Recent advances in point-of-care testing for natriuretic peptides: potential impact on heart failure diagnosis and management.

Heart failure is a leading cause of morbidity and mortality worldwide. The presenting symptoms of heart failure are often nonspecific. The diagnosis of heart failure has traditionally relied heavily upon clinical exam findings, which are often subjective and have low sensitivity. Efficient and rapid diagnosis of heart failure in the emergency room setting can reduce health care costs, hospital admission and ER visits, and improve patient care. Natriuretic peptides are objective biomarkers that can help with diagnosis, prognosis and management of heart failure. The most extensively studied and clinically utilized natriuretic peptides include brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP). Point-of-care testing in the emergency room setting can result in faster triage times. Point-of-care testing can also be utilized in the outpatient setting for real-time management of patients with heart failure.

New Targets in the Drug Treatment of Heart Failure.

Heart failure is a complex syndrome that has been a major contributor to readmissions into hospitals in the USA. Currently, a large number of medications are being used to treat the symptoms of the disease-digoxin, diuretics, renin-angiotensin-aldosterone system inhibitors, ß-blockers, and vasodilators. There is no doubt that the given pharmaceutical therapy has been effective in lowering hospital readmission rates and prolonging life in individual chronic heart failure patients. Despite this, admission rates following heart failure hospitalization remain high, resulting in a substantial financial strain on healthcare institutions. Clearly, there is much room for improvement in heart failure therapy and management in reducing readmission rates. In this review, we address the unmet needs in the current drug treatment of chronic heart failure and describe novel drug targets that are currently under investigation.

Participation in unprofessional behaviors among hospitalists: a multicenter study.

BACKGROUND: Unprofessional behaviors undermine the hospital learning environment and quality of patient care. OBJECTIVE: To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists. DESIGN: Observational survey study. SETTING: Three academic health centers. SUBJECTS: Hospitalists. MEASUREMENTS: Observation, participation in, and perceptions of unprofessional behaviors. RESULTS: Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (ß = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (ß = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (ß = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (ß = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site. CONCLUSION: While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.