Chronic Inflammatory Demyelinating Polyradiculoneuropathy in the Internal Medicine Setting

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A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.


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•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
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Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

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•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
Faculty/Faculty Disclosures

Faculty/Faculty Disclosures
Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

A supplement to Internal Medicine News. This supplement was supported by Talecris Biotherapeutics.


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•Clinical Scenario

•Presenting Symptoms of CIDP

•Differential Diagnosis/Concomitant Conditions

•Obtaining a Diagnosis

•Therapeutic Options

•Best Practices: Key Takeaways
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Peter Donofrio, MD
Department of Neurology
Vanderbilt University
Nashville, Tennessee
Dr. Donofrio is a consultant for the Steering Committee of the Talecris Biotherapeutics ICE Study.

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The Effective Management of Chronic Constipation and IBS-C

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This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
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Harold Fields, MD
Founder, Village Family Practice
Houston, TX


Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

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This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
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Harold Fields, MD
Founder, Village Family Practice
Houston, TX


Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

A supplement to Internal Medicine News and supported by Takeda Pharmaceuticals North America, Inc.


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This supplement has been designed to meet the educational needs of clinicians relative to the diagnosis and effective management of chronic constipation and IBS-C.
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Harold Fields, MD
Founder, Village Family Practice
Houston, TX


Wendy Wright, MS, RN, ARNP, FNP, FAANP
Owner, Wright & Associates
Family Healthcare
Amherst, NH

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Phase 3 trial of pixantrone leaves FDA uneasy

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The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

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The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

The phase 3 EXTEND PIX301 trial, which will be reviewed by the US Food and Drug Administration’s (FDA) Oncologic Drugs Advisory Committee (ODAC) in the near future, is raising serious questions among members regarding the efficacy and safety of pixantrone.

The drug is intended to treat non-Hodgkin’s lymphoma (NHL) that has resisted at least 2 other treatments.

Among multiple concerns, the trial only included 40% of the original 320 participants that were to be enrolled.

A possible explanation is that third-line patients wanted to use multi-agent chemotherapy or supportive care. Regardless of the reason, ODAC members are unsure if 140 participants can provide enough evidence for reliable conclusions.

Twenty percent of patients receiving pixantrone achieved complete responses (CR) or unconfirmed complete responses (CRu), compared to less than 6% in the comparator group (P=0.021).

However, it has been noted that if only 2 fewer patients achieved CR or CRu, the data would not be statistically significant (P=0.06).

The comparator arm was the doctors’ choice of other single-agent chemotherapy.

Grade 3-4 serious adverse events, including neutropenia, anemia, leukopenia, and thrombocytopenia, were higher in the pixantrone arm (77% versus 52%).

There were 12 deaths from adverse events in the pixantrone arm of the study from cardiac failure, infection, respiratory failure, and other causes.

There were only 5 deaths from adverse events in the comparator arm, suggesting that pixantrone is cardiotoxic, although the FDA did not claim to be able to draw conclusions relative to other NHL drugs.

The committee moved 2 patients from the pixantrone arm of the study to a different response category and 1 from the comparator arm after reviewing radiology scans. No bias was detected during the review.

ODAC was scheduled to meet Wednesday, February 10, but the meeting was postponed due to heavy snow.

The EXTEND PIX301 trial is sponsored by Cell Therapeutics, the company developing pixantrone.

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A1c Management and Modest Weight Loss in Type 2 Diabetes

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Anne Peters, MD, FACP, CDE
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Anne Peters, MD, FACP, CDE
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Anne Peters, MD, FACP, CDE
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Immediate-Release Therapy for Control of Nocturnal GERD

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Sheila E. Crowe, MD
Associate Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Digestive Health Center of Excellence
University of Virginia

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Sheila E. Crowe, MD
Associate Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Digestive Health Center of Excellence
University of Virginia

A supplement to Internal Medicine News supported by Supported by Santarus, Inc. The supplement is based on a faculty interview.





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Sheila E. Crowe, MD
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University of Virginia

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Chronic Constipation in the Elderly

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A supplement to Internal Medicine News supported by Takeda Pharmaceuticals North America, Inc. The supplement is based on a faculty interview.





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Anthony J. Lembo, MD
Assistant Professor of Medicine
Beth Israel Deaconess
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Harvard Medical School

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Anthony J. Lembo, MD
Assistant Professor of Medicine
Beth Israel Deaconess
Medical Center
Harvard Medical School

A supplement to Internal Medicine News supported by Takeda Pharmaceuticals North America, Inc. The supplement is based on a faculty interview.





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Anthony J. Lembo, MD
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Beth Israel Deaconess
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Hospitalized Patient Fall Fatalities Eliminated

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A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

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A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

A concerted effort to reduce patient falls in Minnesota hospitals culminated last year as the Gopher State reported zero fatal falls—a result heavily attributed to hospitalist efforts.

A report last month from Minnesota health officials shows that no patients died from falls in 2009. It was the first fatality-free reporting period since the state began publicly disclosing adverse events six years ago. In 2008, 10 fall-related fatalities were reported in Minnesota hospitals.

"We went through our order sets and eliminated potentially unnecessary medications across the board," says Scott Tongen, MD, a hospitalist and medical director for quality at United Hospital in St. Paul. "And we challenged hospitalists to stop prescribing those … and at the same time we had to work with the nursing staff."

Dr. Tongen says his hospital, which is part of the Allina Hospitals and Clinics system, attacked the issue of falls by emphasizing hourly rounding by the nursing staff and collaborating with HM leaders. The state also developed Minnesota Falls Prevention, an award-winning Web site that shines light on the issue of preventable falls.

"I think one of the keys to success is empowering the nursing staff to work with the hospitalist service in partnership to accomplish this goal," says hospitalist James Young, MD, who works at United and is president of SHM's Minnesota chapter. "I know that at United, our nurses are far from mute and are not bashful about telling us when a patient is at risk. We are not bashful in educating them about why sleepers aren't a great idea for elderly patients. … It’s a team effort."

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In the Literature: The Latest Research You Need to Know

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Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

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Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

Clinical question: Does B-type natriuretic peptide (BNP) have prognostic value for cardiovascular events independent of left ventricular end-diastolic pressure in patients suspected of having coronary artery disease?

Background: BNP has prognostic value in predicting death in multiple populations, including patients with stable coronary artery disease, independent of left ventricular ejection fracture (LVEF). However, BNP and invasively measured LV filling pressure correlate weakly, and there is little data on BNP’s ability to predict cardiovascular events independently of LV filling pressure.

Study design: Retrospective cohort study.

Setting: Private, nonprofit hospital.

Synopsis: The study examined 1,059 eligible patients who were referred for coronary angiography from March 2002 to April 2008. The patients were followed for a mean of almost two years.

BNP, LV end-diastolic pressure (LVEDP), and EF were measured within 24 hours of angiography. Outcomes included myocardial infarction (MI), heart failure (HF) admissions, and death.

In univariate analysis, BNP and EF were predictive of death and HF admissions as dichotomous and continuous variables; LVEDP was predictive only as a continuous variable. BNP as a continuous variable also was predictive of future MI.

In multivariate analysis, BNP predicted the composite outcome of HF admission and death, with a hazard ratio (HR) of 1.37. BNP also predicted death alone and HF admissions alone independent of EF and LVEDP.

Overall, BNP was a much better predictor of death and HF admissions than LVEDP. Because BNP is not closely linked to LVEDP, strategies to reduce BNP levels independent of LV filling pressure are warranted.

The study was limited by its retrospective nature and the fact that it included a heterogeneous population.

Bottom line: In patients with coronary disease, BNP is a stronger predictor of death and HF admission than LVEDP.

Citation: Rodgers RK, May HT, Anderson JL, Muhlestein JB. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am Heart J. 2009;158:777-783.

Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Dennis Chang, MD, Brian Markoff, MD, FHM, Erin Rule, MD, Andrew Dunn, MD, FACP, FHM, Division of General Internal Medicine, Mount Sinai School of Medicine, New York City

For more HM-related literature reviews, visit our Web site.

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ONLINE EXCLUSIVE: Audio interviews with annual meeting attendees

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Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.

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Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.

Kelly Wachsberg, MD, a third-year resident at Northwestern University's Feinberg School of Medicine in Chicago talks about what she learned at HM09.

Click here to listen to the audio interview.

Bipin Mistry, MD, talks about what he liked about HM09 in Chicago.

Click here to listen to the audio interview.

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Hospitalists in Haiti

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Hours after the devastating earthquake that shook the Haitian capital of Port-au-Prince, University of Miami Miller School of Medicine physicians, nurses, and administrators were drawing up plans to aid in the relief effort. One day after the quake, a tent hospital was erected at the airport, and dozens of providers were on the ground caring for the wounded, orphaned, and visibly shaken.

Hospitalists Amir Jaffer, MD, FHM, and Lisa Luly-Rivera, MD (photo, at right), recently returned from a five-day medical relief mission. They worked with surgeons and coordinated with nursing staff to ensure patients were properly hydrated and had the right pain medications. The staff also managed patients’ medical conditions and nutrition. Dr. Jaffer, an associate professor and the division chief of hospital medicine at the Miller School of Medicine, oversaw the transfer of 138 patients from a makeshift hospital to the new tent hospital, which opened Jan. 20 and offers spacious wards, a pathology lab, and two operating rooms.

“Most of the patients had a fracture, amputation, infected wound, or a spinal cord injury,” Dr. Jaffer says. “The conditions were dire when we landed. The role of the hospitalists was managing care. We also were involved in triaging patients who were being transferred.”

On Jan. 22, nearly 10 days after the quake, the university opened an imaging center radiology lab. “Some of the patients were splinted and needed X-ray,” Dr. Jaffer says, adding that more than 100 films were completed the first day. “Some patients were being brought in to us a week later who had fractures that had not been cared for.”

One of the poorest countries in the world, Haiti’s lack of infrastructure is wreaking havoc on rescue and relief efforts. The people are afraid to return to their homes, “and they have no place to go,” Dr. Jaffer says.

The 25 hospitalists in the HM group at the University of Miami Miller School of Medicine are planning five-day rotations to Haiti. The hospital needs translators, nurses, and internal-medicine specialists to cover the shifts of providers traveling to Haiti. If you’re interested in helping out, send an e-mail to the university. If you’d like to assist relief efforts in Haiti, make a donation to the American Red Cross.

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Hours after the devastating earthquake that shook the Haitian capital of Port-au-Prince, University of Miami Miller School of Medicine physicians, nurses, and administrators were drawing up plans to aid in the relief effort. One day after the quake, a tent hospital was erected at the airport, and dozens of providers were on the ground caring for the wounded, orphaned, and visibly shaken.

Hospitalists Amir Jaffer, MD, FHM, and Lisa Luly-Rivera, MD (photo, at right), recently returned from a five-day medical relief mission. They worked with surgeons and coordinated with nursing staff to ensure patients were properly hydrated and had the right pain medications. The staff also managed patients’ medical conditions and nutrition. Dr. Jaffer, an associate professor and the division chief of hospital medicine at the Miller School of Medicine, oversaw the transfer of 138 patients from a makeshift hospital to the new tent hospital, which opened Jan. 20 and offers spacious wards, a pathology lab, and two operating rooms.

“Most of the patients had a fracture, amputation, infected wound, or a spinal cord injury,” Dr. Jaffer says. “The conditions were dire when we landed. The role of the hospitalists was managing care. We also were involved in triaging patients who were being transferred.”

On Jan. 22, nearly 10 days after the quake, the university opened an imaging center radiology lab. “Some of the patients were splinted and needed X-ray,” Dr. Jaffer says, adding that more than 100 films were completed the first day. “Some patients were being brought in to us a week later who had fractures that had not been cared for.”

One of the poorest countries in the world, Haiti’s lack of infrastructure is wreaking havoc on rescue and relief efforts. The people are afraid to return to their homes, “and they have no place to go,” Dr. Jaffer says.

The 25 hospitalists in the HM group at the University of Miami Miller School of Medicine are planning five-day rotations to Haiti. The hospital needs translators, nurses, and internal-medicine specialists to cover the shifts of providers traveling to Haiti. If you’re interested in helping out, send an e-mail to the university. If you’d like to assist relief efforts in Haiti, make a donation to the American Red Cross.

Hours after the devastating earthquake that shook the Haitian capital of Port-au-Prince, University of Miami Miller School of Medicine physicians, nurses, and administrators were drawing up plans to aid in the relief effort. One day after the quake, a tent hospital was erected at the airport, and dozens of providers were on the ground caring for the wounded, orphaned, and visibly shaken.

Hospitalists Amir Jaffer, MD, FHM, and Lisa Luly-Rivera, MD (photo, at right), recently returned from a five-day medical relief mission. They worked with surgeons and coordinated with nursing staff to ensure patients were properly hydrated and had the right pain medications. The staff also managed patients’ medical conditions and nutrition. Dr. Jaffer, an associate professor and the division chief of hospital medicine at the Miller School of Medicine, oversaw the transfer of 138 patients from a makeshift hospital to the new tent hospital, which opened Jan. 20 and offers spacious wards, a pathology lab, and two operating rooms.

“Most of the patients had a fracture, amputation, infected wound, or a spinal cord injury,” Dr. Jaffer says. “The conditions were dire when we landed. The role of the hospitalists was managing care. We also were involved in triaging patients who were being transferred.”

On Jan. 22, nearly 10 days after the quake, the university opened an imaging center radiology lab. “Some of the patients were splinted and needed X-ray,” Dr. Jaffer says, adding that more than 100 films were completed the first day. “Some patients were being brought in to us a week later who had fractures that had not been cared for.”

One of the poorest countries in the world, Haiti’s lack of infrastructure is wreaking havoc on rescue and relief efforts. The people are afraid to return to their homes, “and they have no place to go,” Dr. Jaffer says.

The 25 hospitalists in the HM group at the University of Miami Miller School of Medicine are planning five-day rotations to Haiti. The hospital needs translators, nurses, and internal-medicine specialists to cover the shifts of providers traveling to Haiti. If you’re interested in helping out, send an e-mail to the university. If you’d like to assist relief efforts in Haiti, make a donation to the American Red Cross.

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The Hospitalist - 2010(02)
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The Hospitalist - 2010(02)
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