CME NOTES Ever hear of an "intensivist"? It means the same thing as critical-care physician or nurse, and according to a study published in the April 14 issue of the Journal of the American Medical Association, they have an important role to play in the quality of hospital care. And, there may not be enough of them.
Peter Pronovost, MD, and colleagues from Johns Hopkins University in Baltimore found that intensive care units that did not have daily rounds by an ICU physician were associated with a threefold increase in in-hospital deaths after adjusting for various factors. There was a dollars-and-cents argument in favor of more intensivists, too: Higher costs are connected with longer ICU stays, and longer stays were associated with not having daily rounds by an ICU physician, and with an ICU nurse-to-patient ratio of less than one to two.
It has been said that physicians prefer to hear lectures because this is how they learned in medical school. While their comfort level may be greater with lecture formats, there is evidence that physicians learn better in a problem-based learning (PBL) educational design.
With PBL, students study the issues of a problem as they strive to create solutions--normally in small discussion groups facilitated by a tutor. Evidence of the method's effectiveness was found in a study published last year in the Medical Education Journal by researchers at the Henson College of Public Affairs and Continuing Education, Dalhousie University, Halifax, Canada. Researchers compared CME for primary care physicians delivered through a PBL format with that of a lecture-based format. Bottom-line results: CME taught using PBL techniques was associated with greater knowledge acquisition and with greater improvement in clinical reasoning skills.
HOSPITAL NOTES The Society for Academic CME (SACME) is trying to limit the ability of nonacademic, nonprofessional organizations to award Category 1 CME. (See story, page 45.) Whatever the outcome, the organizations that employ SACME members--the nation's teaching hospitals--are in dire financial straits, according to newspaper reports that have been appearing across the country. Not even the brand names in medicine are immune: Harvard University's five major teaching hospitals, for example, have deficits totaling $150 million this year. According an Associated Press report, all of the nation's 400 major teaching hospitals are in financial trouble.
The biggest source of distress is cutbacks in Medicare. From 1998 to 2003, the Balanced Budget Act of 1997 gradually reduces Medicare payments to hospitals, with the biggest hits coming in later years.The Association of American Medical Colleges has called on Congress to restore the money cut from medical edu- cation and charity care.
NOTABLE MEETINGS The American Heart Association (AHA) identified noncompliance--not following appropriate treatment recommendations--as a major hidden health threat in this country at its first Scientific Conference on Compliance in Healthcare and Research held April 29 to 30 in Boston.
Research shows that more than half of all Americans with chronic diseases do not follow their physicians' medication and lifestyle guidance, and nine out of ten take their medications incorrectly. Widespread lack of compliance also drains the nation of $100 billion annually in unnecessary medical costs and lost productivity. The AHA's April conference kicked off a two-year Compliance Action Program.
Sisters are doing it for themselves: The Seventh Annual Congress on Women's Health and Gender-Based Medicine, jointly sponsored by Ohio State University Medical Center and the Journal of Women's Health and Gender-Based Medicine, will take place June 12 to 15, 1999, at the Hyatt Regency Hotel, Hilton Head, S.C.
Sessions range from Gender Differences and Management of Cardiovascular Disease to Weight Management to Gender-Based Research. The full program can be viewed at www.womenshlth.com. For any who doubt the commercial viability of a medical conference aimed at women, note that corporate supporters include such big names as American Express, Pharmacia & Upjohn, Merck & Co., and Procter & Gamble Company.
The American Lung Association (ALA) has ended its century-long relationship with its research arm, the American Thoracic Society (ATS). The organizations formed at the beginning of the century to fight tuberculosis and have been united since 1905. The split was approved at the ALA's April annual meeting in Phoenix.