture─in the poultry and cattle industries, for example─is an area that should be explored.

“One of the things to think about is the amount of antibiotics that are used for non- healthcare reasons,” he says, “and that also is a very large contributor to the problem.”

Thomas R. Collins is a freelance medical writer in South Florida.

A Centers for Disease Control report on Clostridium difficile infections offers encouragement for hospitalists that prevention is possible, but also offers further evidence that more work is needed to prevent the potentially deadly infections.

The report examines three sets of data on C. diff infections. According to an analysis of the CDC’s Emerging Infections Program, 94% of the more than 10,000 infections identified were related to the receipt of healthcare. Also, 75% of the infections had their onset in patients who were not hospitalized at the time.

An analysis of National Healthcare Safety Network data of present-at-admission and hospital-onset C. diff infections found that 52% of the cases involved patients already infected at admission, although they were largely healthcare-related.

And an analysis of data from three state-administered CDI-prevention projects in Illinois, Massachusetts, and New York found that, cumulatively, C. diff infections were reduced by 20%, showing that prevention efforts can pay off.

The heavy involvement of healthcare settings in infections shows that more should be done, says Clifford McDonald, MD, chief of prevention and response in CDC’s Division of Healthcare Quality and Promotion in Atlanta. He took aim specifically at careful use of antibiotics, as broad-spectrum antibiotics kill off bacteria that can help keep C. diff at bay.

“Certainly in the area of antibiotic stewardship, hospitals can do a lot more,” he told The Hospitalist. “A lot of the most potent antibiotics are being prescribed in the hospital. … If they’re necessary, that’s the way it is. It’s necessary and people are put at increased risk because they had to get those antibiotics. But if they weren’t necessary, it’s all the more critical that greater judiciousness be applied to the use of those antibiotics.”

Since many of the cases had their onset outside the hospital, hospitals must emphasize quick evaluation of admitted patients, including asking them an uncomfortable question: “Have you had diarrhea recently?” Three unformed stools in the previous 24 hours, along with antibiotic use in the previous 12 weeks—particularly the previous four to eight weeks—means a C. diff infection is a distinct possibility.

“We don’t think to ask, and patients may not bring it up because they are embarrassed by it,” Dr. McDonald says. Patients suspected of having C. diff infections must be isolated right away, he adds. (Click here to listen to more of Dr. McDonald's interview.)

The success in lowering the infection rate within the three state initiatives is encouraging, Dr. McDonald says, particularly because almost the entire emphasis in those programs was infection control; only the Massachusetts program included antibiotic stewardship, and only as a minor component.

“It does appear that prevention’s possible,” he notes. “Even more can be done if more tools are brought to bear and brought to bear across settings.”

Ketino Kobaidze, MD, PhD, assistant professor at the Emory University School of Medicine in Atlanta and a member of the antimicrobial stewardship and infectious-disease-control committees at Emory’s Hospital Midtown, says that while hospitalists have long been aware of C. diff infections in community settings, she was surprised to learn that 75% of cases were found in patients not currently in the hospital.

“This information will make all hospital-based doctors be more alert when a patient comes with diarrhea—and include CDI in their differential,” she says. “We need to change our approach and make appropriate recommendations on how to screen and prevent further spread.

“What this data tells us is that we need to educate our doctors to prescribe antibiotics more carefully; ask patients about diarrhea even if they are coming in for another disease; and order diagnostic tests if [they report it].”

SHM presid

He also says that while it’s widely accepted that antibiotics are overprescribed, the use of antibiotics in agriculture─in the poultry and cattle industries, for example─is an area that should be explored.

“One of the things to think about is the amount of antibiotics that are used for non- healthcare reasons,” he says, “and that also is a very large contributor to the problem.”

Thomas R. Collins is a freelance medical writer in South Florida.