WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.

WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.

WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.

NEWPORT BEACH, CALIF. – Most gout patients need more than the standard and widely used dose of 300 mg/day of allopurinol to lower their serum urate level enough to prevent flares, according to gout expert Dr. Brian Mandell.

Probably more than half of people need more than 300 mg "if you are going to get to the target level of [6 mg/dL serum urate or lower]. Most people probably need closer to 400 mg," he said (Ann. Rheum. Dis. 1998;57:545-9).

A good target serum urate level is 6 mg/dL. "If you’re at 6, the urate is unlikely to precipitate, [and] you really do dramatically decrease the frequency of attacks," he said at Perspectives in Rheumatic Diseases 2012, held by Global Academy for Medical Education. GAME and this news organization are owned by Frontline Medical Communications.

In a bid to get physicians to use a treat-to-target approach in gout management, Dr. Mandell noted that "you can only treat urate successfully if you measure it after you start therapy," something not all clinicians do. "The correct dose is the dose that drops your urate," said Dr. Mandell, professor and chair of medicine at the Cleveland Clinic.

To avoid triggering a gout flare from too-abrupt urate lowering and to help avoid hypersensitivity reactions, "I always start low at 50 mg/dL" and titrate upward, he said.

"There’s no rush in trying to drop the level. It’s a lifelong disease." When counseling patients about hypersensitivity reactions, Dr. Mandell said that he advises them to stop the drug as soon as they notice a rash and then call him.

Pegylated uricase is "incredibly effective for lowering serum urate," as well, he said. When pegylated uricase is "given as an IV infusion, serum urate plummets to about 0.5 mg/dL and stays down for 2 weeks or longer," Dr. Mandell noted.

Patients should be warned, however, of the risk of flares with the quick urate drop. Also, if they don’t have such a robust response, it probably means they have antibodies to pegylated uricase, which also increases their risk of an infusion reaction. In that case, "stop the drug," he said.

For management of an acute gout attack, Dr. Mandell said he often chooses anakinra (Kineret) so long as patients are in the hospital and can be monitored for infections and other potential problems.

Indomethacin is another option. In fact, "any NSAID will work if you use high enough doses. You need to treat until the attack resolves and then for a couple days longer to really make sure the attack is gone," he advised.

Colchicine can work "if you catch the attack early, but it’s not a panacea. It’s a great drug for prophylaxis but not to treat acute attacks," he said.

Narcotics don’t work well on inflammatory pain and so are not a good choice for an acute attack, Dr. Mandell noted.

A normal serum urate level does not necessarily rule out a gout attack. "Stick a needle in the joint at some point in time to make sure gout is the diagnosis," he said.

Dr. Mandell is a consultant for Novartis, Pfizer, Takeda, and other companies.

SDEF and this news organization are owned by Frontline Medical Communications.

NEWPORT BEACH, CALIF. – Most gout patients need more than the standard and widely used dose of 300 mg/day of allopurinol to lower their serum urate level enough to prevent flares, according to gout expert Dr. Brian Mandell.

Probably more than half of people need more than 300 mg "if you are going to get to the target level of [6 mg/dL serum urate or lower]. Most people probably need closer to 400 mg," he said (Ann. Rheum. Dis. 1998;57:545-9).

A good target serum urate level is 6 mg/dL. "If you’re at 6, the urate is unlikely to precipitate, [and] you really do dramatically decrease the frequency of attacks," he said at Perspectives in Rheumatic Diseases 2012, held by Global Academy for Medical Education. GAME and this news organization are owned by Frontline Medical Communications.

In a bid to get physicians to use a treat-to-target approach in gout management, Dr. Mandell noted that "you can only treat urate successfully if you measure it after you start therapy," something not all clinicians do. "The correct dose is the dose that drops your urate," said Dr. Mandell, professor and chair of medicine at the Cleveland Clinic.

To avoid triggering a gout flare from too-abrupt urate lowering and to help avoid hypersensitivity reactions, "I always start low at 50 mg/dL" and titrate upward, he said.

"There’s no rush in trying to drop the level. It’s a lifelong disease." When counseling patients about hypersensitivity reactions, Dr. Mandell said that he advises them to stop the drug as soon as they notice a rash and then call him.

Pegylated uricase is "incredibly effective for lowering serum urate," as well, he said. When pegylated uricase is "given as an IV infusion, serum urate plummets to about 0.5 mg/dL and stays down for 2 weeks or longer," Dr. Mandell noted.

Patients should be warned, however, of the risk of flares with the quick urate drop. Also, if they don’t have such a robust response, it probably means they have antibodies to pegylated uricase, which also increases their risk of an infusion reaction. In that case, "stop the drug," he said.

For management of an acute gout attack, Dr. Mandell said he often chooses anakinra (Kineret) so long as patients are in the hospital and can be monitored for infections and other potential problems.

Indomethacin is another option. In fact, "any NSAID will work if you use high enough doses. You need to treat until the attack resolves and then for a couple days longer to really make sure the attack is gone," he advised.

Colchicine can work "if you catch the attack early, but it’s not a panacea. It’s a great drug for prophylaxis but not to treat acute attacks," he said.

Narcotics don’t work well on inflammatory pain and so are not a good choice for an acute attack, Dr. Mandell noted.

A normal serum urate level does not necessarily rule out a gout attack. "Stick a needle in the joint at some point in time to make sure gout is the diagnosis," he said.

Dr. Mandell is a consultant for Novartis, Pfizer, Takeda, and other companies.

SDEF and this news organization are owned by Frontline Medical Communications.

NEWPORT BEACH, CALIF. – Most gout patients need more than the standard and widely used dose of 300 mg/day of allopurinol to lower their serum urate level enough to prevent flares, according to gout expert Dr. Brian Mandell.

Probably more than half of people need more than 300 mg "if you are going to get to the target level of [6 mg/dL serum urate or lower]. Most people probably need closer to 400 mg," he said (Ann. Rheum. Dis. 1998;57:545-9).

A good target serum urate level is 6 mg/dL. "If you’re at 6, the urate is unlikely to precipitate, [and] you really do dramatically decrease the frequency of attacks," he said at Perspectives in Rheumatic Diseases 2012, held by Global Academy for Medical Education. GAME and this news organization are owned by Frontline Medical Communications.

In a bid to get physicians to use a treat-to-target approach in gout management, Dr. Mandell noted that "you can only treat urate successfully if you measure it after you start therapy," something not all clinicians do. "The correct dose is the dose that drops your urate," said Dr. Mandell, professor and chair of medicine at the Cleveland Clinic.

To avoid triggering a gout flare from too-abrupt urate lowering and to help avoid hypersensitivity reactions, "I always start low at 50 mg/dL" and titrate upward, he said.

"There’s no rush in trying to drop the level. It’s a lifelong disease." When counseling patients about hypersensitivity reactions, Dr. Mandell said that he advises them to stop the drug as soon as they notice a rash and then call him.

Pegylated uricase is "incredibly effective for lowering serum urate," as well, he said. When pegylated uricase is "given as an IV infusion, serum urate plummets to about 0.5 mg/dL and stays down for 2 weeks or longer," Dr. Mandell noted.

Patients should be warned, however, of the risk of flares with the quick urate drop. Also, if they don’t have such a robust response, it probably means they have antibodies to pegylated uricase, which also increases their risk of an infusion reaction. In that case, "stop the drug," he said.

For management of an acute gout attack, Dr. Mandell said he often chooses anakinra (Kineret) so long as patients are in the hospital and can be monitored for infections and other potential problems.

Indomethacin is another option. In fact, "any NSAID will work if you use high enough doses. You need to treat until the attack resolves and then for a couple days longer to really make sure the attack is gone," he advised.

Colchicine can work "if you catch the attack early, but it’s not a panacea. It’s a great drug for prophylaxis but not to treat acute attacks," he said.

Narcotics don’t work well on inflammatory pain and so are not a good choice for an acute attack, Dr. Mandell noted.

A normal serum urate level does not necessarily rule out a gout attack. "Stick a needle in the joint at some point in time to make sure gout is the diagnosis," he said.

Dr. Mandell is a consultant for Novartis, Pfizer, Takeda, and other companies.

SDEF and this news organization are owned by Frontline Medical Communications.

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

General internists often continue to treat gout the way they were taught to as medical students, and the result of that approach has been that patients continue to have gout attacks and joint damage. Physicians can do much better than that by using available medications to lower the patient’s serum urate level below 6 mg/dL, according to Dr. Brian Mandell, Professor and Chairman of Medicine at the Cleveland Clinic. This interview was conducted at the 5th Annual Perspectives in Rheumatic Diseases Seminar. 

General internists often continue to treat gout the way they were taught to as medical students, and the result of that approach has been that patients continue to have gout attacks and joint damage. Physicians can do much better than that by using available medications to lower the patient’s serum urate level below 6 mg/dL, according to Dr. Brian Mandell, Professor and Chairman of Medicine at the Cleveland Clinic. This interview was conducted at the 5th Annual Perspectives in Rheumatic Diseases Seminar. 

General internists often continue to treat gout the way they were taught to as medical students, and the result of that approach has been that patients continue to have gout attacks and joint damage. Physicians can do much better than that by using available medications to lower the patient’s serum urate level below 6 mg/dL, according to Dr. Brian Mandell, Professor and Chairman of Medicine at the Cleveland Clinic. This interview was conducted at the 5th Annual Perspectives in Rheumatic Diseases Seminar. 

WASHINGTON – Adenotonsillectomy reduced obstructive sleep apnea and bed-wetting in half of 35 children diagnosed with both conditions.

The study was limited by its small size, but the findings suggest that children with severe obstructive sleep apnea and nocturnal enuresis might benefit on both counts with adenotonsillectomy, said Dr. Prasad Thottam of Children’s Hospital of Michigan, Detroit.

The average age of the children studied was 8 years, 60% were male, and their average body mass index was 24 kg/m². Proper bladder function was documented in all of the children, and none had chronic conditions such as cerebral palsy, severe asthma, or morbid obesity. All experienced bed-wetting more than 3 nights per week. Any medications taken for nocturnal enuresis were discontinued for 1 month prior to surgery.

Four children had adenoidectomies, two had tonsillectomies, and 29 had adenotonsillectomies. After an average of 10 weeks post surgery, 51% of the children had reductions in bed-wetting, said Dr. Thottam. The reductions were most notable in children with a higher BMI and worse apnea characteristics on polysomnography.

Girls were five times more likely than were boys to have bed-wetting resolve after surgery. Children with prolonged stage 2 sleep were eight times more likely than were those with a normal duration of stage 2 sleep to have bed-wetting resolve.

In addition, when comparing the sleep architecture of the patients to established normal levels, an apnea-hypopnea index greater than 10 was associated with a higher rate of resolution of bed-wetting compared with the rest of the population.

The findings were presented at the annual meeting of the American Academy for Otolaryngology – Head and Neck Surgery Foundation. Dr. Thottam had no financial conflicts to disclose.

WASHINGTON – Adenotonsillectomy reduced obstructive sleep apnea and bed-wetting in half of 35 children diagnosed with both conditions.

The study was limited by its small size, but the findings suggest that children with severe obstructive sleep apnea and nocturnal enuresis might benefit on both counts with adenotonsillectomy, said Dr. Prasad Thottam of Children’s Hospital of Michigan, Detroit.

The average age of the children studied was 8 years, 60% were male, and their average body mass index was 24 kg/m². Proper bladder function was documented in all of the children, and none had chronic conditions such as cerebral palsy, severe asthma, or morbid obesity. All experienced bed-wetting more than 3 nights per week. Any medications taken for nocturnal enuresis were discontinued for 1 month prior to surgery.

Four children had adenoidectomies, two had tonsillectomies, and 29 had adenotonsillectomies. After an average of 10 weeks post surgery, 51% of the children had reductions in bed-wetting, said Dr. Thottam. The reductions were most notable in children with a higher BMI and worse apnea characteristics on polysomnography.

Girls were five times more likely than were boys to have bed-wetting resolve after surgery. Children with prolonged stage 2 sleep were eight times more likely than were those with a normal duration of stage 2 sleep to have bed-wetting resolve.

In addition, when comparing the sleep architecture of the patients to established normal levels, an apnea-hypopnea index greater than 10 was associated with a higher rate of resolution of bed-wetting compared with the rest of the population.

The findings were presented at the annual meeting of the American Academy for Otolaryngology – Head and Neck Surgery Foundation. Dr. Thottam had no financial conflicts to disclose.

WASHINGTON – Adenotonsillectomy reduced obstructive sleep apnea and bed-wetting in half of 35 children diagnosed with both conditions.

The study was limited by its small size, but the findings suggest that children with severe obstructive sleep apnea and nocturnal enuresis might benefit on both counts with adenotonsillectomy, said Dr. Prasad Thottam of Children’s Hospital of Michigan, Detroit.

The average age of the children studied was 8 years, 60% were male, and their average body mass index was 24 kg/m². Proper bladder function was documented in all of the children, and none had chronic conditions such as cerebral palsy, severe asthma, or morbid obesity. All experienced bed-wetting more than 3 nights per week. Any medications taken for nocturnal enuresis were discontinued for 1 month prior to surgery.

Four children had adenoidectomies, two had tonsillectomies, and 29 had adenotonsillectomies. After an average of 10 weeks post surgery, 51% of the children had reductions in bed-wetting, said Dr. Thottam. The reductions were most notable in children with a higher BMI and worse apnea characteristics on polysomnography.

Girls were five times more likely than were boys to have bed-wetting resolve after surgery. Children with prolonged stage 2 sleep were eight times more likely than were those with a normal duration of stage 2 sleep to have bed-wetting resolve.

In addition, when comparing the sleep architecture of the patients to established normal levels, an apnea-hypopnea index greater than 10 was associated with a higher rate of resolution of bed-wetting compared with the rest of the population.

The findings were presented at the annual meeting of the American Academy for Otolaryngology – Head and Neck Surgery Foundation. Dr. Thottam had no financial conflicts to disclose.

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.

Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?

Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.

Study design: Systematic review of the literature.

Setting: Twenty-six controlled studies.

Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.

Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.

Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.

Read more of our physician reviews of recent, HM-relevant literature.