Today's Hospitalist. The Top Five.

1. FMT treatment cuts C. diff length of stay, mortality
New research backs the use of fecal microbiota transplant (FMT) to treat recurring C. diff, finding that the use of FMT vs. antibiotics delivers substantial benefits. In the randomized single-site trial, patients with recurring C. diff who received FMT had a nearly 30% greater chance of survival while their length of stay was cut in half and their risk of sepsis was reduced almost fourfold. Moreover, only five patients in the FMT group developed a bloodstream infection vs. 22 in the cohort receiving antibiotics. In related news, however, an NEJM report describes two cases of drug-resistant E. coli in patients who received FMT from a single donor. After one of those patients died, the FDA called for heightened screening of FMT donors. Read more in Annals.
2. Hospital prescribing may exacerbate heart failure
A new study that looked at inpatient prescribing that can exacerbate heart failure finds that such medications are often continued in the hospital or even initiated. Researchers looked at more than 550 Medicare beneficiaries hospitalized for heart failure between 2003 and 2014. Among those patients, 49% were prescribed medications before discharge that the AHA has identified as major heart-failure exacerbating agents, while 12% had the number of such scripts increased while they were hospitalized. Of particular concern was the number of patients receiving albuterol, metformin, NSAIDs and diltiazem. "These findings highlight an ongoing need to develop strategies to improve safe prescribing practices in this vulnerable population," the authors wrote. They also called for more research into best prescribing practices for patients with both heart failure and COPD or asthma. Read more from JACC Heart Failure.
3. Suffering from alarm fatigue? Changing parameters helps
Nonactionable alarms, which make up 70% of alarms, not only contribute to alarm fatigue but are a threat to patient safety. Researchers in a recent single-site study used interdisciplinary teams in the ICU to adjust the default alarm thresholds for arrhythmias, as well as specific parameters including oxygen saturation. The results: a reduction of nearly 47% in nonactionable alarms over the course of two weeks. Read more in the Journal of Nursing Care Quality.
4. Debt-free medical school comes with a catch
Pennsylvania's Geisinger Commonwealth School of Medicine is joining the (very short) list of medical schools offering students free tuition—but with a twist. In return for free tuition, students have to commit to working for Geisinger for four years after residency providing primary care. The Geisinger Primary Care Scholars Program will pick 40 students in both the first- and second-year of incoming classes and pay their tuition, fees, and a $2,000 monthly living stipend for four years. Students will be able to match to any residency program in the country, but they will need to specialize in family medicine, internal medicine or med-peds and return to Geisinger to work after residency to avoid having to refund their tuition. Recipients will be selected based on financial need, diversity, academic achievement and their likelihood of remaining in Geisinger's service area. Read more from HealthLeaders.
5. Does your EHR make you feel deficient?
Many charges have been leveled against EHRs, mainly that they are tools for billing and not for clinical support. But in a new essay, a hospitalist takes to task the "voice" of the new Epic system in her San Francisco hospital—a voice, the author writes, that exacerbates "medicine's culture of perfectionism" with constant reminders of tasks left undone, documentation that needs to be corrected, and messages that highlight users' "deficiencies and delinquencies." A "more humane" EHR would feature a different tone, language and graphics, points out author Emily Silverman, MD, who's also the creator of The Nocturnists, a medical storytelling live show and podcast. Until then, the software's intimidating voice "will continue to contribute to the profession’s growing sense of despair." Read more from the New York Times.
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