Saturday, April 19, 2014

SHM 2014: visceral reactions

The 2014 national meeting of the Society of Hospital Medicine was held March 25-27. I've been busy since I got back and am just now getting around to “blogging the conference.” This, I hope, will be but one of a series of posts about the meeting.

Bob Wachter shared some of his thoughts the other day. I thought I'd read his post before starting. Bob can be a little provocative and sure enough his comments got me going.  In Bob's opening I was struck by this:

As Win Whitcomb, who co-founded SHM, wrote to me, the meeting is “a mix of love, deep sense of purpose, community, mission, changing-the world, and just plain sizzle,” and I completely agree.

Unfortunately that quote matches my own observations concerning what the sizzle was about: community, mission, changing the world. But what happened to the clinical care of the individual hospitalized patient? Sadly, there didn't seem to be a lot of energy focused on that aspect. Sure there were clinical break out sessions (yes, they were good and will be the subject of future posts here) but they seemed to be relegated to a lesser status. It was as if the clinical content was incidental. That seems to be the general direction of the organization.

It wasn't always that way. It was different when I first attended our national meeting about a decade ago (when we were known as NAIP, the National Association of Inpatient Physicians). The buzz as I remember it back then was about things like sepsis, pneumonia, mystery cases and complex cases of thromboembolic disease. The focus was clinical.

Not so much nowadays. In the plenary sessions I got the feeling this was a meeting for hospital administrators, policy makers and public health professionals rather than doctors. The “patients” they talked about were the hospitals, the health care systems and the larger communities, not the individuals populating the hospital wards.

We need the leaders of our field to go back to promoting hospitalists as clinicians. Unfortunately I didn't see that happening at SHM 14.

EM talks from Vanderbilt

By Corey Slovis and others.

Tuesday, April 15, 2014

The Z-drugs: zolpidem, zopiclone, and zaleplon

From a recent review:

The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation..Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines..Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose.

Monday, April 14, 2014

The Magic Eye method of ECG rhythm assessment

Magic Eye posters were quite the rage a couple of decades ago. I got pretty good at stereoviewing so I'll have to try this. It might come in handy if there are no calipers around.


Saturday, April 12, 2014

A simple clinical prediction rule for the presence of CAD in patients presenting with heart failure

Published here in AJC. This may help in selecting those patients who need coronary angiography. The new ACC heart failure guidelines do not make a strong statement on coronary angiography or non invasive imaging indications, leaving it to clinical assessment.