Procalcitonin and other changes in medicine

This issue focuses on procalcitonin testing, hospitalist training in residency, oncology care communication, and femoral access for central lines.

This issue of ACP Hospitalist highlights how rapidly hospital medicine changes. Our main story focuses on procalcitonin, a lab test that's become widely available only in recent years and gained expanded FDA approval just last year. According to experts, it has the potential to reduce unnecessary antibiotic use but some caveats and pitfalls make it uncertain whether the full benefits will be realized.

Another article in this issue looks at the growing number of residency electives that prepare internal medicine trainees to be hospitalists. Most of today's hospitalists entered the field without such specific training, but they see benefits to offering potential future colleagues at least a brief preview of the field. The pioneers in this area had to design such programs on their own, but they are beginning to collaborate on more formal structures for those following in their footsteps.

This month's Success Story offers an example of how new problems may make old practices relevant again. One hospital has fought the opioid epidemic by encouraging prescribers to consider subcutaneous delivery of opioids in place of IVs, and the physician leading the project noted that older nurses and doctors remembered when that was the usual method.

A Perspectives article in this issue offers another example of the sometimes circular nature of practice changes, describing how the femoral vein used to be considered an option for central venous access. Guidelines have since recommended that it be avoided, but the authors of this article cite recent evidence to support their claim that femoral access may be best for some patients.

Also in this issue, conference coverage brings you communication strategies from the American Society of Clinical Oncology's annual meeting. A Test Yourself from MKSAP 17 provides related questions.

Have any questions for us? Please always feel free to send an email.

Stacey Butterfield