Factores asociados con la fragilidad en un servicio ambulatorio de geriatría de un hospital universitario en Bogotá (Colombia) / Factors Associated with Frailty in the Geriatric Outpatient Service of a University Hospital in Bogotá (Colombia) / Fatores associados à fragilidade no ambulatório de geriatria de um hospital universitário de Bogotá (Colômbia)

Introducción: la fragilidad, entendida como un estado previo a la discapacidad, confiere mayor vulnerabi-lidad a estresores externos y contribuye a desenlaces negativos como caídas, hospitalización, discapacidad y mortalidad. El objetivo de este estudio fue identificar su prevalencia y evaluar los factores asociados en los pacientes del Servicio Ambulatorio de Geriatría del Hospital Universitario San Ignacio (husi) en Bogotá (Colombia). Materiales y métodos: estudio de corte transversal con 689 pacientes atendidos en la consulta externa de geriatría del husi entre agosto de 2016 y marzo de 2020. Mediante regresiones logísticas se iden-tificaron los factores relacionados con la fragilidad. Resultados: la prevalencia fue del 35.4 %. En el análisis bivariado, las variables asociadas con la fragilidad fueron edad mayor de 80 años (or: 2.07; ic95 %: 1.40-3.20; p = 0.001), sexo femenino (or: 1.40; ic95 %: 0.99-2.02; p = 0.03), multimorbilidad (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) y malnutrición (or: 2.23; ic95 %: 1.22-4.07; p = 0.009). En el análisis multivariado, la multimor-bilidad (or: 2.46; ic95 %: 1.62-3.75; p = 0.001), la velocidad de la marcha lenta (or: 5.15; ic95 %: 3.0-8.60; p = 0.001) y el perímetro de pantorrilla bajo (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) se vincularon con la fragilidad. Conclusión: la prevalencia de fragilidad en el servicio de geriatría del husies mayor a la de los referentes nacionales; adicionalmente, las variables analizadas coinciden con las encontradas en la literatura; todo esto respecto a la gran complejidad clínica de los pacientes. Es clave la detección de los factores que se asocian con fragilidad, a fin de intervenirlos y prevenir desenlaces adversos

Introduction: Frailty, understood as a pre-disability state, increases vulnerability to external stressors and contributes to negative outcomes such as falls, hospitalization, disability, and mortality. This study aims to identify the prevalence of frailty and assess the associated factors in patients attending the geriatric outpatient service of the Hospital Universitario San Ignacio (husi). Materials and methods: A cross-sectional study involving 689 patients treated at the husigeriatric outpatient clinic between August 2016 and March 2020. Logistic regressions were conducted to identify factors associated with frailty. Results: The prevalence of frailty was 35.4 %. In bivariate analysis, variables associated with frailty included age over 80 years (or: 2.07; ci95 %: 1.40-3.20; p = 0.001), female sex (or: 1.40; ci95 %:0.99-2.02; p= 0.03), multimorbidity (or: 2.13; ci95 %:1.40-2.90; p < 0.001) and malnutrition (or: 2.23; ci95 %: 1.22-4.07; p = 0.009). In multivariate analysis, multimorbidity (or: 2.46; ci95 %: 1.62-3.75; p = 0.001), slow walking speed (or: 5.15; ci95 %: 3.0-8.60; p = 0.001) and low calf perimeter (or: 1.60; ci95 %: 1.03-2.50; p = 0.06) were associated with frailty. Conclusion: The prevalence of frailty in our center exceeds national references; and the identified variables align with those reported in the literature; reflecting the considerable clin-ical complexity of our patients. Detecting factors associated with frailty is crucial for intervention and prevention of adverse outcomes

ntrodução: a fragilidade, entendida como um estado anterior à incapacidade, confere maior vulnerabi-lidade a estressores externos e contribui para desfechos negativos como quedas, hospitalização, incapa-cidade e mortalidade. O objetivo deste estudo foi identificar a prevalência e avaliar os fatores associados à fragilidade em pacientes do ambulatório de geriatria do Hospital Universitário San Ignacio (husi) de Bogotá, Colômbia. Materiais e métodos: estudo transversal com 689 pacientes atendidos no ambulatório de geriatria do husi entre agosto de 2016 e março de 2020. Foram realizadas regressões logísticas para identificar fatores associados à fragilidade. Resultados: a prevalência de fragilidade foi de 35.4 %. Na análise bivariada, as variáveis associadas à fragilidade foram: idade acima de 80 anos (or:2.07; ic95 %:1.40-3,20; p = 0.001), gênero feminino (or:1.40; ic95 %:0.99-2.02; p = 0.03), multimorbidade (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) e desnutrição (or:2.23; ic95 %:1.22-4.07; p = 0.009). Na análise multivariada, multimorbidade (or:2.46; ic95 %: 1.62-3.75; p = 0.001), velocidade lenta de caminhada (or:5.15; ic95 %:3.0-8.60; p = 0.001) e baixa circunferência da panturrilha (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) foram associados à fragilidade. Conclusão: a prevalência de fragilidade no husi é superior à das referências nacionais; adicionalmente, as variáveis associadas coincidem com as encontradas na literatura; tudo isso em relação à grande complexidade clínica dos nossos pacientes. É fundamental detectar os fatores associados à fragilidade para intervir e prevenir resultados adversos

An Interprofessional Initiative to Address Tests Pending at Discharge for Hospitalized Pediatric Patients.

INTRODUCTION: Pediatric hospitalized patients often are discharged before all lab tests are completed. Given the risk of medical errors related to inadequate test follow-up, we piloted a collaborative initiative to address tests pending at discharge (TPAD) within our pediatric hospital medicine section. Our objectives were to delineate the responsibilities of case managers and pediatric hospital medicine clinicians in addressing these tests and to establish a communication process. METHODS: We formed an interprofessional team and performed a current state assessment, including a survey to pediatric hospital medicine clinicians to assess time spent following up TPAD and confidence that results were followed up in a timely and appropriate manner. We obtained a list of 1450 individual TPAD for the previous 9 months using an electronic health record data query, from which a list of 26 common and straightforward labs were identified for case manager follow-up. A shared case manager Epic Inbasket for TPAD was created and was checked twice daily. We developed a phased approach to establish a workflow for follow-up. DISCUSSION: The case manager partnership was launched in 4 phases for the duration of the 6-month pilot. However, due to duplication of work and less value of case managers addressing straightforward labs, the pilot was stopped. A more effective and mutually beneficial role for pediatric hospital medicine attendings and case managers may be to have the case managers address complex TPAD and communicate with primary care clinicians and families.

The impact of anticholinergic burden on clinical outcomes in older hospitalised surgical patients.

Polypharmacotherapy is an ever-increasing issue with an ageing patient population. Anticholinergic medications make up a large proportion of patient medication but cause significant side effects, contributing to well-documented issues within the older population and in hospital medicine. This review explores the documented impact of anticholinergic burden in older surgical patients on postoperative delirium, infection, length of stay and readmission, urinary retention, ileus and mortality. It also highlights the need for further high-quality research into anticholinergic burden management among older surgical patients to further impact practice and policy in the area.

Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center.

This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.

A Retrospective Study Analyzing a Palliative Care-Hospital Medicine Collaboration to Improve Quality of Care of Patients With Advanced Illness.

BACKGROUND: Palliative care seeks to improve outcomes for patients with advanced illness (AI). Advocacy exists for making it part of mainstream care for hospitalized patients with AI. AIM: To determine if a partnership between hospital-medicine and specialized palliative care would increase identification of AI patients with palliative care needs requiring palliative consultation. Secondary outcomes: Decreasing 30-day readmission, length of stay (LOS) and pain scores, increasing documentation reflecting goals and advanced care planning. DESIGN: Retrospective chart review of patients with AI admitted to a hospitalist-resident run unit divided into Care Models, "A" and "B," and analyzed over two ten-month periods, "1" and "2." Triggers for palliative needs were provided for "A." During biweekly rounding, needs were assessed and generalist vs. specialist level palliative care concepts were used for consultation. SETTING: Quaternary-level teaching center in the New York Metropolitan area. PATIENTS: 3,395 AI patients were analyzed, 1,707 from "1," and 1,688 from "2." RESULTS: Comparing care models and time frames, palliative care consultation increased in "A" (P-value = .0013, P-value = .0005). When investigating "A" in "1" to "2," CMI was higher. Comparing "B" between "1" and "2," found older age and lower LACE. When adjusting for confounders (LACE and CMI), our models did not show a difference. Data on discharge disposition was significant for subacute rehab but not for mortality. There were no differences between care models and time-periods for secondary outcomes. CONCLUSION: Our study demonstrated the demand for palliative care services integrated into hospital medicine and highlighted areas of focus for future studies.

Cuidado ao Paciente Oncológico na Perspectiva da Oncologia Integrativa / Care for Cancer Patients from the Perspective of Integrative Oncology / Atención al Paciente Oncológico desde la Perspectiva de la Oncología Integrativa

Introdução: A oncologia integrativa é um campo recente e promissor que visa ao cuidado integral centrado no paciente, com uma abordagem baseada em evidências. Objetivo: Verificar o conhecimento científico produzido sobre a oncologia integrativa na atenção hospitalar. Método: Revisão integrativa com buscas nas bases de dados PubMed, LILACS, SciELO e MOSAICO, realizadas de fevereiro a março de 2022. A partir dos critérios de elegibilidade (estudos referentes ao tema publicados de 2000 a 2022, disponíveis na íntegra no acesso público, nos idiomas inglês, português e espanhol), foram selecionados sete artigos, analisados de acordo com a modalidade temática. Resultados: Os artigos elegíveis foram publicados entre 2018 e 2021, com destaque para a produção europeia, que corresponde a quatro (57,14%) artigos. O conteúdo dos estudos foi organizado em dois temas: a implementação de cuidados de oncologia integrativa e o acesso equitativo à oncologia integrativa e outros desafios. Foi observado que a oncologia integrativa tem sido praticada em diferentes cenários, com variadas ações realizadas, e tem como desafio central a ampliação do acesso ao usuário, por meio do desenvolvimento de diretrizes baseadas em evidências e da implementação de políticas de financiamento e qualificação profissional. Conclusão: O conhecimento científico produzido aponta que a implementação de cuidados de oncologia integrativa na atenção hospitalar ainda é limitada, com desafios relacionados ao acesso equitativo, ao financiamento, à gestão e à qualificação dos profissionais de saúde

Introduction: Integrative oncology is a recent and promising field, which aims a patient-centered comprehensive care, within an evidence-based approach. Objective: To investigate the scientific knowledge produced on integrative oncology in hospital care. Method: Integrative review with searches in PubMed, LILACS, SciELO and MOSAICO databases carried out from February to March 2022. Based in the eligibility criteria (studies related to the subject published from 2000 to 2022, available in full by public access, in English, Portuguese and Spanish) seven articles were selected and analyzed according to the thematic modality. Results: The eligible articles were published between 2018 and 2021, with emphasis on European production, which corresponds to four (57.14%) articles. The content of the studies was organized in two themes, namely: the implementation of integrative oncology care and the equitable access to integrative oncology and other challenges. It has been observed that integrative oncology has been practiced in different scenarios, with variable actions taken, and its central challenge is to expand the user access, through the development of evidence-based guidelines and the implementation of funding and professional qualification policies. Conclusion: The scientific knowledge produced indicates that the implementation of integrative oncology care in hospital attention is still limited, with challenges related to equitable access, funding, management and qualification of health professionals

Introducción: La oncología integrativa es un campo reciente y prometedor, que apunta a la atención integral centrada en el paciente, en un enfoque basado en la evidencia. Objetivo: Verificar el conocimiento científico producido sobre oncología integrativa en la atención hospitalaria. Método: Revisión integrativa con búsquedas en las bases de datos PubMed, LILACS, SciELO y MOSAICO, realizada de febrero a marzo de 2022. A partir de los criterios de elegibilidad (estudios relacionados con el tema publicados entre 2000 y 2022, disponibles en su totalidad para acceso público, en inglés, portugués y español) fueron seleccionados siete artículos, analizados según la modalidad temática. Resultados: Los artículos elegidos fueron publicados entre 2018 y 2021, con énfasis en la producción europea, lo que corresponde a cuatro (57,14%) artículos. El contenido de los estudios se organizó en dos temas, a saber: la implementación de la atención oncológica integradora y el acceso equitativo a la oncología integradora y otros desafíos. Se ha observado que la oncología integrativa se ha practicado en diferentes escenarios, con acciones variables, y su desafío central es ampliar el acceso de los usuarios, a través del desarrollo de pautas basadas en evidencia y la implementación de políticas de financiamiento y calificación profesional. Conclusión: El conocimiento científico producido apunta que la implementación de la atención oncológica integrativa en la atención hospitalaria aún es limitada, con desafíos relacionados con el acceso equitativo, el financiamiento, la gestión y la calificación de los profesionales de la salud

Post-discharge early assessment with remote video link (PEARL) initiative for patients discharged from hospital medicine services.

OBJECTIVES: The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services. METHODS: We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL. RESULTS: Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits. CONCLUSION: In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.

Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service.

BACKGROUND: Health systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. However, 7-day readmissions have been understudied in adult hospital medicine. DESIGN: This is a retrospective study. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Mediation analysis was performed for limited English proficiency (LEP) status. Subgroup analyses were performed for patients with initial admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer. PATIENTS: We identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019. MAIN MEASURES: The primary outcome was 7-day all-cause readmission back to the discharging hospital. RESULTS: There were 18,808 patients in our dataset who were discharged between July 2016 and June 2019. A total of 1,297 (6.9%) patients were readmitted within 7 days. Following multivariable regression, patients who identified as Black (OR 1.35, 95% CI 1.15-1.58, p <0.001) and patients who identified as Asian (OR 1.26, 95% CI 1.06-1.50, p = 0.008) had higher odds of readmission compared to white patients. Multivariable regression at the subgroup level for CHF, COPD, and cancer readmissions did not demonstrate significant differences between the racial and ethnic groups. CONCLUSIONS: Black patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.

[End-of-life care and hospital medicine. A field experience.] / Le cure di fine vita e la medicina ospedaliera. Un'esperienza sul campo.

A large number of elderly patients end their life in general wards, where they hardly find appropriate for their specific needs. Physicians and nurses, irrespective of their specialization, should be able to provide the dying patients with end-of-life care (EOL-care) to meet their right to die well. Purposely tailored clinical paths, inspired to the comfort care, should be constructed and disseminated. A specific experience carried on for ten years in an Internal Medicine department is reported. After a two-years period of time spent educating a large group of physicians and nurses and to project its own path, the working group experienced substantial improvements for the patients and the staff itself, in terms of a better control of pain and other main disturbing symptoms, avoidance of futile procedures, a better quality of communication and comprehension, harmonization of the clinical decisions brought about by the physicians and the nurses. Based on this experience, the following recommendations are discussed: after preparing the personnel, routinely implement end-of-life care as part of routine practice in a general ward, whenever appropriate; after starting, be aware that nurses are the main actors in the conduction of EOL-care; be aware that EOL-care in no way is a low profile care in as much as it is challenging and demanding task.

Harnessing the potential of CRISPR-based platforms to advance the field of hospital medicine.

INTRODUCTION: Clustered regularly interspaced short palindromic repeats (CRISPR) are segments of nucleic acid that play a role in prokaryotic defense and form the basis of a genome editing technology that allows permanent alteration of genetic material. This methodology, known as CRISPR-Cas9, is poised to revolutionize molecular biology, but no literature yet exists on how these advances will affect hospitalists. AREAS COVERED: These specialists in inpatient medicine care for a wide variety of hospitalized patients, including those with infectious disease, cancer, cardiovascular disease, autoimmune disease, hematologic disease, and a variety of other conditions that may soon be impacted by advances in gene-modifying technology provided by CRISPR-Cas9. A Literature search was performed using PubMed [1 December 2019-17 April 2020]. EXPERT OPINION: This paper reviews the remarkable diagnostic and therapeutic potential of the CRISPR-Cas9 platform and concludes with a look at ethical issues and technical hurdles pertaining to the implementation of permanent gene modification in the practice of Hospital Medicine.

Empatia de médicos avaliada por meio da Jefferson Scale of Empathy (JSE) - Physician como marcador do cuidado centrado no paciente / Physician empathy evaluated by the Jefferson Scale of Empathy (JSE) - Physician as a marker of patient-centered care

A empatia é considerada um pilar do cuidado centrado na pessoa, de qualidade e seguro, que permite a consolidação de parcerias e melhores desfechos. O objetivo deste estudo foi a adaptação transcultural da Jefferson Scale of Empathy ­ Physician - JSE (versão para médicos) para a língua portuguesa e o contexto brasileiro. É o instrumento mais pesquisado e utilizado no mundo, com validações em outras culturas, no qual a empatia é um atributo predominantemente cognitivo e divide-se em três dimensões: assumir perspectivas diferentes; cuidado com compaixão e vivenciar o lugar do paciente (calçar os sapatos do paciente). Foram realizadas as etapas de equivalências conceitual, semântica (tradução, retradução, equivalência entre retraduções e o instrumento, revisão pelo grupo de especialistas), pré-teste (20 entrevistados), operacional e de mensuração - Análise Fatorial Exploratória (AFE) e Confirmatória (AFC) e, consequentemente, a funcional. A JSE foi aplicada de outubro de 2017 a março de 2018 no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), hospital com longo caminho voltado à qualidade. Responderam 101 médicos, 75% do sexo masculino, com idades entre 24 a 66 anos (média: 39,3). Os valores dos escores variaram de 75 a 140, com média de 117,8 (Desvio padrão - DP:13,5); escores médios dos itens variaram de 6,7 (DP:0,77) a 4,3 (DP:1,82). A estimativa de confiabilidade da escala (Alpha de Cronbach) foi 0,794 (também foram satisfatórios os Alfa de Cronbach padronizado, Alpha ordinal, Theta de Armor e Theta ordinal). Para validade do construto, foi realizada AFE com três dimensões, com rotação ortogonal varimax, oito itens carregaram na primeira dimensão; quatro na segunda e três na terceira. Três itens (1, 8 e 19) apresentaram cargas fatoriais com valores próximos (<0,2) nos fatores 2 e 3, e o item 2 carregou nos fatores 1 e 3. Três fatores com eigenvalues ≥ 1,5 foram extraídos com ACP, que explicam 41,4% da variância total. A análise de Kaiser-Meyer-Olkin apresentou um índice de 0,67, o teste de esfericidade de Bartlett mostrou um valor igual a 1027,04 (p < 0,01), o teste Steiger igual a 1879,70 (p < 0,01) e o teste de Jennrich igual a 276,70 (p < 0,01), que indicam a adequação dos dados para a análise fatorial. As subescalas cuidado com compaixão e assumir perspectivas estavam fortemente correlacionadas (r: 0,627), bem como as escalas vivenciar o lugar do paciente e cuidado com compaixão (r: 0,494). Na análise fatorial confirmatória, o modelo com 20 variáveis dependentes e 3 variáveis latentes apresentou bons índices de ajuste: RMSEA = 0,050 (IC 90%: 0,023-0,070), CFI = 0,952, TLI = 0,945 e SRMR = 0,071. Em nenhum dos estudos que validaram a escala, com variações metodológicas, a mesma se comportou exatamente como no trabalho original. O peso do fator cultural entre os diversos povos ainda não está bem esclarecido. Este é o primeiro estudo brasileiro de validação da JSE (médicos), possui diversas limitações, com clara correlação com o construto. São necessários mais estudos com a mesma, para permitir sua utilização de forma sistemática no nosso meio e elaborar planos de melhorias em prol do cuidado centrado na pessoa

Empathy is considered a pillar of quality, safe, person-centered care, allowing partnerships, leading to better outcomes. The objective of this study was the cross - cultural adaptation of the Jefferson Scale of Empathy - Physician - JSE (version for physicians) to the Portuguese language and the Brazilian context. It is the most researched and used instrument in the world, with validations in other cultures, in which empathy is a predominantly cognitive attribute and is divided into three dimensions: assume different perspectives; care with compassion and experience the patient's place (put on the patient's shoes). The pre-test (20 interviewed), operational and measuring equivalents - Exploratory Factor Analysis (AFE) and Confirmatory (Analysis, Retranslation, Equivalence between retranslations and the instrument, review by the group of experts) were performed. AFC) and, consequently, functional. The JSE was applied from October 2017 to March 2018 at the National Institute of Traumatology and Orthopedics Jamil Haddad (INTO), a hospital with a long road to quality. A total of 101 doctors were male (75%) aged 24 to 66 years (mean: 39.3). The values of the scores ranged from 75 to 140, with a mean of 117.8 (Standard deviation - SD: 13.5); mean scores of items ranged from 6.7 (SD: 0.77) to 4.3 (SD: 1.82). The reliability estimate of the scale (Cronbach's Alpha) was 0.794 (the standard Cronbach's alpha, Alpha ordinal, Armor's Theta and Theta ordinal were also satisfactory). For the validity of the construct, three-dimensional AFE was performed, with orthogonal varimax rotation, eight items loaded in the first dimension; four in the second and three in the third. Three items (1, 8 and 19) presented factorial loads with close values (<0.2) in factors 2 and 3, and item 2 loaded on factors 1 and 3. Three factors with eigenvalues ≥ 1.5 were extracted with ACP , which explain 41.4% of the total variance. The Kaiser-Meyer-Olkin analysis presented an index of 0.67, the Bartlett sphericity test showed a value equal to 1027.04 (p <0.01), the Steiger test equal to 1879.70 (p <0) , 01), and the Jennrich test was 276.70 (p <0.01), which indicates the adequacy of the data for the factorial analysis. The compassionate and compassionate subscales were strongly correlated (r: 0.627), as well as the scales experiencing the patient's place and compassionate care (r: .494). In the confirmatory factor analysis, the model with 20 dependent variables and 3 latent variables had good adjustment indexes: RMSEA = 0.050 (IC 90%: 0.023-0.070), CFI = 0.952, TLI = 0.945 and SRMR = 0.071. In none of the studies that validated the scale, with methodological variations, it behaved exactly as in the original work. The weight of the cultural factor among the various peoples is still not clear. This is the first Brazilian validation study of JSE (physicians), and it has several limitations, but a clear correlation with the construct. Further studies are needed to enable it to be used systematically in our setting and to develop improvement plans for person-centered care

Workforce Trends and Analysis of Selected Pediatric Subspecialties in the United States.

OBJECTIVE: To update pediatric subspecialty workforce data to support evidence-based legislation and public policy decisions by replicating the American Academy of Pediatrics' 1998 Future of Pediatric Education (FOPE II) workforce survey. METHODS: A descriptive and comparative analysis of survey responses from 9950 US pediatric subspecialists who completed an electronic survey. RESULTS: Pediatric subspecialists are working fewer hours and spending less of their time in direct patient care than they did in 1998 but the mean hours worked differs significantly according to subspecialty. Most subspecialists continue to be board-certified, white, non-Hispanic men, although the percentage who are women and from minority groups has increased. The proportion of subspecialists practicing in an academic medical center has increased since 1998. Thirty percent of pediatric subspecialists reported appointment wait times of >2 weeks and pediatric subspecialists in developmental pediatrics, endocrinology, and neurology identified much longer wait times than other subspecialists. CONCLUSION: The demographic and practice characteristics of pediatric subspecialists have changed since the FOPE II survey and access to subspecialty care in a family's community remains a challenge. However, pediatric subspecialties are not monolithic and solutions to workforce shortages will need to take into account these differences to improve access to subspecialty care.

Update in Hospital Medicine: Practical Lessons from the Literature.

BACKGROUND: Hospital Medicine has a widening scope of practice. This article provides a summary of recent highimpact publications for busy clinicians who provide care to hospitalized adults. METHODS: The authors reviewed articles published between March 2016 and March 2017 for the Update in Hospital Medicine presentations at the 2017 Society of Hospital Medicine and Society of General Internal Medicine annual meetings. Nine of the 20 articles presented were selected for this review based on the article quality and potential to influence practice. RESULTS: The key insights gained include: pulmonary embolism may be a more common cause of syncope and acute exacerbation of COPD than previously recognized; nonthoracic low-tesla MRI is safe following a specific protocol for patients with cardiac devices implanted after 2001; routine inpatient blood cultures for fever are of a low yield with a false positive rate similar to the true positive rate; chronic opioid use after surgery occurs more frequently than in the general population; high-sensitivity troponin and a negative ECG performed 3 hours after an episode of chest pain can rule out acute myocardial infarction; sitting at patients' bedsides enhances patients' perception of provider communication; 5 days of antibiotics for community-acquired pneumonia is equivalent to longer courses; oral proton pump inhibitors (PPI) are as effective as IV PPIs after an esophagogastroduodenoscopy (EGD) for the treatment of bleeding peptic ulcers. CONCLUSIONS: Recent research provides insight into how we approach common medical problems in the care of hospitalized adults. These articles have the potential to change or confirm current practices.

Hospital Medicine and Perioperative Care: A Framework for High-Quality, High-Value Collaborative Care.

BACKGROUND: Hospitalists have long been involved in optimizing perioperative care for medically complex patients. In 2015, the Society of Hospital Medicine organized the Perioperative Care Work Group to summarize this experience and to develop a framework for providing optimal perioperative care. METHODS: The work group, which consisted of perioperative care experts from institutions throughout the United States, reviewed current hospitalist-based perioperative care programs, compiled key issues in each perioperative phase, and developed a framework to highlight essential elements to be considered. The framework was reviewed and approved by the board of the Society of Hospital Medicine. RESULTS: The Perioperative Care Matrix for Inpatient Surgeries was developed. This matrix characterizes perioperative phases, coordination, and metrics of success. Additionally, concerns and potential risks were tabulated. Key questions regarding program effectiveness were drafted, and examples of models of care were provided. CONCLUSIONS: The Perioperative Care Matrix for Inpatient Surgeries provides an essential collaborative framework hospitalists can use to develop and continually improve perioperative care programs. Journal of Hospital Medicine 2017;12:277-282.

Hospital Dermatology, Introduction.

Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.

The logistics of an inpatient dermatology service.

Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service.

The efficient, effective community hospital inpatient dermatology consult.

Hospital dermatology is often thought to be too cumbersome for the private practicing dermatologist to handle, leaving patients in our communities without needed care and our medical colleagues in the dark when it comes to diagnosing and/or managing skin disease in the hospitalized patient. This notion that "someone else will figure it out" undervalues our expertise as a specialty and threatens the appropriate health outcomes we knowingly understand patients deserve. In this manuscript, we intend to break down the hospital consult conceptually so as to make clear how simple it can be to help our physician colleagues and make an important impact upon patients at their most vulnerable time.

Teledermatology in the inpatient setting.

Teledermatology (TD) is a health care delivery modality that uses telecommunication technology to provide dermatologic care. It has grown to be a reliable and diagnostically accurate means of producing quality care while increasing access and reducing wait times in the outpatient setting. In the inpatient setting, TD may be an effective method to improve access to dermatologic care by remotely triaging, assisting, or providing dermatologic consultative services. For inpatient dermatology, there is the potential for TD to increase access to care in the community setting where dermatologists have full outpatient schedules. Using inpatient TD to triage conditions may be especially helpful in determining if a patient needs to be emergently/urgently seen, or if outpatient care could be appropriate. To best establish TD in the inpatient setting, certain practice guidelines should be considered to ensure the highest quality patient care. These features include Health Insurance Portability and Accountability Act (HIPAA)-consistent protocols to ensure high-quality video sessions and clinical photographs are acquired, stored, and transmitted using secure software and networks, establishing relationships with primary care teams to ensure trust in consulting advice and ensuring consistent communication regarding recommendations, and appropriate patient follow-up.