The Mount Sinai journal of medicine, New York
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More than a decade ago, Dr. Joseph Goldstein called attention to the increasing dissociation between scientific advances and their translation into improved health with his pithy analysis of the biotechnology industry: “1 new gene per day, 1 new company per week, 1 new drug per year.” Unfortunately, the gap continues to grow, with increasing concerns about whether the enormous increase in knowledge brought about by the sequencing of the human genome and other scientific advances are being matched by the translational effort. For example, a recent review by the Congressional Budget Office found that the dramatic increase in inflation-adjusted funding of biomedical research since 1970 by the pharmaceutical industry and the National Institutes of Health (NIH), in addition to the influx of capital from the biotechnology industry, has had only a minor impact on the number of truly new drugs approved by the Food and Drug Administration each year. The outlook for the immediate future does not appear to be much brighter, with declining numbers of new drugs being submitted for regulatory approval and the investment community expressing grave concerns about the prospects for both the biotechnology and pharmaceutical industries., It is not surprising, therefore, that there has been intense focus on how to successfully bridge the gap between scientific discovery and the development of new strategies to diagnose, treat, and prevent disease; this process is now commonly called translational research.
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Academic hospitalists have grown in number and influence over the past decade. This has fueled concerns about the effect of hospitalists on resident and student education. While the bulk of the literature favors the hospitalist teaching model to a more traditional model concerns remain that hospitalists may negatively impact housestaff autonomy and reduce exposure to subspeciality physicians. This paper will review the literature exploring the effect of the hospitalist teaching model on resident and student education.
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A do-not-resuscitate (DNR) order is commonly used for hospitalized patients with advanced illness. It reflects only the desires of a patient once he or she suffers a full cardiopulmonary arrest. It does not reflect preferences about other forms of life-sustaining treatments. This article reviews the definition of a DNR order, describes the evidence suggesting that physicians use a DNR order in making determinations about other life-sustaining treatments, and will provide tools such as the use of palliative care consultations and combined directives in discussing overall goals of care.
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The promise of the hospital medicine movement is that the hospitalist model of care will provide better outcomes than the system it replaced. This means improving the quality and processes of care, reducing inefficiencies and lowering costs. ⋯ While most internal medicine residency training programs stress inpatient care they underemphasize key components of a successful hospitalist career. This paper overviews the state of the hospitalist movement, the current educational training deficiencies and the methods to deliver hospitalist-focused training.