CME WEB NOTES Cogent Healthcare Inc. has launched the first Internet-based continuing medical education program for hospitalists. The CME program, "New Strategies for Inpatient and Outpatient Deep Venous Thrombosis Management," will be available until April 30, 2001, through the Cogent Healthcare Web site at (www.cogenthealthcare.com). By including both an academic and a practicing hospitalist in the development of each program, Cogent hopes to assure a perspective that focuses on the interests and needs of the practicing hospitalist.

Physicians completing the course and submitting the post-test and evaluation can receive 1.0 hour in category 1 credit towards the AMA Physician's Recognition Award; nurses and pharmacists will receive the equivalent.

Cogent Healthcare Inc. is located in Laguna Hills, Calif. For more information about the CME programs, contact Michael Rovzar, MD, at rovzar.mike@cogenthealthcare.com.

Stanford University launches e-SKOLAR. Based on an internal service called SKOLAR, MD, e-SKOLAR will allow physicians across the country to earn CME credits through a physician-initiated learning process. SKOLAR, MD evolved out of the Stanford Health Information Network for Education, or SHINE. Over the last four years, SHINE was developed by Ken Melmon, MD, associate dean for postgraduate medical education, in collaboration with an interdisciplinary team of faculty members and students from the schools of computer science and medicine.

By entering an unstructured query, a clinician can pull up disease or symptom information ranging from basic definitions to drug dosage schedules for patients with complicating factors such as pregnancy or a secondary illness. Stanford physicians currently use the service to supplement their clinical decision-making. With the formation of e-SKOLAR, the service will no longer be restricted to the Stanford community. Any physician or medical group can subscribe to Stanford SKOLAR, MD for an annual fee of $240 per user.

NEEDS ASSESSMENT NOTES Physicians fail at delivering bad news. In a study of 258 physicians who were responsible for terminally ill patients, Elizabeth Lamont, MD, of the University of Chicago, found that only 37 percent gave these patients what Lamont calls a "frank disclosure," that is, telling them the truth about their conditions. Nearly a quarter of all respondents said they would not tell their patients at all about their fates, while 40 percent said they would equivocate. The worse the patients' conditions, the less likely physicians were to be truthful. The more experienced the physician, the more likely he or she was to equivocate. On the other hand, the older the patient, the greater the likelihood of a frank response from the physician. Lamont suggests that physicians need to overcome their bias against giving bad news, because it may interfere with giving the best end-of-life care.

The American Society of Clinical Oncology runs workshops on how to tell patients bad news. Doctors learn how to listen sympathetically to a patient's distress without becoming emotionally involved and how to phrase the information so the patient doesn't feel misled.

Pediatric psychiatry admissions are on the rise. Preliminary findings of a study, done at the Yale-New Haven (Conn.) Children's Hospital, show that more children are being brought to emergency departments with psychiatric problems than ever before. The study, conducted by Karen A. Santucci, MD, pediatric emergency medicine physician, examined admissions records for a period of five years at the Yale-New Haven Children's Hospital. She found an overall increase of 59 percent in psychiatric-related visits between 1995 and 1999, compared to a 20 percent increase in nonpsychiatric-related visits. Based on data, the numbers could increase even further over time.

Santucci and her co-authors perceive this increase to be in epidemic proportions, and are concerned that many pediatric emergency departments are not fully prepared to handle acute psychiatric emergencies. The researchers recommend that pediatric emergency departments should consider this pattern when planning human resource allocation.