Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

CHICAGO – The best pain scales to use when assessing a child’s level of discomfort are those that have been empirically validated for the intended age and setting, according to Mark Connelly, Ph.D., the acting director of integrative pain management at Children’s Mercy Hospitals and Clinics in Kansas City, Mo.

Validated pain scales include the FLACC (Face, Legs, Activity, Cry, and Consolability) observational scale and Pieces of Hurt Tool (sometimes called the Poker Chip Tool) for toddlers, the Faces Pain Scale-Revised for school-age children aged 4-12 years, and the visual analog scale and numeric rating scale for those 8 years and older. The Non-Communicating Children’s Pain checklist is useful for the cognitively impaired, who can be particularly difficult to evaluate because of limited or lack of verbal skills as well as atypical pain behaviors like smiling when in pain.

Patrice Wendling/IMNG Medical Media

"If you don’t assess pain in children in an age-appropriate manner you can miss an important diagnosis," he said at a symposium sponsored by the American College of Rheumatology.

Pain intensity measures should only make up a very small portion of a multidimensional pediatric pain assessment. Other elements that need to be considered include current pain data such as intensity, duration and etiology, pain history, and contributing physiological, cognitive, emotional, and spiritual factors.

Dr. Connelly and his colleagues have developed a brief multidimensional pain assessment tool for pediatric rheumatology called Super-KIDZ that assesses pain features and impact on functioning, coping, and mood. When tested among 24 children aged 4-7 years and 77 youth, aged 8-18 years, completing the measure online took about 5 minutes, just slightly longer compared with a paper version. Most children preferred the computer version, as did a test group of rheumatologists and pain experts, who said they would recommend the computer summary to their colleagues (Pediatr. Rheumatol. Online J. 2012 Apr 10;10:7. [Epub ahead of print]). SuperKIDZ is still undergoing additional validation testing as well as translation. Eventually, the Child Arthritis and Research Rheumatology Alliance site may host the tool online, making it available to providers to use, Dr. Connelly said in an interview.

Among other top 10 tips Dr. Connelly offered for why kids are not just "little adults" when it comes to pain were:

• Pain behaviors vary from child to child; some kids react to pain by sleeping or eating more, other by doing so less. Some children may curl up and become inactive or cling to their parents, while others may actually run around the room to distract themselves from pain, he said.

• Minor pains are not so minor. Clinicians need to be proactive in treating kids’ pain because even pain from minor procedures can set up a child for more pain in the future, he said. Long-term consequences of undertreated pain include hypersensitivity, hyperinnervation, wind-up of pain pathways, and avoidance of health care.

• Chronic pain can be disabling. It is the minority of children that are disabled by persistent pain, but for those who are, there can be increased direct and indirect costs totaling about $12,000 per year, resulting from social and school difficulties, increased depression and anxiety, and loss of activity and disability into adulthood. When Dr. Connelly and his colleagues asked nine school-age children with juvenile idiopathic arthritis and their parents to use electronic diaries thrice daily to assess their pain, the children reported reducing up to 82% of total activities at any given assessment (J. Pain Symptom Manage. 2010;39:579-90).

• Kids live with their parents. Parents’ responses to a child’s pain can facilitate or hinder functioning. Natural protective behaviors, catastrophizing, personal distress, and modeling of disability are just some of the factors that come into play. The key here is to make parents an essential partner in lessening pediatric pain and disability.

• Children’s pain is plastic. Regardless of disease presentation, a variety of continually changing biological, social, and psychological factors can influence how children experience and express pain. They can include repeated experiences of pain in infancy, hospital experiences, understanding of health care, school or social failures, emotional lability and social isolation. Thus, pain assessment and treatment should always be based on a biopsychosocial understanding of pain.

• Kids go to school, except when they don’t. Having children medical homebound is generally contraindicated for treatment of persistent pain in children because of a growing body of evidence showing that regular exercise and maintenance of routines is beneficial, Dr. Connelly said. Providers can help facilitate regular school attendance by writing an accommodations plan that may include a modified physical education curriculum, additional time or rest breaks in a quiet area, extra time for tests/assignments, or a modified school day.

• Interdisciplinary treatment is recommended for pediatric pain whenever possible. Such teamwork can pull together experts in medication support and interventional pain procedures as well as such nonpharmacologic methods as pain education, pain coping skills training, family counseling, physical therapy, acupuncture, and massage.

Dr. Connelly reported research grants from the National Institute of Neurological Disorders and Stroke, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Arthritis Foundation and Mayday Foundation.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

On May 16, the American Academy of Dermatology will release appropriate use criteria for Mohs surgery. The document will be the first of its kind and "a home run for Mohs surgery," said Dr. Brett M. Coldiron, president of the American College of Mohs Surgery.

During the College's annual meeting in Chicago, Dr. Coldiron said that Mohs surgery is not being overutilized, contrary to what some may believe. The increase in utilization is, instead, the result of the nation's skin cancer epidemic, and the fact that Mohs surgery is effective both clinically and financially.

The College has retained a lobby firm in Washington, D.C. to raise Mohs surgery awareness, and is working with insurers on coverage.

In a video interview with Skin and Allergy News, Dr. Coldiron further explained  the ACMS's position.

Click here to listen to Dr. Frost

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Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.

Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.

Part-time physicians report higher work satisfaction, less burnout, and greater work control.¹ They also cite more time for family, community, and self-care activities, as well as more research time and ability to focus on career goals.²

Those are attractive benefits, to be sure. But is part time right for you?

“They need to look at all the factors of their whole life,” says Jennifer Owens, director of the Working Mother Research Institute in New York City. “Are they trying to compete to get ahead and do they feel they can’t give up hours at work? Are they taking an assignment that’s so big, they just need to be at work to try to get it going? Are there factors in their life, like their kids are sick or their spouse has an illness? It all comes down to a personal, individual assessment. There are tradeoffs.”

A major tradeoff is income. Part-time physicians earn less money and have fewer benefits, which might not be financially feasible, says Iris Grimm, creator of the Atlanta-based Balanced Physician coaching program.

Some part-time female physicians surveyed in a recent study published in Academic Medicine cited slower promotion trajectory or even demotion, getting overlooked for career opportunities, given less desirable work, or being marginalized within their division.²

Physicians who decide to work part time should set goals for themselves based on their personal definition of work-life balance, says Maria Bailey, founder and CEO of BlueSuitMom.com, a Pompano Beach, Fla.-based company that provides information on work and family balance for professional working mothers and their employers. If they haven’t reached those goals within two to three months, they should re-evaluate their part-time status.

“Some of us just have the personality where we’re going to create work for ourselves. It’s really hard to break the habits that we’ve developed over many, many years,” Bailey says. “Working part-time may be a reality check that what we thought we wanted isn’t what we wanted at all.”

Lisa Ryan is a freelance writer in New Jersey.

References

1. Mechaber FH, Levine RB, Manwell LB, et al. Part-time physicians … prevalent, connected, and satisfied. J Gen Intern Med. 2008;23(3):300-303.

2. Harrison RA, Gregg JL. A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs. Acad Med. 2009;84(1):80-86.

Click here to listen to Dr. Nagamine

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New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

New SHM board member Brian Harte, MD, SFHM, traces his passion for leadership in hospital medicine back to his medical residency at the University of California at San Francisco (UCSF) Medical Center, not long after HM pioneer Robert Wachter, MD, MHM, helped coined the term "hospitalist" in a celebrated 1996 New England Journal of Medicine article.

"Scott Flanders was my chief resident and gave me advice about taking my first job," Dr. Harte says. "Andy Auerbach was one of the faculty at UCSF. I worked under Jeff Weise and Steve Pantilat," all of whom are national leaders in the field. Among others, SHM president Shaun Frost, MD, SFHM, FACP, was instrumental in Dr. Harte's career advancement, helping recruit him back to his home state of Ohio, where he was until recently the chief operating officer of Hillcrest Hospital in Mayfield Heights, which is affiliated with Cleveland Clinic.

"I've been fortunate enough to be taken under the wing of a lot of giants in the field—really impressive figures whom I have looked up to as role models," Dr. Harte says.

At Cleveland Clinic, Dr. Harte has worn a number of different hats in a fairly short period of time, quickly advancing from HM department chair to the position he started in April—president of South Pointe Hospital in Warrensville Heights, Ohio, another of the nine community hospitals affiliated with Cleveland Clinic. His experience on that career path, along with a broad range of interests and perspectives, is what he hopes to bring to SHM's board.

"This is a path more hospitalists could be pursuing: physician leadership, hospital and health system leadership, program development. In some cases it means stretching our skills to their capacity and beyond," he says. "At this point, it's not clear what healthcare reform has in store for us. But all of the things we do as hospitalists—leadership, program-building, team—building, clinical care, quality improvement—are very applicable skills that will prepare us for leadership roles."

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.