Brief history: 52-year-old female with uncontrolled hypertension.

Salient findings: The middle third of the arteries are involved with a “string of pearls” appearance of alternating webs and stenoses. This appearance is classic for fibromuscular dysplasia (FMD) (white arrow, above). The patient also has a 1.8-cm right renal artery aneurysm at the trifurcation of her first order renal artery branches (black arrow, above).

Patient population and natural history of disease: FMD is most common in young adult females, and its etiology is unknown. An association with alpha-1 antitrypsin deficiency has been reported in the literature. FMD is a leading cause of curable hypertension. Clinical manifestations of FMD include distal embolization of thrombus formed in small aneurysms, hypertension/ischemia due to obstruction by webs, and occlusion/infarct via spontaneous dissection. The natural prevalence of renal artery aneurysms is low—0.1% in all angiography patients—and its natural course is not well established. Renal artery aneurysms are most common in FMD, vasculitides, neoplasm, trauma, and Ehlers-Danlos Syndrome; they may be iatrogenic or idiopathic.

Management: Symptomatic medial fibroplasia-type FMD responds well to balloon angioplasty. Renal artery aneurysms may be managed medically or surgically, depending on risk factors. Indications for repair of renal artery aneurysms include a size of 2 cm or greater, pregnancy, expansion, renovascular hypertension, distal embolization, and rupture. Mortality from ruptured renal artery aneurysms is 10% in nonpregnant patients and 55% during pregnancy.

This patient had a good response to balloon angioplasty of the left renal artery. The right renal artery could not be angioplastied secondary to increased risk of aneurysm rupture with restoration of arterial blood flow due to increased pressure on the walls of the aneurysm. Hence, physicians surgically resected the right renal artery aneurysm and performed a bypass to the aorta.

Take Home Points

• FMD is most common in young or middle-age women;
• FMD is a type of curable hypertension, treated by renal artery angioplasty;
• FMD is diagnosed by an angiographic study—in classic cases, the involved artery has a string of pearls appearance; and
• FMD is associated with renal artery aneurysms. Consider surgical intervention in aneurysms greater than 2 cm. TH

Helena Summers is a radiology resident and Erik Summers is a hospitalist at the Mayo Clinic College of Medicine, Rochester, Minn.

Bibliography

• Kaufman JA, Lee MJ. Vascular and Interventional Radiology: The Requisites. Philadelphia: Mosby; 2004.
• Bisschops RH, Popma JJ, Meyerovitz MF. Treatment of fibromuscular dysplasia and renal artery aneurysm with use of a stent-graft. J Vasc Interv Radiol. 2001 Jun;12(6):757-760.
• Luscher TF, Lie JT, Stanson AW, et al. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62:931-952.

Brief history: 52-year-old female with uncontrolled hypertension.

Salient findings: The middle third of the arteries are involved with a “string of pearls” appearance of alternating webs and stenoses. This appearance is classic for fibromuscular dysplasia (FMD) (white arrow, above). The patient also has a 1.8-cm right renal artery aneurysm at the trifurcation of her first order renal artery branches (black arrow, above).

Patient population and natural history of disease: FMD is most common in young adult females, and its etiology is unknown. An association with alpha-1 antitrypsin deficiency has been reported in the literature. FMD is a leading cause of curable hypertension. Clinical manifestations of FMD include distal embolization of thrombus formed in small aneurysms, hypertension/ischemia due to obstruction by webs, and occlusion/infarct via spontaneous dissection. The natural prevalence of renal artery aneurysms is low—0.1% in all angiography patients—and its natural course is not well established. Renal artery aneurysms are most common in FMD, vasculitides, neoplasm, trauma, and Ehlers-Danlos Syndrome; they may be iatrogenic or idiopathic.

Management: Symptomatic medial fibroplasia-type FMD responds well to balloon angioplasty. Renal artery aneurysms may be managed medically or surgically, depending on risk factors. Indications for repair of renal artery aneurysms include a size of 2 cm or greater, pregnancy, expansion, renovascular hypertension, distal embolization, and rupture. Mortality from ruptured renal artery aneurysms is 10% in nonpregnant patients and 55% during pregnancy.

This patient had a good response to balloon angioplasty of the left renal artery. The right renal artery could not be angioplastied secondary to increased risk of aneurysm rupture with restoration of arterial blood flow due to increased pressure on the walls of the aneurysm. Hence, physicians surgically resected the right renal artery aneurysm and performed a bypass to the aorta.

Take Home Points

• FMD is most common in young or middle-age women;
• FMD is a type of curable hypertension, treated by renal artery angioplasty;
• FMD is diagnosed by an angiographic study—in classic cases, the involved artery has a string of pearls appearance; and
• FMD is associated with renal artery aneurysms. Consider surgical intervention in aneurysms greater than 2 cm. TH

Helena Summers is a radiology resident and Erik Summers is a hospitalist at the Mayo Clinic College of Medicine, Rochester, Minn.

Bibliography

• Kaufman JA, Lee MJ. Vascular and Interventional Radiology: The Requisites. Philadelphia: Mosby; 2004.
• Bisschops RH, Popma JJ, Meyerovitz MF. Treatment of fibromuscular dysplasia and renal artery aneurysm with use of a stent-graft. J Vasc Interv Radiol. 2001 Jun;12(6):757-760.
• Luscher TF, Lie JT, Stanson AW, et al. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62:931-952.

Brief history: 52-year-old female with uncontrolled hypertension.

Salient findings: The middle third of the arteries are involved with a “string of pearls” appearance of alternating webs and stenoses. This appearance is classic for fibromuscular dysplasia (FMD) (white arrow, above). The patient also has a 1.8-cm right renal artery aneurysm at the trifurcation of her first order renal artery branches (black arrow, above).

Patient population and natural history of disease: FMD is most common in young adult females, and its etiology is unknown. An association with alpha-1 antitrypsin deficiency has been reported in the literature. FMD is a leading cause of curable hypertension. Clinical manifestations of FMD include distal embolization of thrombus formed in small aneurysms, hypertension/ischemia due to obstruction by webs, and occlusion/infarct via spontaneous dissection. The natural prevalence of renal artery aneurysms is low—0.1% in all angiography patients—and its natural course is not well established. Renal artery aneurysms are most common in FMD, vasculitides, neoplasm, trauma, and Ehlers-Danlos Syndrome; they may be iatrogenic or idiopathic.

Management: Symptomatic medial fibroplasia-type FMD responds well to balloon angioplasty. Renal artery aneurysms may be managed medically or surgically, depending on risk factors. Indications for repair of renal artery aneurysms include a size of 2 cm or greater, pregnancy, expansion, renovascular hypertension, distal embolization, and rupture. Mortality from ruptured renal artery aneurysms is 10% in nonpregnant patients and 55% during pregnancy.

This patient had a good response to balloon angioplasty of the left renal artery. The right renal artery could not be angioplastied secondary to increased risk of aneurysm rupture with restoration of arterial blood flow due to increased pressure on the walls of the aneurysm. Hence, physicians surgically resected the right renal artery aneurysm and performed a bypass to the aorta.

Take Home Points

• FMD is most common in young or middle-age women;
• FMD is a type of curable hypertension, treated by renal artery angioplasty;
• FMD is diagnosed by an angiographic study—in classic cases, the involved artery has a string of pearls appearance; and
• FMD is associated with renal artery aneurysms. Consider surgical intervention in aneurysms greater than 2 cm. TH

Helena Summers is a radiology resident and Erik Summers is a hospitalist at the Mayo Clinic College of Medicine, Rochester, Minn.

Bibliography

• Kaufman JA, Lee MJ. Vascular and Interventional Radiology: The Requisites. Philadelphia: Mosby; 2004.
• Bisschops RH, Popma JJ, Meyerovitz MF. Treatment of fibromuscular dysplasia and renal artery aneurysm with use of a stent-graft. J Vasc Interv Radiol. 2001 Jun;12(6):757-760.
• Luscher TF, Lie JT, Stanson AW, et al. Arterial fibromuscular dysplasia. Mayo Clin Proc. 1987;62:931-952.

Due to an overwhelming number of Democratic victories in last November’s midterm elections, the 110th Congress, which took office early this year, has new leaders and a new agenda that could bode well for healthcare legislation.

In this article, Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, explains what the changes in Congress could mean for the near future of healthcare and for the legislation and issues that SHM strongly supports. Based in Washington, D.C., Allendorf is responsible for providing government relations services for SHM. She advises the organization on key legislative and regulatory healthcare issues before Congress and the Bush administration, and she works with SHM leaders and staff on policy development and advocacy strategies.

Majority Rules

The midterm elections brought about a shift in power that goes deeper than numbers of bodies on each side of the aisle. “The Democrats are now the majority in both chambers. This is significant, because they’ve been the minority since 1994, says Allendorf. “As the majority, they control the agenda now—on healthcare and other issues—and they also head the key committees.”

What can we expect to see from the Democratic Congress? “We should expect to see a more expansionist agenda” in general, according to Allendorf. “We’re going to see more activism in the area of healthcare, but whether anything gets done remains to be seen. There’s only a slim majority in the Senate, and President Bush can wield his veto pen. For example, the Democrats would like to give [the Department of] Health and Human Services the power to negotiate drug prices with pharmaceutical companies, specifically on Medicare Part D, but Bush won’t like that.”

Much depends on the issues at hand, as well as on how much bipartisan support exists for each specific bill.

Changing of the Guard

Anyone who glances at the newspaper knows that Democrat Nancy Pelosi (Calif.) is now the Speaker of the House. But Democratic leadership goes much deeper than that because the ruling party has also taken over leadership of Congressional committees. These committees shape the legislation introduced in the House and Senate.

As of press time, Congressional committee assignments had not been formally decided—at least not in the Senate—but many assignments were certain. “Typically, the highest-ranking Democrat [House or Senate] on a committee will become the new head, though Nancy Pelosi isn’t sticking to that,” explains Allendorf. “Pete Stark (D-Calif.) will likely chair the Ways and Means Committee’s Subcommittee on Health, and Charles Rangel (D-N.Y.) will head the House Ways and Means Committee. John Dingell (D-Mich.) will chair the House Energy and Commerce Committee.” (For more on committee chairs, visit http://media-newswire.com/release_1040623.html.)

For a complete list of committee members, visit SHM’s new Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. See “New Advocacy Tool Available,” for more information on the Legislative Action Center, above.)

Starting Over on Key Issues

Many of the bills introduced in 2006—particularly spending bills—were not voted on by the end of the lame duck session last fall. That means that these bills must be reintroduced in the new year. Bills that recommend funding changes are frozen, so agencies continue to receive 2006 funding until the new Congress votes to change their budget.

“All bills have to be reintroduced in the 110th,” stresses Allendorf. “It will take some time—how much depends on the issue. The Democrats may want to hold hearings on legislation, or they may simply dust off legislation that was introduced last year.”

The Democrats are expected to move on many of the issues that SHM has been lobbying for. “They’ve said that they want to reform the healthcare system,” says Allendorf. “Top issues include providing coverage to the uninsured, reforming Medicare Part D, and resolving the physician payment issue.”

Allendorf believes that there will be a bipartisan effort to push through physician payment reform. “There are some 265 members of Congress who requested action on this issue this year [in 2006],” she points out. “There’s a genuine interest and desire to address physician payment reform and pay-for-performance as well. They may differ on how quickly they want to move on some of these.”

The news is not so good on the issue of gainsharing, where physicians are allowed to share the profits realized by a hospital’s cost reductions when linked to specific best practices. “Representative Nancy Johnson (R-Conn.) was a big proponent of this issue in the House, and she was not re-elected,” says Allendorf. “Stark is an opponent of gainsharing, so there may not be the same Congressional push behind it—at least in the House.”

However, the unexpected gainsharing demonstration projects approved in 2006 are underway, and Congress will hear reports on those in several years, once the projects have been analyzed.

Another issue that may not be addressed is liability. “Medical liability reform will be on the back burner,” warns Allendorf. “It’s generally not supported by the Democrats.”

In 2006, SHM supported increased funding for the Agency for Healthcare Research and Quality (AHRQ)—this was one of the major issues addressed by members during Legislative Advocacy Day during the Annual Meeting in Washington, D.C. Whether the next budget includes more money for the agency remains to be seen. “The Democrats support increased funding for NIH (National Institutes of Health), AHRQ, and other healthcare agencies,” says Allendorf. “There’s certainly political will, but where is the money going to come from?”

New Congress, New Issues

What about new issues? “Democrats have signaled that healthcare access for the uninsured will be a priority,” says Allendorf. “I think that we’ll see new legislation with a renewed emphasis on access to care.”

SHM’s Public Policy Committee will be waiting for the first legislation to be introduced regarding coverage for uninsured Americans. “This is an issue that SHM is strongly in favor of,” explains Allendorf. “SHM will look at any bills that come out on this issue and then form a policy.”

Regardless of which healthcare issues come to the forefront first, SHM’s Public Policy Committee, staff, and members are likely to be more active than ever. “I see a very busy year legislatively for SHM,” says Allendorf. TH

Jane Jerrard regularly writes “Public Policy” for The Hospitalist.

Due to an overwhelming number of Democratic victories in last November’s midterm elections, the 110th Congress, which took office early this year, has new leaders and a new agenda that could bode well for healthcare legislation.

In this article, Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, explains what the changes in Congress could mean for the near future of healthcare and for the legislation and issues that SHM strongly supports. Based in Washington, D.C., Allendorf is responsible for providing government relations services for SHM. She advises the organization on key legislative and regulatory healthcare issues before Congress and the Bush administration, and she works with SHM leaders and staff on policy development and advocacy strategies.

Majority Rules

The midterm elections brought about a shift in power that goes deeper than numbers of bodies on each side of the aisle. “The Democrats are now the majority in both chambers. This is significant, because they’ve been the minority since 1994, says Allendorf. “As the majority, they control the agenda now—on healthcare and other issues—and they also head the key committees.”

What can we expect to see from the Democratic Congress? “We should expect to see a more expansionist agenda” in general, according to Allendorf. “We’re going to see more activism in the area of healthcare, but whether anything gets done remains to be seen. There’s only a slim majority in the Senate, and President Bush can wield his veto pen. For example, the Democrats would like to give [the Department of] Health and Human Services the power to negotiate drug prices with pharmaceutical companies, specifically on Medicare Part D, but Bush won’t like that.”

Much depends on the issues at hand, as well as on how much bipartisan support exists for each specific bill.

Changing of the Guard

Anyone who glances at the newspaper knows that Democrat Nancy Pelosi (Calif.) is now the Speaker of the House. But Democratic leadership goes much deeper than that because the ruling party has also taken over leadership of Congressional committees. These committees shape the legislation introduced in the House and Senate.

As of press time, Congressional committee assignments had not been formally decided—at least not in the Senate—but many assignments were certain. “Typically, the highest-ranking Democrat [House or Senate] on a committee will become the new head, though Nancy Pelosi isn’t sticking to that,” explains Allendorf. “Pete Stark (D-Calif.) will likely chair the Ways and Means Committee’s Subcommittee on Health, and Charles Rangel (D-N.Y.) will head the House Ways and Means Committee. John Dingell (D-Mich.) will chair the House Energy and Commerce Committee.” (For more on committee chairs, visit http://media-newswire.com/release_1040623.html.)

For a complete list of committee members, visit SHM’s new Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. See “New Advocacy Tool Available,” for more information on the Legislative Action Center, above.)

Starting Over on Key Issues

Many of the bills introduced in 2006—particularly spending bills—were not voted on by the end of the lame duck session last fall. That means that these bills must be reintroduced in the new year. Bills that recommend funding changes are frozen, so agencies continue to receive 2006 funding until the new Congress votes to change their budget.

“All bills have to be reintroduced in the 110th,” stresses Allendorf. “It will take some time—how much depends on the issue. The Democrats may want to hold hearings on legislation, or they may simply dust off legislation that was introduced last year.”

The Democrats are expected to move on many of the issues that SHM has been lobbying for. “They’ve said that they want to reform the healthcare system,” says Allendorf. “Top issues include providing coverage to the uninsured, reforming Medicare Part D, and resolving the physician payment issue.”

Allendorf believes that there will be a bipartisan effort to push through physician payment reform. “There are some 265 members of Congress who requested action on this issue this year [in 2006],” she points out. “There’s a genuine interest and desire to address physician payment reform and pay-for-performance as well. They may differ on how quickly they want to move on some of these.”

The news is not so good on the issue of gainsharing, where physicians are allowed to share the profits realized by a hospital’s cost reductions when linked to specific best practices. “Representative Nancy Johnson (R-Conn.) was a big proponent of this issue in the House, and she was not re-elected,” says Allendorf. “Stark is an opponent of gainsharing, so there may not be the same Congressional push behind it—at least in the House.”

However, the unexpected gainsharing demonstration projects approved in 2006 are underway, and Congress will hear reports on those in several years, once the projects have been analyzed.

Another issue that may not be addressed is liability. “Medical liability reform will be on the back burner,” warns Allendorf. “It’s generally not supported by the Democrats.”

In 2006, SHM supported increased funding for the Agency for Healthcare Research and Quality (AHRQ)—this was one of the major issues addressed by members during Legislative Advocacy Day during the Annual Meeting in Washington, D.C. Whether the next budget includes more money for the agency remains to be seen. “The Democrats support increased funding for NIH (National Institutes of Health), AHRQ, and other healthcare agencies,” says Allendorf. “There’s certainly political will, but where is the money going to come from?”

New Congress, New Issues

What about new issues? “Democrats have signaled that healthcare access for the uninsured will be a priority,” says Allendorf. “I think that we’ll see new legislation with a renewed emphasis on access to care.”

SHM’s Public Policy Committee will be waiting for the first legislation to be introduced regarding coverage for uninsured Americans. “This is an issue that SHM is strongly in favor of,” explains Allendorf. “SHM will look at any bills that come out on this issue and then form a policy.”

Regardless of which healthcare issues come to the forefront first, SHM’s Public Policy Committee, staff, and members are likely to be more active than ever. “I see a very busy year legislatively for SHM,” says Allendorf. TH

Jane Jerrard regularly writes “Public Policy” for The Hospitalist.

Due to an overwhelming number of Democratic victories in last November’s midterm elections, the 110th Congress, which took office early this year, has new leaders and a new agenda that could bode well for healthcare legislation.

In this article, Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, explains what the changes in Congress could mean for the near future of healthcare and for the legislation and issues that SHM strongly supports. Based in Washington, D.C., Allendorf is responsible for providing government relations services for SHM. She advises the organization on key legislative and regulatory healthcare issues before Congress and the Bush administration, and she works with SHM leaders and staff on policy development and advocacy strategies.

Majority Rules

The midterm elections brought about a shift in power that goes deeper than numbers of bodies on each side of the aisle. “The Democrats are now the majority in both chambers. This is significant, because they’ve been the minority since 1994, says Allendorf. “As the majority, they control the agenda now—on healthcare and other issues—and they also head the key committees.”

What can we expect to see from the Democratic Congress? “We should expect to see a more expansionist agenda” in general, according to Allendorf. “We’re going to see more activism in the area of healthcare, but whether anything gets done remains to be seen. There’s only a slim majority in the Senate, and President Bush can wield his veto pen. For example, the Democrats would like to give [the Department of] Health and Human Services the power to negotiate drug prices with pharmaceutical companies, specifically on Medicare Part D, but Bush won’t like that.”

Much depends on the issues at hand, as well as on how much bipartisan support exists for each specific bill.

Changing of the Guard

Anyone who glances at the newspaper knows that Democrat Nancy Pelosi (Calif.) is now the Speaker of the House. But Democratic leadership goes much deeper than that because the ruling party has also taken over leadership of Congressional committees. These committees shape the legislation introduced in the House and Senate.

As of press time, Congressional committee assignments had not been formally decided—at least not in the Senate—but many assignments were certain. “Typically, the highest-ranking Democrat [House or Senate] on a committee will become the new head, though Nancy Pelosi isn’t sticking to that,” explains Allendorf. “Pete Stark (D-Calif.) will likely chair the Ways and Means Committee’s Subcommittee on Health, and Charles Rangel (D-N.Y.) will head the House Ways and Means Committee. John Dingell (D-Mich.) will chair the House Energy and Commerce Committee.” (For more on committee chairs, visit http://media-newswire.com/release_1040623.html.)

For a complete list of committee members, visit SHM’s new Legislative Action Center at http://capwiz.com/hospitalmedicine/home/. See “New Advocacy Tool Available,” for more information on the Legislative Action Center, above.)

Starting Over on Key Issues

Many of the bills introduced in 2006—particularly spending bills—were not voted on by the end of the lame duck session last fall. That means that these bills must be reintroduced in the new year. Bills that recommend funding changes are frozen, so agencies continue to receive 2006 funding until the new Congress votes to change their budget.

“All bills have to be reintroduced in the 110th,” stresses Allendorf. “It will take some time—how much depends on the issue. The Democrats may want to hold hearings on legislation, or they may simply dust off legislation that was introduced last year.”

The Democrats are expected to move on many of the issues that SHM has been lobbying for. “They’ve said that they want to reform the healthcare system,” says Allendorf. “Top issues include providing coverage to the uninsured, reforming Medicare Part D, and resolving the physician payment issue.”

Allendorf believes that there will be a bipartisan effort to push through physician payment reform. “There are some 265 members of Congress who requested action on this issue this year [in 2006],” she points out. “There’s a genuine interest and desire to address physician payment reform and pay-for-performance as well. They may differ on how quickly they want to move on some of these.”

The news is not so good on the issue of gainsharing, where physicians are allowed to share the profits realized by a hospital’s cost reductions when linked to specific best practices. “Representative Nancy Johnson (R-Conn.) was a big proponent of this issue in the House, and she was not re-elected,” says Allendorf. “Stark is an opponent of gainsharing, so there may not be the same Congressional push behind it—at least in the House.”

However, the unexpected gainsharing demonstration projects approved in 2006 are underway, and Congress will hear reports on those in several years, once the projects have been analyzed.

Another issue that may not be addressed is liability. “Medical liability reform will be on the back burner,” warns Allendorf. “It’s generally not supported by the Democrats.”

In 2006, SHM supported increased funding for the Agency for Healthcare Research and Quality (AHRQ)—this was one of the major issues addressed by members during Legislative Advocacy Day during the Annual Meeting in Washington, D.C. Whether the next budget includes more money for the agency remains to be seen. “The Democrats support increased funding for NIH (National Institutes of Health), AHRQ, and other healthcare agencies,” says Allendorf. “There’s certainly political will, but where is the money going to come from?”

New Congress, New Issues

What about new issues? “Democrats have signaled that healthcare access for the uninsured will be a priority,” says Allendorf. “I think that we’ll see new legislation with a renewed emphasis on access to care.”

SHM’s Public Policy Committee will be waiting for the first legislation to be introduced regarding coverage for uninsured Americans. “This is an issue that SHM is strongly in favor of,” explains Allendorf. “SHM will look at any bills that come out on this issue and then form a policy.”

Regardless of which healthcare issues come to the forefront first, SHM’s Public Policy Committee, staff, and members are likely to be more active than ever. “I see a very busy year legislatively for SHM,” says Allendorf. TH

Jane Jerrard regularly writes “Public Policy” for The Hospitalist.

This year marks the 10-year anniversary of Robert Wachter’s coining of the term “hospitalist,” as well as the celebration of the decade-old SHM. The celebration culminates in a stellar annual meeting that epitomizes the growth of hospital medicine.

The SHM Annual Meeting attendance has grown from just a handful of participants to more than 1,200 expected at the 2007 Annual Meeting. More importantly, as the role of hospitalists has changed from primarily focusing on providing care to the hospitalized patient to serving as the leader of quality improvement, a key staff educator, and a facilitator of care transitions, so have their educational needs. Thus, the annual meeting has evolved in order to provide an educational experience that has relevance on a practical level.

The SHM 2007 Annual Meeting Committee (AMC), led by Course Director Chad Whelan, MD, challenged itself to develop a program that will meet the needs of a diverse audience that includes community-based and academic-based hospitalists; research-oriented and clinician-focused seasoned veteran physicians and early career hospitalists; as well as pediatric, geriatric, and family practice hospitalists. Such an effort begins with the big picture: What is happening in the environment that will impact healthcare today and in the future?

The answer is found in the role of information technology, and SHM will welcome two renowned speakers to provide current and future perspectives. David Brailer, MD, PhD, the first National Coordinator for Health Information Technology (2004-2006), will examine the forces driving health information technology and how technology affects pressures on the quality and cost of care. Jonathan Perlin, MD, PhD, chief medical officer and senior vice president for Quality for Hospital Corporation of America, will look to healthcare’s challenges and opportunities in the decade ahead, with a focus on health IT and performance and the role of hospital medicine as it relates to care improvement.

The 2007 Annual Meeting will again feature Robert Wachter, MD, as the keynote speaker in the closing plenary session. Dr. Wachter is sure to entertain as he examines “The Hospitalist Movement a Decade Later: Life as a Swiss Army Knife.”

The goal of a broad-based program will be achieved through separate breakout sessions and workshops, divided into seven tracks. Though the format is similar to other years, the 2007 program has some new twists. One clinical track focuses on “Things You Didn’t Learn in Medical School,” and a palliative care track has been added. Relevant sessions have been selected using the Core Competencies in Hospital Medicine and collaborating with SHM’s committees, which serve the interests of all of the groups.

The connection between the program and SHM’s committees will be strong. The committees will focus their efforts on topics and goals that are important to our members. The AMC solicits ideas for breakout sessions from the committees; it also profiles the output of a committee that has significance to attendees in their daily responsibilities.

click for large version

Suggestions from the committees have resulted in a combination of pertinent and innovative sessions. Here are just a few to whet your appetite for the complete program:

• A workshop jointly planned by the Hospital Quality and Patient Safety (HQPS) and Education Committees, designed to obtain input and consensus on SHM-developed communication and hand-off standards;
• An Academic Track, intended to appeal to those hospitalists focused on teaching, quality improvement, research, and growing a hospital medicine program;
• A workshop, proposed by the Career Satisfaction Task Force, that addresses relevant career issues from the leaders’ and hospitalists’ perspectives;
• A Quality Track defined by the HQPS Committee that, in addition to the consensus-building workshop, features medication reconciliation and Toyota Methods sessions;
• A Pediatric Track, designed to address the needs of our fastest growing member segment, features a range of clinical and leadership topics, including electronic health records, the prevention of the transmission of infectious agents, and the utilization of dashboards to improve care;
• The work of the Benchmarks Committee will be profiled in a session that will demonstrate how to use key performance metrics to improve hospital medicine and the care of the hospitalized patient;
• The Public Policy Committee has recommended a pay-for-performance (P4P) breakout session, because P4P has been identified as an important issue in hospital medicine;
• A Palliative Care Track, proposed and developed by the Palliative Care Task Force, includes relevant topics such as pain management, the ethical and legal considerations of palliative care, and communications skills; and
• A visiting professor, Stephan Fihn, MD, MPH, will conduct poster rounds, lead a workshop, and participate in “Breakfast with Leaders in Hospital Medicine.”

The Annual Meeting Committee focused on identifying faculty members who can share their experience and expertise in an entertaining and elucidating way. We anticipate that you will enjoy presentations by experts new to the SHM Annual Meeting, as well as return engagements by past faculty.

Letters

Correction

On p. 6 of the January 2007 issue the “Profile of Academic Hospitalists” contained errors inadvertently introduced in the editing process.

Line 4 of the table should read: “Clinical Full Time Equivalency—Academic Hospitalists .69, All Hospitalists .89.”

Line 8 of the table should read “Nurse Practitioners Per Group—Academic Hospitalists .82, All Hospitalists .43.”

The SHM Annual Meeting traditionally offers networking opportunities with more than 1,100 hospitalists. Special Interest Forums provide each attendee not only with a unique occasion to meet with hospitalists who share similar interests but also with the venue to express their opinions on a national level. SHM utilizes the input to change and grow the organization and hospital medicine. Planned Special Interest Forums include:

• Research;
• Community-based hospitalists;
• Pediatric hospitalists;
• Medical directors and leadership;
• Family practice hospitalists;
• Geriatric hospitalists;
• Nurse practitioners and physician assistants;
• Women in hospital medicine;
• Early career hospitalists;
• Education;
• Curriculum/fellowship;
• Public policy; and
• History of medicine.

Other networking mainstays of the Annual Meeting, including the Research, Innovations, and Clinical Vignettes Competition; Exhibits; President’s Lunch; and Town Meeting, will again be featured. Satellite symposia are planned, as well as the following pre-courses:

• Inpatient Coding and Documentation: Getting Paid What You Deserve;
• Best Practices in Managing a Hospital Medicine Program;
• Critical Care Medicine for the Hospitalist;
• Perioperative Medicine for the Hospitalist; and
• High Impact Quality Improvement: How to Ensure a Successful Project.

Additionally, a PICC Line Placement for Pediatric and Adult Hospitalists pre-course is being proposed by the Pediatrics Committee.

As you can see, 2007 Annual Meeting will present variety and choice; there is something for everyone. Don’t miss this premier educational event for hospitalists and the opportunity to be a part of the hospital medicine movement. The SHM 2007 Annual Meeting will be held at the Gaylord Texan Resort and Convention Center outside Dallas on May 24 and 25, with pre-courses held on May 23. Visit the SHM Web site at www.hospitalmedicine.org/hospitalmedicine2007 for complete program details or to register online. You may also register by calling SHM at (800) 843-3360. Come to Texas and help us celebrate 10 years of improving the quality of healthcare!

SHM: BEHIND THE SCENES

Resolutions

By Tina Budnitz, MPH

This is the time of year when many New Year’s resolutions dissolve. In some cases, people set unrealistic goals. Others lack the tools to succeed or live in an environment that makes change too difficult. In 2006 I resolved to start running each morning before work. I have the determination and the physical ability to meet this goal. Disarming the house alarm at 5 a.m., however, awakens my two toddlers. And detaching two toddlers from my legs proves to be quite a challenge. It also turns out that my tolerance for cold weather is low, while my ability to forgive a missed run is high.

Sustaining quality improvement initiatives at the hospital is lot like sustaining New Year’s resolutions. The best of intentions are often thwarted by a lack of time, resources, or energy to change the system, as well as by those within the system who resist change. For example, SHM members tell me that attempting to introduce a new discharge planning process feels a lot like trying to run through the hospital with two toddlers hanging on to your legs. SHM strives to support hospitalists in their resolutions to implement positive change in the hospital.

My role at SHM is to lead the development of programs, tool kits, and support mechanisms that will enable you, our members, to implement and sustain local quality improvement efforts.

SHM currently supports members in their efforts to improve outcomes for patients with heart failure, stroke, or diabetes; we work to prevent venous thromboembolism (VTE) and hospital-acquired blood-stream infections. We also support members in their efforts to improve the discharge process for older adults, thereby reducing readmission rates and adverse drug events while improving communications with receiving physicians.

We support members in their efforts to implement, evaluate, and sustain QI initiatives using a variety of methodologies. We offer symposia, workshops, and a full-day Annual Meeting Pre-Course on quality improvement; we also provide Leadership Academy Level I and Level II and networking opportunities for members and their mentors. We’ve designed Web-based clinical tool kits around specific disease states and special patient populations. We offer Web-based resource rooms to guide members from start to finish through a new local QI initiative. We have funded demonstration projects to pilot new approaches and tools for use in discharge planning, along with innovative research to improve care for heart failure patients. And we’ve only just begun.

Researching the Approach

For each QI area we address, an advisory board is recruited to represent the best available experts, organizations, and multidisciplinary professionals. For example, the Discharge Planning for Older Adults Advisory Board includes representatives from the American Geriatrics Society (AGS), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Society of General Internal Medicine (SGIM), the Case Management Society of America (CMSA), the National Quality Forum (NQF), and the Association for Health-System Pharmacists (AHSP), in addition to nationally renowned leaders in care transitions, geriatrics, nursing, patient literacy, and pharmacy.

Each Advisory Board conducts a needs assessment and a review of the literature to examine interventions and approaches. The board identifies existing “gaps” in clinical tools and guidelines. Finally, the Advisory Board determines specific, measurable targets for a hospitalist-led intervention and suggests the evidence-based approach(es) that should be most effective.

Implementing an Intervention: Where the Rubber Meets the Road

As I pointed out earlier, resolving what should be done and getting it done are two very different things. In most cases, few people debate the need for the intervention—reducing the incidence of inpatient VTEs, for example—or the validity of the proposed intervention. The challenge arises in changing the system of care so that the intervention becomes the new standard of care. Therefore, after the Advisory Board has determined the aims and intervention(s), SHM develops a “workbook,” a step-by-step field guide for hospitalists that walks them through the process of building a project team, establishing project aims and key metrics, obtaining institutional support, planning the intervention, launching the intervention, measuring impact, and sustaining system improvements.

The workbooks are posted in the SHM Resource Rooms along with other key resources, including slide sets, bedside teaching tools, patient education literature, CME modules, reviews of key literature, interactive “Ask the Expert” discussion boards, and improvement reports detailing the strategies, successes, and setbacks of other institutions. SHM currently offers resource rooms for Preventing VTE, Heart Failure, Stroke, Discharge Planning for the Elderly, Glycemic Control, and Antimicrobial Resistance. To access the resource rooms, visit our Web site at www.hospitalmedicine.org.

Training Leaders

SHM offers its members diverse training opportunities designed to accommodate the range of knowledge, expertise, and resources available at local institutions. The resource rooms and workbooks described above are made freely available to everyone. At the 2007 SHM Annual Meeting, we will offer a quality pre-course for hands-on training to lead a QI initiative for discharge planning, VTE prevention, or glycemic control.

For SHM members who desire additional support, SHM is developing “Mentored Implementation” and “On-Site Consulting” programs. The Mentored Implementation Program provides enrolled sites with all of the tools described above and an additional yearlong training program conducted via monthly conference calls with SHM mentors and/or one-day training programs. The On-Site Consulting Program surveys an institution’s resources and infrastructure. The SHM consultant team reviews the assessment with the site. Following this assessment, the consultant team visits the site to meet with hospital administrators, QI teams, and others to further assess the site and to help build internal support for the QI initiative. Following the visit, each site receives a customized report detailing recommendations and strategies to advance specific local QI initiatives.

SHM recently launched a Mentored Implementation and On-Site Consulting Program for VTE (known as the SHM VTE Collaborative). Similar programs are scheduled to launch for discharge planning this spring. In the coming years, we hope to add training programs in several other key patient safety areas.

Additionally, SHM is engaged in a strategic planning process to determine how best to attract the highest caliber medical students into hospital medicine and to mentor, train, and retain the next generation of leaders.

In summary, I hope the range of training opportunities and educational programs, the depth of SHM tool kits, and the scope of patient safety initiatives are meeting your needs to plan, implement, evaluate, and sustain positive change at your institution. If you are interested in learning more about SHM QI programs or have suggestions on how we might improve them to better meet your needs, please e-mail me at [email protected].

And, in case you were wondering, I’m making progress on my resolution to run. This year my resolution has the support of my department chairs (Jacob, five; Noah, two), with better-defined outcomes (run three times a week for more than 40 minutes each time), and a better tool kit (gloves, ear muffs). In the planning stage, I addressed my biggest barrier (leave the alarm off) and built a support team (my neighbor joins me).

If you see me at the annual meeting, please let me know how your resolutions are working to prevent DVT or to improve the discharge process, glycemic control, or heart failure care. Or better yet, submit those stories to me to share with members in our “Improvement Stories” or resource rooms Web site areas or in print via The Hospitalist or Journal of Hospital Medicine.

Budnitz is senior advisor, quality initiatives, for SHM.

This year marks the 10-year anniversary of Robert Wachter’s coining of the term “hospitalist,” as well as the celebration of the decade-old SHM. The celebration culminates in a stellar annual meeting that epitomizes the growth of hospital medicine.

The SHM Annual Meeting attendance has grown from just a handful of participants to more than 1,200 expected at the 2007 Annual Meeting. More importantly, as the role of hospitalists has changed from primarily focusing on providing care to the hospitalized patient to serving as the leader of quality improvement, a key staff educator, and a facilitator of care transitions, so have their educational needs. Thus, the annual meeting has evolved in order to provide an educational experience that has relevance on a practical level.

The SHM 2007 Annual Meeting Committee (AMC), led by Course Director Chad Whelan, MD, challenged itself to develop a program that will meet the needs of a diverse audience that includes community-based and academic-based hospitalists; research-oriented and clinician-focused seasoned veteran physicians and early career hospitalists; as well as pediatric, geriatric, and family practice hospitalists. Such an effort begins with the big picture: What is happening in the environment that will impact healthcare today and in the future?

The answer is found in the role of information technology, and SHM will welcome two renowned speakers to provide current and future perspectives. David Brailer, MD, PhD, the first National Coordinator for Health Information Technology (2004-2006), will examine the forces driving health information technology and how technology affects pressures on the quality and cost of care. Jonathan Perlin, MD, PhD, chief medical officer and senior vice president for Quality for Hospital Corporation of America, will look to healthcare’s challenges and opportunities in the decade ahead, with a focus on health IT and performance and the role of hospital medicine as it relates to care improvement.

The 2007 Annual Meeting will again feature Robert Wachter, MD, as the keynote speaker in the closing plenary session. Dr. Wachter is sure to entertain as he examines “The Hospitalist Movement a Decade Later: Life as a Swiss Army Knife.”

The goal of a broad-based program will be achieved through separate breakout sessions and workshops, divided into seven tracks. Though the format is similar to other years, the 2007 program has some new twists. One clinical track focuses on “Things You Didn’t Learn in Medical School,” and a palliative care track has been added. Relevant sessions have been selected using the Core Competencies in Hospital Medicine and collaborating with SHM’s committees, which serve the interests of all of the groups.

The connection between the program and SHM’s committees will be strong. The committees will focus their efforts on topics and goals that are important to our members. The AMC solicits ideas for breakout sessions from the committees; it also profiles the output of a committee that has significance to attendees in their daily responsibilities.

click for large version

Suggestions from the committees have resulted in a combination of pertinent and innovative sessions. Here are just a few to whet your appetite for the complete program:

• A workshop jointly planned by the Hospital Quality and Patient Safety (HQPS) and Education Committees, designed to obtain input and consensus on SHM-developed communication and hand-off standards;
• An Academic Track, intended to appeal to those hospitalists focused on teaching, quality improvement, research, and growing a hospital medicine program;
• A workshop, proposed by the Career Satisfaction Task Force, that addresses relevant career issues from the leaders’ and hospitalists’ perspectives;
• A Quality Track defined by the HQPS Committee that, in addition to the consensus-building workshop, features medication reconciliation and Toyota Methods sessions;
• A Pediatric Track, designed to address the needs of our fastest growing member segment, features a range of clinical and leadership topics, including electronic health records, the prevention of the transmission of infectious agents, and the utilization of dashboards to improve care;
• The work of the Benchmarks Committee will be profiled in a session that will demonstrate how to use key performance metrics to improve hospital medicine and the care of the hospitalized patient;
• The Public Policy Committee has recommended a pay-for-performance (P4P) breakout session, because P4P has been identified as an important issue in hospital medicine;
• A Palliative Care Track, proposed and developed by the Palliative Care Task Force, includes relevant topics such as pain management, the ethical and legal considerations of palliative care, and communications skills; and
• A visiting professor, Stephan Fihn, MD, MPH, will conduct poster rounds, lead a workshop, and participate in “Breakfast with Leaders in Hospital Medicine.”

The Annual Meeting Committee focused on identifying faculty members who can share their experience and expertise in an entertaining and elucidating way. We anticipate that you will enjoy presentations by experts new to the SHM Annual Meeting, as well as return engagements by past faculty.

Letters

Correction

On p. 6 of the January 2007 issue the “Profile of Academic Hospitalists” contained errors inadvertently introduced in the editing process.

Line 4 of the table should read: “Clinical Full Time Equivalency—Academic Hospitalists .69, All Hospitalists .89.”

Line 8 of the table should read “Nurse Practitioners Per Group—Academic Hospitalists .82, All Hospitalists .43.”

The SHM Annual Meeting traditionally offers networking opportunities with more than 1,100 hospitalists. Special Interest Forums provide each attendee not only with a unique occasion to meet with hospitalists who share similar interests but also with the venue to express their opinions on a national level. SHM utilizes the input to change and grow the organization and hospital medicine. Planned Special Interest Forums include:

• Research;
• Community-based hospitalists;
• Pediatric hospitalists;
• Medical directors and leadership;
• Family practice hospitalists;
• Geriatric hospitalists;
• Nurse practitioners and physician assistants;
• Women in hospital medicine;
• Early career hospitalists;
• Education;
• Curriculum/fellowship;
• Public policy; and
• History of medicine.

Other networking mainstays of the Annual Meeting, including the Research, Innovations, and Clinical Vignettes Competition; Exhibits; President’s Lunch; and Town Meeting, will again be featured. Satellite symposia are planned, as well as the following pre-courses:

• Inpatient Coding and Documentation: Getting Paid What You Deserve;
• Best Practices in Managing a Hospital Medicine Program;
• Critical Care Medicine for the Hospitalist;
• Perioperative Medicine for the Hospitalist; and
• High Impact Quality Improvement: How to Ensure a Successful Project.

Additionally, a PICC Line Placement for Pediatric and Adult Hospitalists pre-course is being proposed by the Pediatrics Committee.

As you can see, 2007 Annual Meeting will present variety and choice; there is something for everyone. Don’t miss this premier educational event for hospitalists and the opportunity to be a part of the hospital medicine movement. The SHM 2007 Annual Meeting will be held at the Gaylord Texan Resort and Convention Center outside Dallas on May 24 and 25, with pre-courses held on May 23. Visit the SHM Web site at www.hospitalmedicine.org/hospitalmedicine2007 for complete program details or to register online. You may also register by calling SHM at (800) 843-3360. Come to Texas and help us celebrate 10 years of improving the quality of healthcare!

SHM: BEHIND THE SCENES

Resolutions

By Tina Budnitz, MPH

This is the time of year when many New Year’s resolutions dissolve. In some cases, people set unrealistic goals. Others lack the tools to succeed or live in an environment that makes change too difficult. In 2006 I resolved to start running each morning before work. I have the determination and the physical ability to meet this goal. Disarming the house alarm at 5 a.m., however, awakens my two toddlers. And detaching two toddlers from my legs proves to be quite a challenge. It also turns out that my tolerance for cold weather is low, while my ability to forgive a missed run is high.

Sustaining quality improvement initiatives at the hospital is lot like sustaining New Year’s resolutions. The best of intentions are often thwarted by a lack of time, resources, or energy to change the system, as well as by those within the system who resist change. For example, SHM members tell me that attempting to introduce a new discharge planning process feels a lot like trying to run through the hospital with two toddlers hanging on to your legs. SHM strives to support hospitalists in their resolutions to implement positive change in the hospital.

My role at SHM is to lead the development of programs, tool kits, and support mechanisms that will enable you, our members, to implement and sustain local quality improvement efforts.

SHM currently supports members in their efforts to improve outcomes for patients with heart failure, stroke, or diabetes; we work to prevent venous thromboembolism (VTE) and hospital-acquired blood-stream infections. We also support members in their efforts to improve the discharge process for older adults, thereby reducing readmission rates and adverse drug events while improving communications with receiving physicians.

We support members in their efforts to implement, evaluate, and sustain QI initiatives using a variety of methodologies. We offer symposia, workshops, and a full-day Annual Meeting Pre-Course on quality improvement; we also provide Leadership Academy Level I and Level II and networking opportunities for members and their mentors. We’ve designed Web-based clinical tool kits around specific disease states and special patient populations. We offer Web-based resource rooms to guide members from start to finish through a new local QI initiative. We have funded demonstration projects to pilot new approaches and tools for use in discharge planning, along with innovative research to improve care for heart failure patients. And we’ve only just begun.

Researching the Approach

For each QI area we address, an advisory board is recruited to represent the best available experts, organizations, and multidisciplinary professionals. For example, the Discharge Planning for Older Adults Advisory Board includes representatives from the American Geriatrics Society (AGS), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Society of General Internal Medicine (SGIM), the Case Management Society of America (CMSA), the National Quality Forum (NQF), and the Association for Health-System Pharmacists (AHSP), in addition to nationally renowned leaders in care transitions, geriatrics, nursing, patient literacy, and pharmacy.

Each Advisory Board conducts a needs assessment and a review of the literature to examine interventions and approaches. The board identifies existing “gaps” in clinical tools and guidelines. Finally, the Advisory Board determines specific, measurable targets for a hospitalist-led intervention and suggests the evidence-based approach(es) that should be most effective.

Implementing an Intervention: Where the Rubber Meets the Road

As I pointed out earlier, resolving what should be done and getting it done are two very different things. In most cases, few people debate the need for the intervention—reducing the incidence of inpatient VTEs, for example—or the validity of the proposed intervention. The challenge arises in changing the system of care so that the intervention becomes the new standard of care. Therefore, after the Advisory Board has determined the aims and intervention(s), SHM develops a “workbook,” a step-by-step field guide for hospitalists that walks them through the process of building a project team, establishing project aims and key metrics, obtaining institutional support, planning the intervention, launching the intervention, measuring impact, and sustaining system improvements.

The workbooks are posted in the SHM Resource Rooms along with other key resources, including slide sets, bedside teaching tools, patient education literature, CME modules, reviews of key literature, interactive “Ask the Expert” discussion boards, and improvement reports detailing the strategies, successes, and setbacks of other institutions. SHM currently offers resource rooms for Preventing VTE, Heart Failure, Stroke, Discharge Planning for the Elderly, Glycemic Control, and Antimicrobial Resistance. To access the resource rooms, visit our Web site at www.hospitalmedicine.org.

Training Leaders

SHM offers its members diverse training opportunities designed to accommodate the range of knowledge, expertise, and resources available at local institutions. The resource rooms and workbooks described above are made freely available to everyone. At the 2007 SHM Annual Meeting, we will offer a quality pre-course for hands-on training to lead a QI initiative for discharge planning, VTE prevention, or glycemic control.

For SHM members who desire additional support, SHM is developing “Mentored Implementation” and “On-Site Consulting” programs. The Mentored Implementation Program provides enrolled sites with all of the tools described above and an additional yearlong training program conducted via monthly conference calls with SHM mentors and/or one-day training programs. The On-Site Consulting Program surveys an institution’s resources and infrastructure. The SHM consultant team reviews the assessment with the site. Following this assessment, the consultant team visits the site to meet with hospital administrators, QI teams, and others to further assess the site and to help build internal support for the QI initiative. Following the visit, each site receives a customized report detailing recommendations and strategies to advance specific local QI initiatives.

SHM recently launched a Mentored Implementation and On-Site Consulting Program for VTE (known as the SHM VTE Collaborative). Similar programs are scheduled to launch for discharge planning this spring. In the coming years, we hope to add training programs in several other key patient safety areas.

Additionally, SHM is engaged in a strategic planning process to determine how best to attract the highest caliber medical students into hospital medicine and to mentor, train, and retain the next generation of leaders.

In summary, I hope the range of training opportunities and educational programs, the depth of SHM tool kits, and the scope of patient safety initiatives are meeting your needs to plan, implement, evaluate, and sustain positive change at your institution. If you are interested in learning more about SHM QI programs or have suggestions on how we might improve them to better meet your needs, please e-mail me at [email protected].

And, in case you were wondering, I’m making progress on my resolution to run. This year my resolution has the support of my department chairs (Jacob, five; Noah, two), with better-defined outcomes (run three times a week for more than 40 minutes each time), and a better tool kit (gloves, ear muffs). In the planning stage, I addressed my biggest barrier (leave the alarm off) and built a support team (my neighbor joins me).

If you see me at the annual meeting, please let me know how your resolutions are working to prevent DVT or to improve the discharge process, glycemic control, or heart failure care. Or better yet, submit those stories to me to share with members in our “Improvement Stories” or resource rooms Web site areas or in print via The Hospitalist or Journal of Hospital Medicine.

Budnitz is senior advisor, quality initiatives, for SHM.

This year marks the 10-year anniversary of Robert Wachter’s coining of the term “hospitalist,” as well as the celebration of the decade-old SHM. The celebration culminates in a stellar annual meeting that epitomizes the growth of hospital medicine.

The SHM Annual Meeting attendance has grown from just a handful of participants to more than 1,200 expected at the 2007 Annual Meeting. More importantly, as the role of hospitalists has changed from primarily focusing on providing care to the hospitalized patient to serving as the leader of quality improvement, a key staff educator, and a facilitator of care transitions, so have their educational needs. Thus, the annual meeting has evolved in order to provide an educational experience that has relevance on a practical level.

The SHM 2007 Annual Meeting Committee (AMC), led by Course Director Chad Whelan, MD, challenged itself to develop a program that will meet the needs of a diverse audience that includes community-based and academic-based hospitalists; research-oriented and clinician-focused seasoned veteran physicians and early career hospitalists; as well as pediatric, geriatric, and family practice hospitalists. Such an effort begins with the big picture: What is happening in the environment that will impact healthcare today and in the future?

The answer is found in the role of information technology, and SHM will welcome two renowned speakers to provide current and future perspectives. David Brailer, MD, PhD, the first National Coordinator for Health Information Technology (2004-2006), will examine the forces driving health information technology and how technology affects pressures on the quality and cost of care. Jonathan Perlin, MD, PhD, chief medical officer and senior vice president for Quality for Hospital Corporation of America, will look to healthcare’s challenges and opportunities in the decade ahead, with a focus on health IT and performance and the role of hospital medicine as it relates to care improvement.

The 2007 Annual Meeting will again feature Robert Wachter, MD, as the keynote speaker in the closing plenary session. Dr. Wachter is sure to entertain as he examines “The Hospitalist Movement a Decade Later: Life as a Swiss Army Knife.”

The goal of a broad-based program will be achieved through separate breakout sessions and workshops, divided into seven tracks. Though the format is similar to other years, the 2007 program has some new twists. One clinical track focuses on “Things You Didn’t Learn in Medical School,” and a palliative care track has been added. Relevant sessions have been selected using the Core Competencies in Hospital Medicine and collaborating with SHM’s committees, which serve the interests of all of the groups.

The connection between the program and SHM’s committees will be strong. The committees will focus their efforts on topics and goals that are important to our members. The AMC solicits ideas for breakout sessions from the committees; it also profiles the output of a committee that has significance to attendees in their daily responsibilities.

click for large version

Suggestions from the committees have resulted in a combination of pertinent and innovative sessions. Here are just a few to whet your appetite for the complete program:

• A workshop jointly planned by the Hospital Quality and Patient Safety (HQPS) and Education Committees, designed to obtain input and consensus on SHM-developed communication and hand-off standards;
• An Academic Track, intended to appeal to those hospitalists focused on teaching, quality improvement, research, and growing a hospital medicine program;
• A workshop, proposed by the Career Satisfaction Task Force, that addresses relevant career issues from the leaders’ and hospitalists’ perspectives;
• A Quality Track defined by the HQPS Committee that, in addition to the consensus-building workshop, features medication reconciliation and Toyota Methods sessions;
• A Pediatric Track, designed to address the needs of our fastest growing member segment, features a range of clinical and leadership topics, including electronic health records, the prevention of the transmission of infectious agents, and the utilization of dashboards to improve care;
• The work of the Benchmarks Committee will be profiled in a session that will demonstrate how to use key performance metrics to improve hospital medicine and the care of the hospitalized patient;
• The Public Policy Committee has recommended a pay-for-performance (P4P) breakout session, because P4P has been identified as an important issue in hospital medicine;
• A Palliative Care Track, proposed and developed by the Palliative Care Task Force, includes relevant topics such as pain management, the ethical and legal considerations of palliative care, and communications skills; and
• A visiting professor, Stephan Fihn, MD, MPH, will conduct poster rounds, lead a workshop, and participate in “Breakfast with Leaders in Hospital Medicine.”

The Annual Meeting Committee focused on identifying faculty members who can share their experience and expertise in an entertaining and elucidating way. We anticipate that you will enjoy presentations by experts new to the SHM Annual Meeting, as well as return engagements by past faculty.

Letters

Correction

On p. 6 of the January 2007 issue the “Profile of Academic Hospitalists” contained errors inadvertently introduced in the editing process.

Line 4 of the table should read: “Clinical Full Time Equivalency—Academic Hospitalists .69, All Hospitalists .89.”

Line 8 of the table should read “Nurse Practitioners Per Group—Academic Hospitalists .82, All Hospitalists .43.”

The SHM Annual Meeting traditionally offers networking opportunities with more than 1,100 hospitalists. Special Interest Forums provide each attendee not only with a unique occasion to meet with hospitalists who share similar interests but also with the venue to express their opinions on a national level. SHM utilizes the input to change and grow the organization and hospital medicine. Planned Special Interest Forums include:

• Research;
• Community-based hospitalists;
• Pediatric hospitalists;
• Medical directors and leadership;
• Family practice hospitalists;
• Geriatric hospitalists;
• Nurse practitioners and physician assistants;
• Women in hospital medicine;
• Early career hospitalists;
• Education;
• Curriculum/fellowship;
• Public policy; and
• History of medicine.

Other networking mainstays of the Annual Meeting, including the Research, Innovations, and Clinical Vignettes Competition; Exhibits; President’s Lunch; and Town Meeting, will again be featured. Satellite symposia are planned, as well as the following pre-courses:

• Inpatient Coding and Documentation: Getting Paid What You Deserve;
• Best Practices in Managing a Hospital Medicine Program;
• Critical Care Medicine for the Hospitalist;
• Perioperative Medicine for the Hospitalist; and
• High Impact Quality Improvement: How to Ensure a Successful Project.

Additionally, a PICC Line Placement for Pediatric and Adult Hospitalists pre-course is being proposed by the Pediatrics Committee.

As you can see, 2007 Annual Meeting will present variety and choice; there is something for everyone. Don’t miss this premier educational event for hospitalists and the opportunity to be a part of the hospital medicine movement. The SHM 2007 Annual Meeting will be held at the Gaylord Texan Resort and Convention Center outside Dallas on May 24 and 25, with pre-courses held on May 23. Visit the SHM Web site at www.hospitalmedicine.org/hospitalmedicine2007 for complete program details or to register online. You may also register by calling SHM at (800) 843-3360. Come to Texas and help us celebrate 10 years of improving the quality of healthcare!

SHM: BEHIND THE SCENES

Resolutions

By Tina Budnitz, MPH

This is the time of year when many New Year’s resolutions dissolve. In some cases, people set unrealistic goals. Others lack the tools to succeed or live in an environment that makes change too difficult. In 2006 I resolved to start running each morning before work. I have the determination and the physical ability to meet this goal. Disarming the house alarm at 5 a.m., however, awakens my two toddlers. And detaching two toddlers from my legs proves to be quite a challenge. It also turns out that my tolerance for cold weather is low, while my ability to forgive a missed run is high.

Sustaining quality improvement initiatives at the hospital is lot like sustaining New Year’s resolutions. The best of intentions are often thwarted by a lack of time, resources, or energy to change the system, as well as by those within the system who resist change. For example, SHM members tell me that attempting to introduce a new discharge planning process feels a lot like trying to run through the hospital with two toddlers hanging on to your legs. SHM strives to support hospitalists in their resolutions to implement positive change in the hospital.

My role at SHM is to lead the development of programs, tool kits, and support mechanisms that will enable you, our members, to implement and sustain local quality improvement efforts.

SHM currently supports members in their efforts to improve outcomes for patients with heart failure, stroke, or diabetes; we work to prevent venous thromboembolism (VTE) and hospital-acquired blood-stream infections. We also support members in their efforts to improve the discharge process for older adults, thereby reducing readmission rates and adverse drug events while improving communications with receiving physicians.

We support members in their efforts to implement, evaluate, and sustain QI initiatives using a variety of methodologies. We offer symposia, workshops, and a full-day Annual Meeting Pre-Course on quality improvement; we also provide Leadership Academy Level I and Level II and networking opportunities for members and their mentors. We’ve designed Web-based clinical tool kits around specific disease states and special patient populations. We offer Web-based resource rooms to guide members from start to finish through a new local QI initiative. We have funded demonstration projects to pilot new approaches and tools for use in discharge planning, along with innovative research to improve care for heart failure patients. And we’ve only just begun.

Researching the Approach

For each QI area we address, an advisory board is recruited to represent the best available experts, organizations, and multidisciplinary professionals. For example, the Discharge Planning for Older Adults Advisory Board includes representatives from the American Geriatrics Society (AGS), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Society of General Internal Medicine (SGIM), the Case Management Society of America (CMSA), the National Quality Forum (NQF), and the Association for Health-System Pharmacists (AHSP), in addition to nationally renowned leaders in care transitions, geriatrics, nursing, patient literacy, and pharmacy.

Each Advisory Board conducts a needs assessment and a review of the literature to examine interventions and approaches. The board identifies existing “gaps” in clinical tools and guidelines. Finally, the Advisory Board determines specific, measurable targets for a hospitalist-led intervention and suggests the evidence-based approach(es) that should be most effective.

Implementing an Intervention: Where the Rubber Meets the Road

As I pointed out earlier, resolving what should be done and getting it done are two very different things. In most cases, few people debate the need for the intervention—reducing the incidence of inpatient VTEs, for example—or the validity of the proposed intervention. The challenge arises in changing the system of care so that the intervention becomes the new standard of care. Therefore, after the Advisory Board has determined the aims and intervention(s), SHM develops a “workbook,” a step-by-step field guide for hospitalists that walks them through the process of building a project team, establishing project aims and key metrics, obtaining institutional support, planning the intervention, launching the intervention, measuring impact, and sustaining system improvements.

The workbooks are posted in the SHM Resource Rooms along with other key resources, including slide sets, bedside teaching tools, patient education literature, CME modules, reviews of key literature, interactive “Ask the Expert” discussion boards, and improvement reports detailing the strategies, successes, and setbacks of other institutions. SHM currently offers resource rooms for Preventing VTE, Heart Failure, Stroke, Discharge Planning for the Elderly, Glycemic Control, and Antimicrobial Resistance. To access the resource rooms, visit our Web site at www.hospitalmedicine.org.

Training Leaders

SHM offers its members diverse training opportunities designed to accommodate the range of knowledge, expertise, and resources available at local institutions. The resource rooms and workbooks described above are made freely available to everyone. At the 2007 SHM Annual Meeting, we will offer a quality pre-course for hands-on training to lead a QI initiative for discharge planning, VTE prevention, or glycemic control.

For SHM members who desire additional support, SHM is developing “Mentored Implementation” and “On-Site Consulting” programs. The Mentored Implementation Program provides enrolled sites with all of the tools described above and an additional yearlong training program conducted via monthly conference calls with SHM mentors and/or one-day training programs. The On-Site Consulting Program surveys an institution’s resources and infrastructure. The SHM consultant team reviews the assessment with the site. Following this assessment, the consultant team visits the site to meet with hospital administrators, QI teams, and others to further assess the site and to help build internal support for the QI initiative. Following the visit, each site receives a customized report detailing recommendations and strategies to advance specific local QI initiatives.

SHM recently launched a Mentored Implementation and On-Site Consulting Program for VTE (known as the SHM VTE Collaborative). Similar programs are scheduled to launch for discharge planning this spring. In the coming years, we hope to add training programs in several other key patient safety areas.

Additionally, SHM is engaged in a strategic planning process to determine how best to attract the highest caliber medical students into hospital medicine and to mentor, train, and retain the next generation of leaders.

In summary, I hope the range of training opportunities and educational programs, the depth of SHM tool kits, and the scope of patient safety initiatives are meeting your needs to plan, implement, evaluate, and sustain positive change at your institution. If you are interested in learning more about SHM QI programs or have suggestions on how we might improve them to better meet your needs, please e-mail me at [email protected].

And, in case you were wondering, I’m making progress on my resolution to run. This year my resolution has the support of my department chairs (Jacob, five; Noah, two), with better-defined outcomes (run three times a week for more than 40 minutes each time), and a better tool kit (gloves, ear muffs). In the planning stage, I addressed my biggest barrier (leave the alarm off) and built a support team (my neighbor joins me).

If you see me at the annual meeting, please let me know how your resolutions are working to prevent DVT or to improve the discharge process, glycemic control, or heart failure care. Or better yet, submit those stories to me to share with members in our “Improvement Stories” or resource rooms Web site areas or in print via The Hospitalist or Journal of Hospital Medicine.

Budnitz is senior advisor, quality initiatives, for SHM.

We need not be afraid of the future, for the future will be in our own hands.

—Thomas E. Dewey

Your SHM board recently spent some time on the most comprehensive strategic planning that we have undertaken. Our last strategic planning meeting was almost three years ago. It is reassuring to review those minutes and see that we have accomplished a number of things that we set out to do. We have:

• Enhanced our chapters by making more resources and staff assistance available to them;
• Expanded our leadership training offerings;
• Established relationships with other organizations, such as the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations, the Society of Critical Care Medicine, and many others; and
• Explored a credential for the hospitalist that distinguishes our work from other practitioners.

Planning to Plan

In these exciting times, however, we decided it was important to stop and take stock to either confirm that we are on the right track or adjust our direction. To prepare for the meeting, we hired an outside facilitator. We invited all board members and our staff from Philadelphia. Our staff has grown from several people to more than 20. They are a diverse group with a tremendous amount of talent. Their perspective and input remain crucial to our success.

We included some of our key committee chairs as well. These individuals have regular contact with other agencies, our members, and their employees. We surveyed our membership and hospitalist leaders to determine their perspective on the dilemmas that they face. We interviewed 13 “futurists” to obtain their opinions about key trends that will affect hospitalists, including:

• The current environment for hospitalists;
• The implications of future trends in patient populations;
• The regulatory and political environment;
• The competitive forces; and
• Advancements in science, technology, and pharmaceuticals.

Bang for the Buck

The SHM board, when surveyed, expressed a strong interest in better understanding SHM’s customer groups, what they value, and what we can offer to them. We conduct many activities and support many projects through our staff, our volunteer leadership, and our members. We need to know if we are spending our resources in a way that optimizes our impact on our members and our field. Each participant spent two to three hours reviewing materials in preparation for the meeting.

When we gathered for two days, our facilitator worked us hard. We began by reviewing what we are doing and checking that against the needs and directions identified by our members and others. We then attempted to prioritize new initiatives so that we could focus on “bang for the buck.”

As we continued the process of refining our findings and designing our action plans, a few things become apparent. Among them:

• There is and will continue to be a shortage of qualified hospitalists;
• The demands of an aging population, in conjunction with the expectations of healthcare givers, will be a source of pressure;
• It will take more time to deliver care to our incoming group of patients than it did for their grandparents;
• The technology and options that are available continue to expand, as does the need to stay abreast of ongoing changes; and
• There will be more medical information to absorb and more to communicate and organize.

As this pressure increases, the facilities’ search for solutions to the impact on cost will increase. In addition, the transparency of hospital results, as well as pay for performance, will drive a desire to improve quality results. The process improvement changes that will be needed cannot be accomplished without a committed medical staff. Hospitalists are uniquely positioned to take on this role. Thus, the demands on hospitalists for participation and leadership will increase.

Labor Shortage a Key Issue

It appears from our membership survey that the labor shortage is a key worry. Because we have no control over demand and we expect demand to increase, we will need to be creative about impacting supply. SHM may be able to address this issue. One approach is to increase supply in the following ways:

1. Design programs that attract individuals who want to be hospitalists into the primary residencies for hospitalists: internal medicine, pediatrics, and family medicine.

An example:

• Influencing training programs and educators to develop positive experiences for residents.

2. Create a model that includes nursing and physician assistants, as well as others, who can extend physicians’ capabilities

Another approach is to improve retention, a goal that might be accomplished by:

• Educating hospitals on their roles in creating a good working environment with excellent support systems for their hospitalists;
• Training group leaders to manage their programs for success;
• Creating alternative delivery models that enhance the physician lifestyle and practice experience; and
• Training individuals to matching their career goals with the right program.

Leadership Gap

Our members and their leaders seem to feel adequately prepared for clinical decision-making to deliver high quality care, but they see a gap when it comes to how they are equipped to provide leadership in a number of areas. These areas include transitions and coordination of care, resource utilization, and collaboration with multidisciplinary teams. SHM can respond to this need with training and mentoring. Perhaps we can also influence training programs and their curriculum.

Caring for the Uninsured

As many of you experience, hospitalists are increasingly called on to provide care for those without funds. When caring for the uninsured, physicians experience special challenges that create job dissatisfaction and affect the sustainability of the practice. In many cases, hospitals are willing to pay for this care because they are required by government regulation to provide it. As they see their profit margins erode, however, they are reluctant to compensate this work. It is important for SHM to be positioned to participate in these discussions as the payment and care of the uninsured gets increasing attention. Our public policy committee will continue to try to identify our best opportunities to impact this issue. How their mission will change is unclear, but this issue continues to be identified by our members as an important one.

This article only touches briefly on the many topics that SHM continues to explore as we try to see the future and take it into our hands. TH

Dr. Gorman is the president of SHM.

We need not be afraid of the future, for the future will be in our own hands.

—Thomas E. Dewey

Your SHM board recently spent some time on the most comprehensive strategic planning that we have undertaken. Our last strategic planning meeting was almost three years ago. It is reassuring to review those minutes and see that we have accomplished a number of things that we set out to do. We have:

• Enhanced our chapters by making more resources and staff assistance available to them;
• Expanded our leadership training offerings;
• Established relationships with other organizations, such as the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations, the Society of Critical Care Medicine, and many others; and
• Explored a credential for the hospitalist that distinguishes our work from other practitioners.

Planning to Plan

In these exciting times, however, we decided it was important to stop and take stock to either confirm that we are on the right track or adjust our direction. To prepare for the meeting, we hired an outside facilitator. We invited all board members and our staff from Philadelphia. Our staff has grown from several people to more than 20. They are a diverse group with a tremendous amount of talent. Their perspective and input remain crucial to our success.

We included some of our key committee chairs as well. These individuals have regular contact with other agencies, our members, and their employees. We surveyed our membership and hospitalist leaders to determine their perspective on the dilemmas that they face. We interviewed 13 “futurists” to obtain their opinions about key trends that will affect hospitalists, including:

• The current environment for hospitalists;
• The implications of future trends in patient populations;
• The regulatory and political environment;
• The competitive forces; and
• Advancements in science, technology, and pharmaceuticals.

Bang for the Buck

The SHM board, when surveyed, expressed a strong interest in better understanding SHM’s customer groups, what they value, and what we can offer to them. We conduct many activities and support many projects through our staff, our volunteer leadership, and our members. We need to know if we are spending our resources in a way that optimizes our impact on our members and our field. Each participant spent two to three hours reviewing materials in preparation for the meeting.

When we gathered for two days, our facilitator worked us hard. We began by reviewing what we are doing and checking that against the needs and directions identified by our members and others. We then attempted to prioritize new initiatives so that we could focus on “bang for the buck.”

As we continued the process of refining our findings and designing our action plans, a few things become apparent. Among them:

• There is and will continue to be a shortage of qualified hospitalists;
• The demands of an aging population, in conjunction with the expectations of healthcare givers, will be a source of pressure;
• It will take more time to deliver care to our incoming group of patients than it did for their grandparents;
• The technology and options that are available continue to expand, as does the need to stay abreast of ongoing changes; and
• There will be more medical information to absorb and more to communicate and organize.

As this pressure increases, the facilities’ search for solutions to the impact on cost will increase. In addition, the transparency of hospital results, as well as pay for performance, will drive a desire to improve quality results. The process improvement changes that will be needed cannot be accomplished without a committed medical staff. Hospitalists are uniquely positioned to take on this role. Thus, the demands on hospitalists for participation and leadership will increase.

Labor Shortage a Key Issue

It appears from our membership survey that the labor shortage is a key worry. Because we have no control over demand and we expect demand to increase, we will need to be creative about impacting supply. SHM may be able to address this issue. One approach is to increase supply in the following ways:

1. Design programs that attract individuals who want to be hospitalists into the primary residencies for hospitalists: internal medicine, pediatrics, and family medicine.

An example:

• Influencing training programs and educators to develop positive experiences for residents.

2. Create a model that includes nursing and physician assistants, as well as others, who can extend physicians’ capabilities

Another approach is to improve retention, a goal that might be accomplished by:

• Educating hospitals on their roles in creating a good working environment with excellent support systems for their hospitalists;
• Training group leaders to manage their programs for success;
• Creating alternative delivery models that enhance the physician lifestyle and practice experience; and
• Training individuals to matching their career goals with the right program.

Leadership Gap

Our members and their leaders seem to feel adequately prepared for clinical decision-making to deliver high quality care, but they see a gap when it comes to how they are equipped to provide leadership in a number of areas. These areas include transitions and coordination of care, resource utilization, and collaboration with multidisciplinary teams. SHM can respond to this need with training and mentoring. Perhaps we can also influence training programs and their curriculum.

Caring for the Uninsured

As many of you experience, hospitalists are increasingly called on to provide care for those without funds. When caring for the uninsured, physicians experience special challenges that create job dissatisfaction and affect the sustainability of the practice. In many cases, hospitals are willing to pay for this care because they are required by government regulation to provide it. As they see their profit margins erode, however, they are reluctant to compensate this work. It is important for SHM to be positioned to participate in these discussions as the payment and care of the uninsured gets increasing attention. Our public policy committee will continue to try to identify our best opportunities to impact this issue. How their mission will change is unclear, but this issue continues to be identified by our members as an important one.

This article only touches briefly on the many topics that SHM continues to explore as we try to see the future and take it into our hands. TH

Dr. Gorman is the president of SHM.

We need not be afraid of the future, for the future will be in our own hands.

—Thomas E. Dewey

Your SHM board recently spent some time on the most comprehensive strategic planning that we have undertaken. Our last strategic planning meeting was almost three years ago. It is reassuring to review those minutes and see that we have accomplished a number of things that we set out to do. We have:

• Enhanced our chapters by making more resources and staff assistance available to them;
• Expanded our leadership training offerings;
• Established relationships with other organizations, such as the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations, the Society of Critical Care Medicine, and many others; and
• Explored a credential for the hospitalist that distinguishes our work from other practitioners.

Planning to Plan

In these exciting times, however, we decided it was important to stop and take stock to either confirm that we are on the right track or adjust our direction. To prepare for the meeting, we hired an outside facilitator. We invited all board members and our staff from Philadelphia. Our staff has grown from several people to more than 20. They are a diverse group with a tremendous amount of talent. Their perspective and input remain crucial to our success.

We included some of our key committee chairs as well. These individuals have regular contact with other agencies, our members, and their employees. We surveyed our membership and hospitalist leaders to determine their perspective on the dilemmas that they face. We interviewed 13 “futurists” to obtain their opinions about key trends that will affect hospitalists, including:

• The current environment for hospitalists;
• The implications of future trends in patient populations;
• The regulatory and political environment;
• The competitive forces; and
• Advancements in science, technology, and pharmaceuticals.

Bang for the Buck

The SHM board, when surveyed, expressed a strong interest in better understanding SHM’s customer groups, what they value, and what we can offer to them. We conduct many activities and support many projects through our staff, our volunteer leadership, and our members. We need to know if we are spending our resources in a way that optimizes our impact on our members and our field. Each participant spent two to three hours reviewing materials in preparation for the meeting.

When we gathered for two days, our facilitator worked us hard. We began by reviewing what we are doing and checking that against the needs and directions identified by our members and others. We then attempted to prioritize new initiatives so that we could focus on “bang for the buck.”

As we continued the process of refining our findings and designing our action plans, a few things become apparent. Among them:

• There is and will continue to be a shortage of qualified hospitalists;
• The demands of an aging population, in conjunction with the expectations of healthcare givers, will be a source of pressure;
• It will take more time to deliver care to our incoming group of patients than it did for their grandparents;
• The technology and options that are available continue to expand, as does the need to stay abreast of ongoing changes; and
• There will be more medical information to absorb and more to communicate and organize.

As this pressure increases, the facilities’ search for solutions to the impact on cost will increase. In addition, the transparency of hospital results, as well as pay for performance, will drive a desire to improve quality results. The process improvement changes that will be needed cannot be accomplished without a committed medical staff. Hospitalists are uniquely positioned to take on this role. Thus, the demands on hospitalists for participation and leadership will increase.

Labor Shortage a Key Issue

It appears from our membership survey that the labor shortage is a key worry. Because we have no control over demand and we expect demand to increase, we will need to be creative about impacting supply. SHM may be able to address this issue. One approach is to increase supply in the following ways:

1. Design programs that attract individuals who want to be hospitalists into the primary residencies for hospitalists: internal medicine, pediatrics, and family medicine.

An example:

• Influencing training programs and educators to develop positive experiences for residents.

2. Create a model that includes nursing and physician assistants, as well as others, who can extend physicians’ capabilities

Another approach is to improve retention, a goal that might be accomplished by:

• Educating hospitals on their roles in creating a good working environment with excellent support systems for their hospitalists;
• Training group leaders to manage their programs for success;
• Creating alternative delivery models that enhance the physician lifestyle and practice experience; and
• Training individuals to matching their career goals with the right program.

Leadership Gap

Our members and their leaders seem to feel adequately prepared for clinical decision-making to deliver high quality care, but they see a gap when it comes to how they are equipped to provide leadership in a number of areas. These areas include transitions and coordination of care, resource utilization, and collaboration with multidisciplinary teams. SHM can respond to this need with training and mentoring. Perhaps we can also influence training programs and their curriculum.

Caring for the Uninsured

As many of you experience, hospitalists are increasingly called on to provide care for those without funds. When caring for the uninsured, physicians experience special challenges that create job dissatisfaction and affect the sustainability of the practice. In many cases, hospitals are willing to pay for this care because they are required by government regulation to provide it. As they see their profit margins erode, however, they are reluctant to compensate this work. It is important for SHM to be positioned to participate in these discussions as the payment and care of the uninsured gets increasing attention. Our public policy committee will continue to try to identify our best opportunities to impact this issue. How their mission will change is unclear, but this issue continues to be identified by our members as an important one.

This article only touches briefly on the many topics that SHM continues to explore as we try to see the future and take it into our hands. TH

Dr. Gorman is the president of SHM.

Hospitalists Prone to Evidence-Based Treatments

Researchers from Harvard Medical School (Boston) and other institutions surveyed 213 pediatric hospitalists and a random sample of 352 community pediatricians. They found that, overall, the hospitalist group showed greater adherence to evidence-based therapies and tests for common pediatric illnesses in hospitalized patients, and relied less on those therapies and tests of unproven benefits.

Hourly Rounding Pays Off

According to a study by the Studer Group (Gulf Breeze, Fl.) and the Alliance for Health Care Research, having nurses round every hour results in an average 8.9-point increase in patient satisfaction, a 50% decrease in patient falls, a reduction in the use of call lights, and an undocumented improvement in clinical outcomes.

SHM Makes Acute Heart Failure a High Priority

SHM, supported in part by funding from Scios, Inc., will undertake a major outreach campaign on quality improvement related to acute heart failure. These initiatives will focus on the “front end” of the acutely decompensated heart failure patient admission, beginning with early diagnosis and aggressive treatment and intervention including emergency department and observation unit care to optimize outcomes.

“Hospitalists manage a significant number of heart failure patients across the hospital continuum,” says Larry Wellikson, MD, CEO of SHM. “Our goal is to improve heart failure care by disseminating the necessary tools and knowledge to hospitalists.”

Google as Diagnostic Tool

The popular Web site Google (Mountain View, Calif.) can help physicians with diagnoses, according to researchers from Princess Alexandria Hospital in Brisbane, Australia. The team “googled” symptoms of 26 mystery cases, and a Web search resulted in a correct diagnosis for 15 of them. The researchers call Google a useful aid for physicians.

SHM Participates in IHI Campaign

When the Institute for Healthcare Improvement (IHI) introduced its “5 Million Lives” campaign recently, SHM was one of the few organizations asked to speak about their part in the campaign.

“We are ready … and could not be more enthusiastic about participating in this landmark campaign,” said Russell Holman, M.D., SHM’s president-elect.

A Winning Team Reaps Rewards

Caritas Good Samaritan Medical Center in Brockton, Mass., and hospital medicine provider Cogent Healthcare (Irvine, Calif.) collaborated to achieve quality of care goals that earned the facility pay-for-performance bonuses from major commercial payers. Cogent used best practices that also helped reduce length of stay and unnecessary re-admissions, and improve patient and physician satisfaction.

A Prevalence of Persistent Pain

The “Health United States 2006” report issued by the National Center for Health Statistics (Hyattsville, Md.) finds a prevalence of pain in the U.S. One in four adults reported a daylong bout of pain in the last month, and one in 10 say they’ve suffered pain for at least a year.

Palliative Medicine Now Official Subspecialty

The American Board of Medical Specialties (ABMS) will establish a subspecialty certificate in Hospice and Palliative Medicine. “[This certification] affirms the concept that specialized knowledge and skills must be learned to care for the increasingly complex-care needs of the dying and their families,” says David Weissman, MD, FACP, editor-in-chief of the Journal of Palliative Medicine.

Busy Shifts Put Elderly Admissions at Risk

Older patients admitted during busy hospital shifts may have a greater mortality rate, according to a study by the University of California San Francisco’s Moffitt-Long Hospital. The retrospective cohort analysis included 5,742 adults admitted to the general medicine service and intensive care unit without cardiovascular, neurologic, or cancer- related primary diagnoses. TH

Hospitalists Prone to Evidence-Based Treatments

Researchers from Harvard Medical School (Boston) and other institutions surveyed 213 pediatric hospitalists and a random sample of 352 community pediatricians. They found that, overall, the hospitalist group showed greater adherence to evidence-based therapies and tests for common pediatric illnesses in hospitalized patients, and relied less on those therapies and tests of unproven benefits.

Hourly Rounding Pays Off

According to a study by the Studer Group (Gulf Breeze, Fl.) and the Alliance for Health Care Research, having nurses round every hour results in an average 8.9-point increase in patient satisfaction, a 50% decrease in patient falls, a reduction in the use of call lights, and an undocumented improvement in clinical outcomes.

SHM Makes Acute Heart Failure a High Priority

SHM, supported in part by funding from Scios, Inc., will undertake a major outreach campaign on quality improvement related to acute heart failure. These initiatives will focus on the “front end” of the acutely decompensated heart failure patient admission, beginning with early diagnosis and aggressive treatment and intervention including emergency department and observation unit care to optimize outcomes.

“Hospitalists manage a significant number of heart failure patients across the hospital continuum,” says Larry Wellikson, MD, CEO of SHM. “Our goal is to improve heart failure care by disseminating the necessary tools and knowledge to hospitalists.”

Google as Diagnostic Tool

The popular Web site Google (Mountain View, Calif.) can help physicians with diagnoses, according to researchers from Princess Alexandria Hospital in Brisbane, Australia. The team “googled” symptoms of 26 mystery cases, and a Web search resulted in a correct diagnosis for 15 of them. The researchers call Google a useful aid for physicians.

SHM Participates in IHI Campaign

When the Institute for Healthcare Improvement (IHI) introduced its “5 Million Lives” campaign recently, SHM was one of the few organizations asked to speak about their part in the campaign.

“We are ready … and could not be more enthusiastic about participating in this landmark campaign,” said Russell Holman, M.D., SHM’s president-elect.

A Winning Team Reaps Rewards

Caritas Good Samaritan Medical Center in Brockton, Mass., and hospital medicine provider Cogent Healthcare (Irvine, Calif.) collaborated to achieve quality of care goals that earned the facility pay-for-performance bonuses from major commercial payers. Cogent used best practices that also helped reduce length of stay and unnecessary re-admissions, and improve patient and physician satisfaction.

A Prevalence of Persistent Pain

The “Health United States 2006” report issued by the National Center for Health Statistics (Hyattsville, Md.) finds a prevalence of pain in the U.S. One in four adults reported a daylong bout of pain in the last month, and one in 10 say they’ve suffered pain for at least a year.

Palliative Medicine Now Official Subspecialty

The American Board of Medical Specialties (ABMS) will establish a subspecialty certificate in Hospice and Palliative Medicine. “[This certification] affirms the concept that specialized knowledge and skills must be learned to care for the increasingly complex-care needs of the dying and their families,” says David Weissman, MD, FACP, editor-in-chief of the Journal of Palliative Medicine.

Busy Shifts Put Elderly Admissions at Risk

Older patients admitted during busy hospital shifts may have a greater mortality rate, according to a study by the University of California San Francisco’s Moffitt-Long Hospital. The retrospective cohort analysis included 5,742 adults admitted to the general medicine service and intensive care unit without cardiovascular, neurologic, or cancer- related primary diagnoses. TH

Hospitalists Prone to Evidence-Based Treatments

Researchers from Harvard Medical School (Boston) and other institutions surveyed 213 pediatric hospitalists and a random sample of 352 community pediatricians. They found that, overall, the hospitalist group showed greater adherence to evidence-based therapies and tests for common pediatric illnesses in hospitalized patients, and relied less on those therapies and tests of unproven benefits.

Hourly Rounding Pays Off

According to a study by the Studer Group (Gulf Breeze, Fl.) and the Alliance for Health Care Research, having nurses round every hour results in an average 8.9-point increase in patient satisfaction, a 50% decrease in patient falls, a reduction in the use of call lights, and an undocumented improvement in clinical outcomes.

SHM Makes Acute Heart Failure a High Priority

SHM, supported in part by funding from Scios, Inc., will undertake a major outreach campaign on quality improvement related to acute heart failure. These initiatives will focus on the “front end” of the acutely decompensated heart failure patient admission, beginning with early diagnosis and aggressive treatment and intervention including emergency department and observation unit care to optimize outcomes.

“Hospitalists manage a significant number of heart failure patients across the hospital continuum,” says Larry Wellikson, MD, CEO of SHM. “Our goal is to improve heart failure care by disseminating the necessary tools and knowledge to hospitalists.”

Google as Diagnostic Tool

The popular Web site Google (Mountain View, Calif.) can help physicians with diagnoses, according to researchers from Princess Alexandria Hospital in Brisbane, Australia. The team “googled” symptoms of 26 mystery cases, and a Web search resulted in a correct diagnosis for 15 of them. The researchers call Google a useful aid for physicians.

SHM Participates in IHI Campaign

When the Institute for Healthcare Improvement (IHI) introduced its “5 Million Lives” campaign recently, SHM was one of the few organizations asked to speak about their part in the campaign.

“We are ready … and could not be more enthusiastic about participating in this landmark campaign,” said Russell Holman, M.D., SHM’s president-elect.

A Winning Team Reaps Rewards

Caritas Good Samaritan Medical Center in Brockton, Mass., and hospital medicine provider Cogent Healthcare (Irvine, Calif.) collaborated to achieve quality of care goals that earned the facility pay-for-performance bonuses from major commercial payers. Cogent used best practices that also helped reduce length of stay and unnecessary re-admissions, and improve patient and physician satisfaction.

A Prevalence of Persistent Pain

The “Health United States 2006” report issued by the National Center for Health Statistics (Hyattsville, Md.) finds a prevalence of pain in the U.S. One in four adults reported a daylong bout of pain in the last month, and one in 10 say they’ve suffered pain for at least a year.

Palliative Medicine Now Official Subspecialty

The American Board of Medical Specialties (ABMS) will establish a subspecialty certificate in Hospice and Palliative Medicine. “[This certification] affirms the concept that specialized knowledge and skills must be learned to care for the increasingly complex-care needs of the dying and their families,” says David Weissman, MD, FACP, editor-in-chief of the Journal of Palliative Medicine.

Busy Shifts Put Elderly Admissions at Risk

Older patients admitted during busy hospital shifts may have a greater mortality rate, according to a study by the University of California San Francisco’s Moffitt-Long Hospital. The retrospective cohort analysis included 5,742 adults admitted to the general medicine service and intensive care unit without cardiovascular, neurologic, or cancer- related primary diagnoses. TH

Supplement Editor:
Marc S. Penn, MD, PhD

Contents

Introduction
Heart-brain medicine: Where we go from here and why
Marc S. Penn, MD, PhD, Cleveland Clinic, Cleveland, Ohio, and Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Opening remarks
The dream behind the summit
Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Keynote address
'Voodoo' death revisited: The modern lessons of neurocardiology
Martin A. Samuels, MD, DSc (hon), Brigham and Women's Hospital, Boston, Massachusetts

The broken heart syndrome
Ilan S. Wittstein, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland

Brain imaging in cardiovascular disease: State of the art
Michael Phillips, MD, Cleveland Clinic, Cleveland, Ohio

Cortical control of the heart
Stephen Oppenheimer, MD, PhD, Sentient Medical Systems, Cockeysville, Maryland

Neurological mechanisms of chest pain and cardiac disease
Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Hypertension in sleep apnea: The role of the sympathetic pathway
Diana L. Kunze, PhD; David Kline, PhD; and Angelina Ramirez-Navarro, PhD, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio

Inflammation: Implications for understanding the heart-brain connection
Mehdi H. Shishehbor, DO; Carlos Alves, MD; and Vivek Rajagopal, MD, Cleveland Clinic, Cleveland, Ohio

The anti-ischemic effects of electrical neurostimulation in the heart
Jessica de Vries, MD, University of Groningen, The Netherlands; Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Mike J.L.  DeJongste, MD, PhD, University of Groningen, The Netherlands

The little brain on the heart
J. Andrew Armour, MD, PhD, Hôpital du Sacré-Coeur and Université de Montréal, Montréal, Québec, Canada

Open heart surgery and cognitive decline
Mark F. Newman, MD, Duke University Medical Center, Durham, North Carolina

The heart and the brain within the broader context of wellness
Michael O’Donnell, PhD, MBA, MPH, Cleveland Clinic, Cleveland, Ohio

The heart-brain interaction during emotionally provoked myocardial ischemia: Implications of cortical hyperactivation in CAD and gender interactions
Robert Soufer, MD, Yale University, New Haven, Connecticut, and Matthew M. Burg, PhD, Yale University, New Haven, Connecticut, and Columbia University, New York, New York

Depression and heart disease
François Lespérance, MD, Montréal Heart Institute, and Nancy Frasure-Smith, PhD, McGill University and Montréal Heart Institute, Montréal, Québec, Canada

Sick at heart: The pathophysiology of negative emotions
Laura D. Kubzansky, PhD, MPH, Harvard School of Public Health, Boston, Massachusetts

Role of the brain in ventricular fibrillation and hypertension: From animal models to early human studies
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

New paradigms in heart-brain medicine: Nonlinear physiology, state-dependent proteomics
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

Subarachnoid hemorrhage: A model for heart-brain interactions
J. Javier Provencio, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac denervation in patients with Parkinson disease
David S. Goldstein, MD, PhD, National Institutes of Health, Bethesda, Maryland

Aging and the brain renin-angiotensin system: Insights from studies in transgenic rats
Debra I. Diz, PhD; Sherry O. Kasper, PhD; Atsushi Sakima, MD; and Carlos M. Ferrario, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Contextual cardiology: What modern medicine can learn from ancient Hawaiian wisdom
Paul Pearsall, PhD, University of Hawaii at Manoa and Hawaii State Consortium for Integrative Medicine, Honolulu, Hawaii

Cardiocerebral resuscitation: The optimal approach to cardiac arrest
Gordon A. Ewy, MD, University of Arizona College of Medicine, Tucson, Arizona

Heart transplantation: A magnified model of heart-brain interactions
Mohamad H. Yamani, MD, and Randall C. Starling, MD, MPH, Cleveland Clinic, Cleveland, Ohio

Patent foramen ovale and migraine
Gian Paolo Anzola, MD, S. Orsola Hospital FBF, Brescia, Italy

Patent foramen ovale and stroke: To close or not to close?
Anthony J. Furlan, MD, Cleveland Clinic, Cleveland, Ohio

Sudden unexplained death in epilepsy: The role of the heart
Stephan U. Schuele, MD, Cleveland Clinic, Cleveland, Ohio, and Northwestern University, Chicago, Illinois; Peter Widdess-Walsh, MD, Adriana Bermeo, MD, and Hans O. Lüders, MD, PhD, Cleveland Clinic, Cleveland, Ohio

Hydrocephalus and the heart: Interactions of the first and third circulations
Mark Luciano, MD, PhD, and Stephen Dombrowski, PhD, Cleveland Clinic, Cleveland, Ohio

Cognitive impairment in chronic heart failure
Cathy A. Sila, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac events and brain injury: Ethical implications
Paul J. Ford, PhD, Cleveland Clinic, Cleveland, Ohio

Supplement Editor:
Marc S. Penn, MD, PhD

Contents

Introduction
Heart-brain medicine: Where we go from here and why
Marc S. Penn, MD, PhD, Cleveland Clinic, Cleveland, Ohio, and Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Opening remarks
The dream behind the summit
Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Keynote address
'Voodoo' death revisited: The modern lessons of neurocardiology
Martin A. Samuels, MD, DSc (hon), Brigham and Women's Hospital, Boston, Massachusetts

The broken heart syndrome
Ilan S. Wittstein, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland

Brain imaging in cardiovascular disease: State of the art
Michael Phillips, MD, Cleveland Clinic, Cleveland, Ohio

Cortical control of the heart
Stephen Oppenheimer, MD, PhD, Sentient Medical Systems, Cockeysville, Maryland

Neurological mechanisms of chest pain and cardiac disease
Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Hypertension in sleep apnea: The role of the sympathetic pathway
Diana L. Kunze, PhD; David Kline, PhD; and Angelina Ramirez-Navarro, PhD, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio

Inflammation: Implications for understanding the heart-brain connection
Mehdi H. Shishehbor, DO; Carlos Alves, MD; and Vivek Rajagopal, MD, Cleveland Clinic, Cleveland, Ohio

The anti-ischemic effects of electrical neurostimulation in the heart
Jessica de Vries, MD, University of Groningen, The Netherlands; Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Mike J.L.  DeJongste, MD, PhD, University of Groningen, The Netherlands

The little brain on the heart
J. Andrew Armour, MD, PhD, Hôpital du Sacré-Coeur and Université de Montréal, Montréal, Québec, Canada

Open heart surgery and cognitive decline
Mark F. Newman, MD, Duke University Medical Center, Durham, North Carolina

The heart and the brain within the broader context of wellness
Michael O’Donnell, PhD, MBA, MPH, Cleveland Clinic, Cleveland, Ohio

The heart-brain interaction during emotionally provoked myocardial ischemia: Implications of cortical hyperactivation in CAD and gender interactions
Robert Soufer, MD, Yale University, New Haven, Connecticut, and Matthew M. Burg, PhD, Yale University, New Haven, Connecticut, and Columbia University, New York, New York

Depression and heart disease
François Lespérance, MD, Montréal Heart Institute, and Nancy Frasure-Smith, PhD, McGill University and Montréal Heart Institute, Montréal, Québec, Canada

Sick at heart: The pathophysiology of negative emotions
Laura D. Kubzansky, PhD, MPH, Harvard School of Public Health, Boston, Massachusetts

Role of the brain in ventricular fibrillation and hypertension: From animal models to early human studies
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

New paradigms in heart-brain medicine: Nonlinear physiology, state-dependent proteomics
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

Subarachnoid hemorrhage: A model for heart-brain interactions
J. Javier Provencio, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac denervation in patients with Parkinson disease
David S. Goldstein, MD, PhD, National Institutes of Health, Bethesda, Maryland

Aging and the brain renin-angiotensin system: Insights from studies in transgenic rats
Debra I. Diz, PhD; Sherry O. Kasper, PhD; Atsushi Sakima, MD; and Carlos M. Ferrario, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Contextual cardiology: What modern medicine can learn from ancient Hawaiian wisdom
Paul Pearsall, PhD, University of Hawaii at Manoa and Hawaii State Consortium for Integrative Medicine, Honolulu, Hawaii

Cardiocerebral resuscitation: The optimal approach to cardiac arrest
Gordon A. Ewy, MD, University of Arizona College of Medicine, Tucson, Arizona

Heart transplantation: A magnified model of heart-brain interactions
Mohamad H. Yamani, MD, and Randall C. Starling, MD, MPH, Cleveland Clinic, Cleveland, Ohio

Patent foramen ovale and migraine
Gian Paolo Anzola, MD, S. Orsola Hospital FBF, Brescia, Italy

Patent foramen ovale and stroke: To close or not to close?
Anthony J. Furlan, MD, Cleveland Clinic, Cleveland, Ohio

Sudden unexplained death in epilepsy: The role of the heart
Stephan U. Schuele, MD, Cleveland Clinic, Cleveland, Ohio, and Northwestern University, Chicago, Illinois; Peter Widdess-Walsh, MD, Adriana Bermeo, MD, and Hans O. Lüders, MD, PhD, Cleveland Clinic, Cleveland, Ohio

Hydrocephalus and the heart: Interactions of the first and third circulations
Mark Luciano, MD, PhD, and Stephen Dombrowski, PhD, Cleveland Clinic, Cleveland, Ohio

Cognitive impairment in chronic heart failure
Cathy A. Sila, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac events and brain injury: Ethical implications
Paul J. Ford, PhD, Cleveland Clinic, Cleveland, Ohio

Supplement Editor:
Marc S. Penn, MD, PhD

Contents

Introduction
Heart-brain medicine: Where we go from here and why
Marc S. Penn, MD, PhD, Cleveland Clinic, Cleveland, Ohio, and Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Opening remarks
The dream behind the summit
Earl E. Bakken, DSc (hon), Medtronic, Inc., Minneapolis, Minnesota, and North Hawaii Community Hospital, Kamuela, Hawaii

Keynote address
'Voodoo' death revisited: The modern lessons of neurocardiology
Martin A. Samuels, MD, DSc (hon), Brigham and Women's Hospital, Boston, Massachusetts

The broken heart syndrome
Ilan S. Wittstein, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland

Brain imaging in cardiovascular disease: State of the art
Michael Phillips, MD, Cleveland Clinic, Cleveland, Ohio

Cortical control of the heart
Stephen Oppenheimer, MD, PhD, Sentient Medical Systems, Cockeysville, Maryland

Neurological mechanisms of chest pain and cardiac disease
Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Hypertension in sleep apnea: The role of the sympathetic pathway
Diana L. Kunze, PhD; David Kline, PhD; and Angelina Ramirez-Navarro, PhD, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio

Inflammation: Implications for understanding the heart-brain connection
Mehdi H. Shishehbor, DO; Carlos Alves, MD; and Vivek Rajagopal, MD, Cleveland Clinic, Cleveland, Ohio

The anti-ischemic effects of electrical neurostimulation in the heart
Jessica de Vries, MD, University of Groningen, The Netherlands; Robert D. Foreman, PhD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Mike J.L.  DeJongste, MD, PhD, University of Groningen, The Netherlands

The little brain on the heart
J. Andrew Armour, MD, PhD, Hôpital du Sacré-Coeur and Université de Montréal, Montréal, Québec, Canada

Open heart surgery and cognitive decline
Mark F. Newman, MD, Duke University Medical Center, Durham, North Carolina

The heart and the brain within the broader context of wellness
Michael O’Donnell, PhD, MBA, MPH, Cleveland Clinic, Cleveland, Ohio

The heart-brain interaction during emotionally provoked myocardial ischemia: Implications of cortical hyperactivation in CAD and gender interactions
Robert Soufer, MD, Yale University, New Haven, Connecticut, and Matthew M. Burg, PhD, Yale University, New Haven, Connecticut, and Columbia University, New York, New York

Depression and heart disease
François Lespérance, MD, Montréal Heart Institute, and Nancy Frasure-Smith, PhD, McGill University and Montréal Heart Institute, Montréal, Québec, Canada

Sick at heart: The pathophysiology of negative emotions
Laura D. Kubzansky, PhD, MPH, Harvard School of Public Health, Boston, Massachusetts

Role of the brain in ventricular fibrillation and hypertension: From animal models to early human studies
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

New paradigms in heart-brain medicine: Nonlinear physiology, state-dependent proteomics
James E. Skinner, PhD, Vicor Technologies, Inc., Boca Raton, Florida

Subarachnoid hemorrhage: A model for heart-brain interactions
J. Javier Provencio, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac denervation in patients with Parkinson disease
David S. Goldstein, MD, PhD, National Institutes of Health, Bethesda, Maryland

Aging and the brain renin-angiotensin system: Insights from studies in transgenic rats
Debra I. Diz, PhD; Sherry O. Kasper, PhD; Atsushi Sakima, MD; and Carlos M. Ferrario, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Contextual cardiology: What modern medicine can learn from ancient Hawaiian wisdom
Paul Pearsall, PhD, University of Hawaii at Manoa and Hawaii State Consortium for Integrative Medicine, Honolulu, Hawaii

Cardiocerebral resuscitation: The optimal approach to cardiac arrest
Gordon A. Ewy, MD, University of Arizona College of Medicine, Tucson, Arizona

Heart transplantation: A magnified model of heart-brain interactions
Mohamad H. Yamani, MD, and Randall C. Starling, MD, MPH, Cleveland Clinic, Cleveland, Ohio

Patent foramen ovale and migraine
Gian Paolo Anzola, MD, S. Orsola Hospital FBF, Brescia, Italy

Patent foramen ovale and stroke: To close or not to close?
Anthony J. Furlan, MD, Cleveland Clinic, Cleveland, Ohio

Sudden unexplained death in epilepsy: The role of the heart
Stephan U. Schuele, MD, Cleveland Clinic, Cleveland, Ohio, and Northwestern University, Chicago, Illinois; Peter Widdess-Walsh, MD, Adriana Bermeo, MD, and Hans O. Lüders, MD, PhD, Cleveland Clinic, Cleveland, Ohio

Hydrocephalus and the heart: Interactions of the first and third circulations
Mark Luciano, MD, PhD, and Stephen Dombrowski, PhD, Cleveland Clinic, Cleveland, Ohio

Cognitive impairment in chronic heart failure
Cathy A. Sila, MD, Cleveland Clinic, Cleveland, Ohio

Cardiac events and brain injury: Ethical implications
Paul J. Ford, PhD, Cleveland Clinic, Cleveland, Ohio