SAN FRANCISCO – Belimumab has come up short for the treatment of systemic lupus erythematosus in black patients in a major phase 3/4 postmarketing randomized trial ordered by the Food and Drug Administration.

Numerically, the outcome trends in the EMBRACE study consistently favored belimumab (Benlysta) over placebo. And not just for all three components of the primary endpoint, but for each of the three major prespecified secondary endpoints as well. Yet not a single one of those six favorable trends attained statistical significance, Jim C. Oates, MD, reported at an international congress on systemic lupus erythematosus.

“The study did not achieve its primary endpoint, although there was a numeric advantage for patients on belimumab, with a 40% increase in the chance of response,” observed Dr. Oates, professor of medicine, director of the division of rheumatology and immunology, and vice chair for research at the Medical University of South Carolina, Charleston.

EMBRACE was a 52-week, double-blind trial in which 503 black systemic lupus erythematosus (SLE) patients were randomized 2:1 to 48 weeks of IV belimumab at the approved dose of 10 mg/kg or to placebo infusions on top of standard care background therapies. The postmarketing study was required by the FDA as a condition for the agency’s 2011 marketing approval of belimumab, a human monoclonal antibody that inhibits B-cell activating factor, also known as a B-lymphocyte stimulator. The agency request came because the three premarketing phase 3 intravenous trials, as well as the phase 3 subcutaneous belimumab trial, included only small numbers of black patients, and the results in that population were conflicting.

The EMBRACE results are particularly disappointing in light of the increased prevalence, severity, and mortality of SLE in black patients. However, the final word on EMBRACE isn’t in, as the data from the recently completed open-label extension phase beyond 52 weeks have not yet been analyzed.

Roughly three-quarters of EMBRACE enrollees completed the full 52 weeks of study. Withdrawal for adverse events or lack of efficacy occurred in 6.7% and 5.4%, respectively, of placebo-treated controls, and in a respective 5.4% and 4.7% of patients in the belimumab arm.


The primary study outcome at 52 weeks was the SLE Responder Index (SRI) response rate with the modified SLE Disease Activity Index (SLEDAI)–2000 scoring for proteinuria (SRI-S2K). This required at least a 4-point reduction from baseline in the Safety of Estrogens in Lupus Erythematosus – National Assessment (SELENA)-SLEDAI, no worsening in the Physician Global Assessment, as well as no new British Isles Lupus Assessment Group (BILAG) A or two new BILAG B organ domain scores. This outcome was achieved in 48.7% of the belimumab group and 41.6% of controls, for 40% greater likelihood in the active treatment arm in a logistic regression analysis, which didn’t achieve statistical significance. While the between-group difference was significant in favor of belimumab during the monthly assessments at weeks 32-44, the belimumab and placebo response rates converged thereafter.

The belimumab safety profile contained no surprises. Of note, rates of opportunistic infections, depression, and suicide or self-injury, which had been deemed adverse events of special interest based upon previous studies, were numerically lower than in controls.

Bruce Jancin/MDedge News

The deflating EMBRACE results are sure to come under close scrutiny, since black patients with SLE have been identified as a population with a major unmet need for improved therapies. Of note, 44% of study participants were from the United States and Canada, and they had a longer disease duration, lower damage scores, and less serologically active disease than subjects from the rest of the world.

Because the results of prior phase 3 studies showed increased belimumab response rates in patients with serologically more active disease, prespecified subgroup analyses of the composite endpoint were conducted. These analyses parsed out several subgroups who were significantly more likely to achieve the primary endpoint with belimumab than with placebo. Black patients with a baseline SELENA-SLEDAI-S2K score of 10 or greater had a 52.5% response rate to belimumab, compared with 40.9% with placebo, for a 76% relative increase. Patients with a low baseline C3 and/or C4 were 200% more likely to respond to the biologic agent than placebo, by a margin of 47.2% versus 24.6%. And patients from outside North America were 80% more likely to respond to belimumab, with a 57.5% response rate, compared with 44.0% on placebo.

One audience member noted there is evidence that the use of mycophenolate appears to be advantageous in African American SLE patients and wondered if the EMBRACE subgroup on belimumab plus background mycophenolate fared significantly better than with placebo. Dr. Oates replied that, although it’s an important question, the subset analysis isn’t available yet.

The EMBRACE trial was sponsored by GlaxoSmithKline. Dr. Oates reported receiving research funding from that pharmaceutical company and several others, the National Institutes of Health, and the Department of Veterans Affairs.

[email protected]

SOURCE: Oates JC et al. Lupus Sci Med. 2019;6[suppl 1], Abstract 200.

SAN FRANCISCO – Belimumab has come up short for the treatment of systemic lupus erythematosus in black patients in a major phase 3/4 postmarketing randomized trial ordered by the Food and Drug Administration.

Numerically, the outcome trends in the EMBRACE study consistently favored belimumab (Benlysta) over placebo. And not just for all three components of the primary endpoint, but for each of the three major prespecified secondary endpoints as well. Yet not a single one of those six favorable trends attained statistical significance, Jim C. Oates, MD, reported at an international congress on systemic lupus erythematosus.

“The study did not achieve its primary endpoint, although there was a numeric advantage for patients on belimumab, with a 40% increase in the chance of response,” observed Dr. Oates, professor of medicine, director of the division of rheumatology and immunology, and vice chair for research at the Medical University of South Carolina, Charleston.

EMBRACE was a 52-week, double-blind trial in which 503 black systemic lupus erythematosus (SLE) patients were randomized 2:1 to 48 weeks of IV belimumab at the approved dose of 10 mg/kg or to placebo infusions on top of standard care background therapies. The postmarketing study was required by the FDA as a condition for the agency’s 2011 marketing approval of belimumab, a human monoclonal antibody that inhibits B-cell activating factor, also known as a B-lymphocyte stimulator. The agency request came because the three premarketing phase 3 intravenous trials, as well as the phase 3 subcutaneous belimumab trial, included only small numbers of black patients, and the results in that population were conflicting.

The EMBRACE results are particularly disappointing in light of the increased prevalence, severity, and mortality of SLE in black patients. However, the final word on EMBRACE isn’t in, as the data from the recently completed open-label extension phase beyond 52 weeks have not yet been analyzed.

Roughly three-quarters of EMBRACE enrollees completed the full 52 weeks of study. Withdrawal for adverse events or lack of efficacy occurred in 6.7% and 5.4%, respectively, of placebo-treated controls, and in a respective 5.4% and 4.7% of patients in the belimumab arm.


The primary study outcome at 52 weeks was the SLE Responder Index (SRI) response rate with the modified SLE Disease Activity Index (SLEDAI)–2000 scoring for proteinuria (SRI-S2K). This required at least a 4-point reduction from baseline in the Safety of Estrogens in Lupus Erythematosus – National Assessment (SELENA)-SLEDAI, no worsening in the Physician Global Assessment, as well as no new British Isles Lupus Assessment Group (BILAG) A or two new BILAG B organ domain scores. This outcome was achieved in 48.7% of the belimumab group and 41.6% of controls, for 40% greater likelihood in the active treatment arm in a logistic regression analysis, which didn’t achieve statistical significance. While the between-group difference was significant in favor of belimumab during the monthly assessments at weeks 32-44, the belimumab and placebo response rates converged thereafter.

The belimumab safety profile contained no surprises. Of note, rates of opportunistic infections, depression, and suicide or self-injury, which had been deemed adverse events of special interest based upon previous studies, were numerically lower than in controls.

Bruce Jancin/MDedge News

The deflating EMBRACE results are sure to come under close scrutiny, since black patients with SLE have been identified as a population with a major unmet need for improved therapies. Of note, 44% of study participants were from the United States and Canada, and they had a longer disease duration, lower damage scores, and less serologically active disease than subjects from the rest of the world.

Because the results of prior phase 3 studies showed increased belimumab response rates in patients with serologically more active disease, prespecified subgroup analyses of the composite endpoint were conducted. These analyses parsed out several subgroups who were significantly more likely to achieve the primary endpoint with belimumab than with placebo. Black patients with a baseline SELENA-SLEDAI-S2K score of 10 or greater had a 52.5% response rate to belimumab, compared with 40.9% with placebo, for a 76% relative increase. Patients with a low baseline C3 and/or C4 were 200% more likely to respond to the biologic agent than placebo, by a margin of 47.2% versus 24.6%. And patients from outside North America were 80% more likely to respond to belimumab, with a 57.5% response rate, compared with 44.0% on placebo.

One audience member noted there is evidence that the use of mycophenolate appears to be advantageous in African American SLE patients and wondered if the EMBRACE subgroup on belimumab plus background mycophenolate fared significantly better than with placebo. Dr. Oates replied that, although it’s an important question, the subset analysis isn’t available yet.

The EMBRACE trial was sponsored by GlaxoSmithKline. Dr. Oates reported receiving research funding from that pharmaceutical company and several others, the National Institutes of Health, and the Department of Veterans Affairs.

[email protected]

SOURCE: Oates JC et al. Lupus Sci Med. 2019;6[suppl 1], Abstract 200.

SAN FRANCISCO – Belimumab has come up short for the treatment of systemic lupus erythematosus in black patients in a major phase 3/4 postmarketing randomized trial ordered by the Food and Drug Administration.

Numerically, the outcome trends in the EMBRACE study consistently favored belimumab (Benlysta) over placebo. And not just for all three components of the primary endpoint, but for each of the three major prespecified secondary endpoints as well. Yet not a single one of those six favorable trends attained statistical significance, Jim C. Oates, MD, reported at an international congress on systemic lupus erythematosus.

“The study did not achieve its primary endpoint, although there was a numeric advantage for patients on belimumab, with a 40% increase in the chance of response,” observed Dr. Oates, professor of medicine, director of the division of rheumatology and immunology, and vice chair for research at the Medical University of South Carolina, Charleston.

EMBRACE was a 52-week, double-blind trial in which 503 black systemic lupus erythematosus (SLE) patients were randomized 2:1 to 48 weeks of IV belimumab at the approved dose of 10 mg/kg or to placebo infusions on top of standard care background therapies. The postmarketing study was required by the FDA as a condition for the agency’s 2011 marketing approval of belimumab, a human monoclonal antibody that inhibits B-cell activating factor, also known as a B-lymphocyte stimulator. The agency request came because the three premarketing phase 3 intravenous trials, as well as the phase 3 subcutaneous belimumab trial, included only small numbers of black patients, and the results in that population were conflicting.

The EMBRACE results are particularly disappointing in light of the increased prevalence, severity, and mortality of SLE in black patients. However, the final word on EMBRACE isn’t in, as the data from the recently completed open-label extension phase beyond 52 weeks have not yet been analyzed.

Roughly three-quarters of EMBRACE enrollees completed the full 52 weeks of study. Withdrawal for adverse events or lack of efficacy occurred in 6.7% and 5.4%, respectively, of placebo-treated controls, and in a respective 5.4% and 4.7% of patients in the belimumab arm.


The primary study outcome at 52 weeks was the SLE Responder Index (SRI) response rate with the modified SLE Disease Activity Index (SLEDAI)–2000 scoring for proteinuria (SRI-S2K). This required at least a 4-point reduction from baseline in the Safety of Estrogens in Lupus Erythematosus – National Assessment (SELENA)-SLEDAI, no worsening in the Physician Global Assessment, as well as no new British Isles Lupus Assessment Group (BILAG) A or two new BILAG B organ domain scores. This outcome was achieved in 48.7% of the belimumab group and 41.6% of controls, for 40% greater likelihood in the active treatment arm in a logistic regression analysis, which didn’t achieve statistical significance. While the between-group difference was significant in favor of belimumab during the monthly assessments at weeks 32-44, the belimumab and placebo response rates converged thereafter.

The belimumab safety profile contained no surprises. Of note, rates of opportunistic infections, depression, and suicide or self-injury, which had been deemed adverse events of special interest based upon previous studies, were numerically lower than in controls.

Bruce Jancin/MDedge News

The deflating EMBRACE results are sure to come under close scrutiny, since black patients with SLE have been identified as a population with a major unmet need for improved therapies. Of note, 44% of study participants were from the United States and Canada, and they had a longer disease duration, lower damage scores, and less serologically active disease than subjects from the rest of the world.

Because the results of prior phase 3 studies showed increased belimumab response rates in patients with serologically more active disease, prespecified subgroup analyses of the composite endpoint were conducted. These analyses parsed out several subgroups who were significantly more likely to achieve the primary endpoint with belimumab than with placebo. Black patients with a baseline SELENA-SLEDAI-S2K score of 10 or greater had a 52.5% response rate to belimumab, compared with 40.9% with placebo, for a 76% relative increase. Patients with a low baseline C3 and/or C4 were 200% more likely to respond to the biologic agent than placebo, by a margin of 47.2% versus 24.6%. And patients from outside North America were 80% more likely to respond to belimumab, with a 57.5% response rate, compared with 44.0% on placebo.

One audience member noted there is evidence that the use of mycophenolate appears to be advantageous in African American SLE patients and wondered if the EMBRACE subgroup on belimumab plus background mycophenolate fared significantly better than with placebo. Dr. Oates replied that, although it’s an important question, the subset analysis isn’t available yet.

The EMBRACE trial was sponsored by GlaxoSmithKline. Dr. Oates reported receiving research funding from that pharmaceutical company and several others, the National Institutes of Health, and the Department of Veterans Affairs.

[email protected]

SOURCE: Oates JC et al. Lupus Sci Med. 2019;6[suppl 1], Abstract 200.

The Food and Drug Administration on April 19 approved the first generic naloxone hydrochloride nasal spray (Narcan) as treatment for stopping or reversing an opioid overdose.

“In the wake of the opioid crisis, a number of efforts are underway to make this emergency overdose reversal treatment more readily available and more accessible,” said Douglas Throckmorton, MD, deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, in a press release. “In addition to this approval of the first generic naloxone nasal spray, moving forward, we will prioritize our review of generic drug applications for naloxone.”

The agency said the naloxone nasal spray does not need assembly and can be used by anyone, regardless of medical training. The drug is administered by spraying naloxone into one nostril while a patient is lying on his or her back and can be repeated. If the spray is administered quickly after the overdose begins, the effect of the opioid will be countered, often within minutes. However, patients should still seek immediate medical attention.

The FDA cautioned that, when used on a patient with an opioid dependence, naloxone can cause severe opioid withdrawal, characterized by symptoms such as body aches, diarrhea, tachycardia, fever, runny nose, sneezing, goose bumps, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure.

Find the full press release on the FDA website.

[email protected]

The Food and Drug Administration on April 19 approved the first generic naloxone hydrochloride nasal spray (Narcan) as treatment for stopping or reversing an opioid overdose.

“In the wake of the opioid crisis, a number of efforts are underway to make this emergency overdose reversal treatment more readily available and more accessible,” said Douglas Throckmorton, MD, deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, in a press release. “In addition to this approval of the first generic naloxone nasal spray, moving forward, we will prioritize our review of generic drug applications for naloxone.”

The agency said the naloxone nasal spray does not need assembly and can be used by anyone, regardless of medical training. The drug is administered by spraying naloxone into one nostril while a patient is lying on his or her back and can be repeated. If the spray is administered quickly after the overdose begins, the effect of the opioid will be countered, often within minutes. However, patients should still seek immediate medical attention.

The FDA cautioned that, when used on a patient with an opioid dependence, naloxone can cause severe opioid withdrawal, characterized by symptoms such as body aches, diarrhea, tachycardia, fever, runny nose, sneezing, goose bumps, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure.

Find the full press release on the FDA website.

[email protected]

The Food and Drug Administration on April 19 approved the first generic naloxone hydrochloride nasal spray (Narcan) as treatment for stopping or reversing an opioid overdose.

“In the wake of the opioid crisis, a number of efforts are underway to make this emergency overdose reversal treatment more readily available and more accessible,” said Douglas Throckmorton, MD, deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, in a press release. “In addition to this approval of the first generic naloxone nasal spray, moving forward, we will prioritize our review of generic drug applications for naloxone.”

The agency said the naloxone nasal spray does not need assembly and can be used by anyone, regardless of medical training. The drug is administered by spraying naloxone into one nostril while a patient is lying on his or her back and can be repeated. If the spray is administered quickly after the overdose begins, the effect of the opioid will be countered, often within minutes. However, patients should still seek immediate medical attention.

The FDA cautioned that, when used on a patient with an opioid dependence, naloxone can cause severe opioid withdrawal, characterized by symptoms such as body aches, diarrhea, tachycardia, fever, runny nose, sneezing, goose bumps, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure.

Find the full press release on the FDA website.

[email protected]

Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

Both sleep quantity and quality is disturbed in hospitalized patients

A cross-sectional, observational, single-day study of over 2,000 hospitalized patients showed that, on average, these patients received 83 minutes less sleep time than at home. Quality of sleep – as measured by the Consensus Sleep Diary (CSD) and the Dutch-Flemish Patient-Reported-Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank – was also significantly disturbed. Sleep disruptions were most commonly caused by noise from other patients and by being awakened by hospital staff.

Citation: Wesselius H et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.2669.

Health care costs and mortality improve in Medicare beneficiaries who receive transitional care management (TCM) service

In a retrospective cohort analysis of Medicare Fee-for-Service beneficiaries, the adjusted total Medicare costs (average, $3,358 vs. $3,033) and mortality (1.6% vs 1.0%) were higher among those beneficiaries who did not receive TCM services, compared with those who did receive TCM services, in the 31-60 days following an eligible discharge; however, use of this service by clinicians remained very low.

Citation: Bindman AB et al. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries. JAMA Intern Med. 2018 Jul 30. doi: 10.1001/jamainternmed.2018.2572.

Unsafe zolpidem use is common

In a review of the 2015 US Medical Expenditure Panel Survey, investigators found that up to 77% of patients prescribed zolpidem reported being prescribed longer durations and higher doses, as well as the drug being prescribed alongside other CNS depressants, despite known risks and recommended prescription and Food and Drug Administration guidelines.

Citation: Moore T et al. Assessment of patterns of potentially unsafe use of zolpidem. JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.3031.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

A clue to the neuroanatomy of obsessive-compulsive personality disorder may lay in abnormal hippocampal or amygdalar structures, according to a new observational imaging study.

MRI showed that the right and left volumes of the hippocampus and amygdala are smaller in patients with obsessive-compulsive personality disorder than in healthy controls, researchers found.

These findings lend support to the likelihood that obsessive-compulsive personality disorder “seems to be a neurocognitive function disorder rather than a personality disorder,” Mehmet Gurkan Gurok, of Firat University, Elazig, Turkey, and his associates reported in the Journal of Clinical Neuroscience.

The authors previously had investigated volumes of hippocampus and amygdala in patients with obsessive-compulsive disorder and found these patients had “increased white matter volumes, greater left and right thalamus volumes and significantly reduced left and right orbitofrontal cortex volumes, compared with healthy controls.”

For this study, they similarly used MRI to assess hippocampal and amygdalar volumes in 16 patients with obsessive-compulsive personality disorder (inpatients and outpatients at Firat University) and in 18 healthy controls – matched for age, sex, education, and handedness – who were studying at the hospital.

The researchers used the DSM-IV and the Structured Clinical Interview for the Diagnostic Schedule for Mental Disorders-Fourth Edition for diagnoses but noted later in their limitations that “the validity of diagnosis should be questioned” for personality disorders.

Participants were excluded if they had a comorbid Axis I psychiatric diagnosis besides depression, any contraindications for MRI, history of alcohol or substance dependence within the previous 6 months, use of psychoactive medications within 4 weeks of the study, or any current severe medical conditions. In addition, neither controls nor their first-degree relatives had a history of psychiatric disorders.

The findings showed that those with obsessive-compulsive personality disorder had smaller volumes on both sides of the hippocampus, compared with healthy controls. Amygdalar volume on both the left and right sides were similarly smaller in patients with obsessive-compulsive personality disorder, compared with healthy controls (left, P = .001; right, P = .002). The authors also reported they “did not find any correlation between hippocampus and amygdala volumes and any clinical and demographic variables.”

The research was funded by Firat University. The authors reported having no conflicts of interest.

SOURCE: Gurok MG et al. J Clin Neurosci. 2019 Apr 5. doi: 10.1016/j.jocn.2019.03.060.

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

PHILADELPHIA – Women physicians face a potential additional challenge in their contract negotiations that they need to account for: the gender wage gap.

Gregory Twachtman/MDedge News

“Find a lawyer ... that will support your fight for pay equity,” Michael Sinha, MD, advised in a presentation at the annual meeting of the American College of Physicians.

“Definitely interview them,” said Dr. Sinha of Harvard Medical School, Boston. “Get a sense of how committed they are to that cause. Seek recommendations from other women in medicine. Maybe they will point you to the person who really is committed to this cause and wants to help you.”

He also cautioned that physicians might have to help their lawyer fill in the knowledge gap. “Sometimes you need to provide that lawyer with data. There are a lot of reports that have been published from various organizations [including the ACP]. Don’t assume that the lawyer has the evidence.”

Armed with evidence, he said there is opportunity to address gender pay gaps in the contract. “You can put a lot of things into your contract, why not some of these things? If there is institutional evidence of a pay gap or a leaky promotional pipeline, you are telling them you have a problem with salary discrepancies between male and female physicians and I need to protect my own self-worth.”

Dr. Sinha recommended prospective employees develop strategies with their lawyers, which could mean letting the lawyer take the lead in the negotiations.

“Maybe that reduces stress or emotion in the process. That will preserve a good relationship with the employer,” he said. “A confident, knowledgeable lawyer may help mitigate gender differences in negotiation strategy.”

In order to help close the gender gap, Dr. Sinha said he advises his male colleagues to help female physicians by being open about their compensation, especially if compensation is not public information. “I have been encouraging male physician colleagues of mine to share that information when you are asked. Don’t make it impossible for someone to figure out.”

He noted that it is not likely that closing the gender gap by raising women’s compensation is going to result in male physicians losing money, but rather in the long run it will mean better compensation for everyone.

Dr. Sinha also had this advice for employers: “Before you do anything else, level your pay gap. ... For every physician that works in your organization, level your pay gap. Offer equitable salary packages up front to men and women. Understand your responsibilities under federal and state equal pay laws.”

When it comes to equitable compensation packages, all offerings, including salary and fringe benefits, should be offered to both male and female physicians or to neither.

“Don’t make something nonnegotiable for women but engage men in negotiations,” he said. “I think that is obvious but I have seen that happen.”

Dr. Sinha also said it is important to check your gender biases at the door before entering negotiations. Don’t view a woman asking for something as demanding or harsh when a male asking for the same exact thing is viewed as assertive and self-confident.

“Don’t fall into those traps. And if you have people that can call out your biases and help you see that, that’s important,” Dr. Sinha noted.

He also stated that hiring committees need to show diversity in terms of gender, race, and ethnicity, adding that it is “hugely important” that you do that.

The bottom line is to not force women to negotiate for equal pay, Dr. Sinha noted. “The gender gap is well documented in medicine, and you really have to do your part.”

[email protected]

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

Click here to download this supplement. 

A majority of patients with psoriasis are undertreated. In recent years, however, new formulations of topical medications for psoriasis have been introduced, with the goal of enhancing penetration, efficacy, and patient acceptance. Along with new systemic therapies, these treatments allow for more aggressive goals for disease clearance.

Topical medications can be used as monotherapy but combining topical agents can increase efficacy and may allow for use of lower doses with fewer adverse events. Fixed-dose combination treatments combine active ingredients in one vehicle and may improve patient adherence and acceptance by simplifying the treatment regimen.

This supplement provides physicians with education on evidence-based assessment and management of psoriasis, the combination of systemic and topical medications, and strategies for improving patient adherence to treatment regimens.

Click here to download this supplement. 

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

PHILADELPHIA – The latest published report links calcium intake from supplements to increased risk of cancer death, a nutrition specialist noted at the annual meeting of the American College of Physicians.

Andrew D. Bowser/MDedge News

The report, published (Ann Intern Med. 2019 Apr 9. doi: 10.7326/M18-2478) just 2 days before the start of the Internal Medicine meeting, found no mortality benefits associated with any reported dietary supplement use among nearly 31,000 adults in the National Health and Nutrition Examination Survey.

On the contrary, they found that excess calcium consumption was associated with increased risk for cancer-related deaths. Calcium supplements were specifically implicated in the excess of mortality, according to the investigators, with a rate ratio of 1.53 (95% confidence interval, 1.04-2.25) for intakes of 1,000 mg/day versus no intake.

“It’s better to get all of your vitamins from your food, over supplements,” said Marijane Hynes, MD, director of weight management at George Washington University, Washington, in a meet-the-professor session at the conference.

The amount of calcium patients are getting from food can be estimated with one rule of thumb: Multiply the number of dairy servings per day by 300 mg, Dr. Hynes said, who added that a serving is 8 ounces of milk or 1 ounce of hard cheese. Dark green vegetables, breads, cereals, and some nuts can provide 100-200 mg of calcium per day.

Calcium carbonate can be taken with food to enhance calcium absorption, according to Dr. Hynes, while calcium citrate can be taken without food, and is preferred for patients taking acid reflux medications.

Because calcium absorption is reduced at higher doses, patients who need more than 600 mg/day should be taking divided doses, she said.

Bone health goes beyond the dairy aisle, Dr. Hynes added. High vitamin K intake was linked to reduced hip fracture risk among the Framingham Heart Study participants. To get the recommended amount of vitamin K in the diet, patients can consume one or more servings of broccoli, kale, collard greens, or dark green lettuce.

Dr. Hynes reported she that had no relationships with entities producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

In the March 2019 issue of The Hospitalist, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46% of survey respondents viewed the relationships between physicians and hospitals as somewhat or mostly negative and adversarial.

Several physicians posted comments online, and they deeply saddened me. My heart hurt for those doctors who wrote, “I loved medicine. It was good for my soul, but medicine left me. Doctors gave up most of their power and large corporations without an ethical foundation and no god, but money took over.” Or “They are waiting so all the senior physicians will retire. Nurses will become leaders who will follow administration’s lead and control physicians. Money and cost cutting is the major driver. Physicians are not valuable anymore because they have different opinions which cost a lot. There is a lot of window dressing, but they actually don’t care. They just want to run a business.” I also read “I was tossed out like dirty laundry water at age 59.” And “On a personal basis, I will try to reason with management exactly once before I bail.” Sigh.

These commenters are well-meaning physicians who had bad experiences with hospital leaders they saw as uncaring and unresponsive to their concerns as clinicians. Their experiences left them demoralized and embittered. I’m truly sorry for that.

I’m a recovering hospital administrator myself. My business partner John Nelson, MD, MHM, likes to tell people that he has successfully deprogrammed me from the way most administrators think about doctors, but he’s mostly joking (at least I think he is). I can tell you that most of the hospital leaders I have met – both when I was still an administrator and now in my consulting work – are well-intentioned people who care deeply about patients and their fellow health care professionals and are trying hard to do the right thing. Many of them could have earned more and had better career opportunities doing similar work in a field other than health care, but they chose health care out of a sincere desire to do good and help people.

A big part of the problem is that doctors and administrators come to health care from very different starting points, and so have very different perspectives. They generally function in separate silos, each paying attention to their own comfortable little part of that monster we call a health care delivery system. Often, neither administrators nor doctors have made enough effort to cross over and understand the issues and perspectives of people in other silos. As a result, it’s easy for assumptions and biases to creep in and poison our interactions.

When we interpret the behavior of others, we humans tend to overemphasize dispositional factors, such as personality or motives, and to discount situational factors, such as external stressors. Psychologists call this the fundamental attribution error or correspondence bias, and the result is usually heightened conflict as a result of presumed negative intentions on the part of others (“All she cares about is making a profit”) and discounting circumstantial factors that might be influencing others’ behavior (“She is facing reduced market share and a funding shortfall, and she’s fearful for the future of the institution”).

Add in another phenomenon known as the actor-observer bias, in which we tend to attribute others’ behavior to their dispositions but attribute our own behavior to the circumstances (“That administrator lost his temper because he’s a demanding jerk, but I only lost my temper because he pushed me over the edge”).

Is it possible that hospital leaders and doctors are reading each other inaccurately and that they’re making assumptions about each other’s intentions that get in the way of having constructive dialogue? How can we get to a place of greater trust? I don’t know the whole answer, of course, but I have a few ideas to offer.

Read the full post at hospitalleader.org.

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

Bryce Gartland, MD, was working as a full-time hospitalist at Emory University Hospital in Atlanta when hospital administrators first started asking him to take on administrative roles, such as clinical site director or medical director of care coordination.

Today, Dr. Gartland is hospital group president and cochief of clinical operations for Emory Healthcare, with responsibility for overall performance and achievement across all 11 Emory hospitals. In that role, he keeps his eyes open for similar talent and leadership potential in younger physicians.

Following internal medicine residency at Cedars-Sinai Medical Center in Los Angeles, Dr. Gartland moved into a traditional private practice setting in Beverly Hills. “Two years later, my wife and I decided to move back to my home town of Atlanta. This was 2005 and hospital medicine was a nascent movement in health care. I was intrigued, and Emory had a strong hospitalist program based in a major academic medical setting, which has since grown from approximately 20 physicians to over 120 across seven hospitals,” he said.

Senior leaders at Emory recognized something in Dr. Gartland and more administrative offers were forthcoming.

“After a year of practicing at Emory, the system’s chief financial officer knocked on my door to ask if I would be interested in becoming medical director for care coordination. This role afforded me tremendous opportunities to get involved in clinical/administrative activities at Emory – utilization review, hospice and palliative care, transitions of care, interface with managed care organizations. The role was very rewarding. In some ways, I became a kind of chief translator at the hospital for anything clinical that also had financial implications,” he recalled.

“Then we went through a reorganization and I was offered the opportunity to step into the chief operating officer position at Emory University Hospital. Shortly thereafter, there was leadership turnover within the division of hospital medicine and I was asked by the CEO of Emory Healthcare and chair of the department of medicine to serve as section head for hospital medicine.” Dr. Gartland wore both of those hats for about 2 years, later becoming the CEO of Emory University Hospital and two other facilities within the system. He was appointed to his current position as hospital group president and cochief of clinical operations for Emory Healthcare in 2018.

Consumed with administrative responsibilities, he largely had to step away from patient care, although with mixed emotions.

“Over the years, I worked hard to maintain a strong clinical role, but the reality is that if you are not delivering patient care routinely, it’s difficult to practice at the highest level of current medical practice,” he said. Nonetheless, Dr. Gartland tries to keep a hand in patient care by routinely rounding with hospitalist teams and attending care conferences.

Fixing the larger health care system

“I am a huge supporter of more physicians becoming actively engaged in administrative positions in health care. They are key to helping us best fix the larger health care system,” Dr. Gartland said. “However, we’ve all seen clinicians drafted into administrative positions who were not great administrators. One needs to be bilingual in both medicine and business. While some skills, such as strong communication, may cross over, it’s important to recognize that clinical strength and success do not necessarily equate to administrative achievement.”

Dr. Gartland also believes in the importance of mentorship in developing future leaders and in seeking and engaging mentors from other disciplines outside of one’s own specialty. “I’ve been fortunate to have a number of mentors who saw something in me and supported investment in my personal and professional development. I am now fortunate to be in the position to give back by mentoring a number of younger hospitalists who are interested in growing their nonclinical roles.”

“One bit of advice from a mentor that really resonated with me was: Don’t let the urgent get in the way of the important,” Dr. Gartland said. “Life is busy and full of urgent day-to-day fires. It’s important to take the time to pause and consider where you are going and what you are doing to enhance your career development. Are you getting the right kinds of feedback?” He explained that a coach or mentor who can provide constructive feedback is important and is something he has relied upon throughout his own professional development.

Different paths to learning business

Dr. Gartland did not pursue formal business training before the administrative opportunities started to multiply for him at Emory, although in college he had a strong interest in both business and medicine and at one time contemplated going into either.

“Over the years, my mentors have given me a lot of advice, one of which was that a medical degree can be a passport to a lot of different career paths, with real opportunities for merging business and medicine,” he said.

He has since intentionally pursued business training opportunities wherever they came up, such as courses offered by the American College of Physician Executives (now the American Association for Physician Leadership). “At one point, I considered going back to college in an MBA program, but that’s when John Fox – then Emory Healthcare’s CEO – called and said he wanted to send me to the Harvard Business School’s Managing Health Care Delivery executive education program, with an Emory team comprising the chief nurse executive, chief of human resources, and CEO for one of our hospitals.” Harvard’s roughly 9-month program involves 3 weeks on campus with assignments between the on-campus visits.

“In my current role as hospital group president, I have direct responsibility for our hospitals’ and system’s clinically essential services such as radiology, laboratory, pharmacy, and perioperative medicine. I also still serve as CEO for Emory University Hospital while we recruit my replacement,” Dr. Gartland said. “Overall, my work time breaks down roughly into thirds. One-third is spent on strategy and strategic initiatives – such as organizational and program design. Our system recently acquired a large community health system whose strategic and operational integration I am actively leading.”

Another third of his time is focused on operations, and the final third is focused on talent management and development. “People are truly the most valuable asset any organization has, particularly in health care,” he noted. “Being intentional about organizational design, coaching, and supporting the development and deployment of talent at all levels of the organization helps everyone achieve their full potential. It is one of the most important roles a leader can play.”

Dr. Gartland said that Emory is committed to Lean-based management systems, using both horizontal and vertical strategies for process improvement and waste reduction, with implementation beginning in urology, transplant, and heart and vascular services. Experts say Lean success starts at the very top, and Emory and Dr. Gartland are all in.

“These types of changes are measured in 5- to 7-year increments or more, not in months. We believe this is key to creating the best workplace to support the highest quality, experience, and value in health care delivery. It creates and supports the right culture within an organization, and we have made the commitment to following that path,” he said.

Recognizing leadership potential

What does Dr. Gartland look for in physicians with leadership potential?

“Are you someone who collaborates well?” he asked. “Someone who raises your hand at meetings or gets engaged with the issues? Do you volunteer to take on assignments? Are you someone with a balanced perspective, system minded in thinking and inquisitive, with a positive approach to problem solving?”

A lot of physicians might come to a meeting with the hospital or their boss and complain about all the things that aren’t working, he said, but “it’s rarer for them to come in and say: ‘I see these problems, and here’s where I think we can make improvements. How can I help?’ ” Dr. Gartland looks for evidence of emotional intelligence and the ability to effect change management across disciplines. Another skill with ever-greater importance is comfort with data and data-driven decision making.

“When our national health care system is experiencing so much change and upheaval, much of which is captured in newspaper headlines, it can sound scary,” he said. “I encourage people to see that complex, dynamic times like these, filled with so much change, are also a tremendous opportunity. Run towards and embrace the opportunity for change. Hospitalists, by nature, bring with them a tremendous background and experience set that is invaluable to help lead positive change in these dynamic times.”

The SHM has offerings for hospitalists wanting to advance in leadership positions, Dr. Gartland said, including its annual Leadership Academy. The next one is scheduled to be held in Nashville, Tenn., Nov. 4-7, 2019.

“The Leadership Academy is a great initial step for physicians, especially those early in their careers. Also, try to gain exposure to a variety of perspectives outside of hospital medicine,” he said. “I’d love to see further advances in leadership for our specialty – growing the number of hospitalists who serve as hospital CEOs or CMOs and in other leadership roles. We have more to learn collectively about leadership as a specialty, and I’d love to see us grow that capacity by offering further learning opportunities and bringing together hospitalists who have an interest in advancing leadership.”

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.

The severity and duration of vaccine-proximate febrile seizures (VP-FSs) are no worse than non–vaccine proximate febrile seizures (NVP-FSs), according to a study in Pediatrics.

KatarzynaBialasiewicz/Thinkstock

Lucy Deng, MBBS, of the University of Sydney and her colleagues investigated 1,022 index febrile seizures in children aged 6 years or less, of which 6% (n = 67) were VP-FSs and 94% (n = 955) were NVP-FSs. Both univariate and multivariate analyses showed no increased risk of severe seizure associated with VP-FSs, compared with NVP-FS. Most of the febrile seizures of either type were brief (15 minutes or less) and had a length of stay of 1 day or less; there also were no differences in 24-hour recurrence. The most common symptom was respiratory, and the rates were similar in each group (62.7% with VP-FS vs. 62.8% with NVP-FS). In keeping with a known 100% increased risk associated with measles vaccination, 84% of VP-FSs were associated with measles-containing vaccines. The majority of the remaining VP-FSs occurred after combination vaccines.

One limitation is that, because these cases were documented in sentinel tertiary pediatric hospitals, the case ascertainment may not be representative. Also, the small proportion of VP-FSs and limited cohort size means the study may not have been powered to detect true differences in prolonged seizures between the groups, Dr. Deng and her colleagues wrote.

“This study confirms that VP-FSs are clinically not any different from NVP-FSs and should be managed the same way,” the researchers concluded.

The authors reported no relevant financial disclosures, although Dr. Deng is supported by the University of Sydney Training Program scholarship, and two other study authors are supported by Australian National Health and Medical Research Council Career Development Fellowships. The study was funded by a grant from the Australian Government Department of Health and the National Health and Medical Research Council.

[email protected]

SOURCE: Deng L et al. Pediatrics. 2019 Apr 19. doi: 10.1542/peds.2018-2120.