Institute for Healthcare Improvement (IHI)

Author in the Room: Incontinence in Older Women

August 2010 Author in the Room^® Teleconference

 

Author: Patricia S. Goode, MD

 

Article: "Incontinence in Older Women"

 

Summary Points:

• Urinary incontinence (UI) is very common in older women and should be in Review of System for ALL older women.
• Initial behavioral therapy (pelvic floor muscle exercises, urge and stress strategies, caffeine avoidance) is easy to do and should be the FIRST line treatment for older women with urge and stress urinary incontinence.
• Modifiable Contributing Factors for urinary incontinence should be addressed before prescribing antimuscarinic medications and include: urinary tract infection, constipation, diabetes control, mobility impairment, sleep apnea, caffeine, timing of diuretics, oversedation.​

Author in the Room: Detecting Impaired or Incompetent Physicians

September 2010 Author in the Room^® Teleconference

 

Author: Mathew Wynia, MD, MPH

 

Article: "The Role of Professionalism and Self-Regulation in Detecting Impaired or Incompetent Physicians"

 

Summary Points:

• Describe the frequency with which physicians report encountering other physicians who may be impaired or incompetent
• Explain the three basic options available to policy makers for regulating and ensuring the quality of medical practitioners
• Name at least three newer mechanisms by which the profession of medicine is enhancing its ability to self-regulate and detect physicians who are not providing high-quality care

Author in the Room: Pertussis Screening and Treatment

​October 2010 Author in the Room^® Teleconference

 

Author: Ralph Gonzales, MD, MSPH

 

Article: "Does This Coughing Adolescent or Adult Patient Have Pertussis?"

 

Summary Points:

• When evaluating adolescents and adults with persistent cough illness, the presence of classic symptoms of pertussis (paroxysmal cough, whooping cough, post-tussive emesis) modestly increase the likelihood of pertussis, and their absence modestly decreases the likelihood of pertussis; but they are not strong enough to rule-in or rule-out disease.
• Most patients in whom pertussis is suspected will not derive symptomatic benefit from antibiotic treatment because their illness duration is usually >10 days.
• Vigilant testing and treatment should be provided to adolescents and adults who have been exposed to a known case of pertussis, or have contact with individuals at high risk for serious complications of pertussis (i.e., child care providers and teachers, health care workers, and patients who live or work with infants <6 months of age; unvaccinated children; or immunosuppressed individuals).

Author in the Room: Managing Medications in Clinically Complex Elders

November 2010 Author in the Room^® Teleconference

 

Author: Michael A. Steinman, MD

 

Article: "Managing Medications in Clinically Complex Elders"

 

Summary Points:

• A systematic approach to approaching prescribing is essential. 
• An essential first step is to know what medications the patient is actually taking right now, and to clarify what goals you are trying to achieve by prescribing drugs. 
• It is critical to individualize care based on what benefits and harms a patient is actually experiencing from their drugs.​

Author in the Room: Medical Team Training and Surgical Mortality

December 2010 Author in the Room^® Teleconference

 

Author: Julia Neily, RN, MS, MPH

 

Article: "Implementation of a Medical Team Training Program and Surgical Mortality"

 

Summary Points:

• Improved communication is associated with decreased surgical mortality.
• Since there was a dose response relationship, this indicates that continuing follow up was related to better results.
• Briefings and debriefings is more than a checklist, it is about the conversation.​

Author in the Room: Treatment for Men with Low-Risk Prostate Cancer

January 2011 Author in the Room^® Teleconference

 

Author: Julia Howell Hayes, MD

 

Article: "Active Surveillance Compared with Initial Treatment for Men with Low-Risk Prostate Cancer: A Decision Analysis"

 

Summary Points:

• Active surveillance is a reasonable approach to consider for carefully selected 65-year-old men with low-risk clinically localized prostate cancer, providing improved quality of life even if associated with an increased risk of prostate cancer-specific death.
• The results depend on patient preferences.
• It is crucial that individual patients make this decision in conjunction with their doctors.​

Author in the Room: Herpes Zoster in Older Adults

February 2011 Author in the Room^® Teleconference

 

Author: Steven J. Jacobsen, MD, PhD

 

Article: "Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease"

 

Summary Points:

• The findings suggest that the zoster vaccine is as effective in a community setting with its mixed population and routine clinical practices as was found in the controlled clinical trials. 
• To date, the uptake of the zoster vaccine has been modest due to a number of reasons, including weaknesses in the adult vaccine infrastructure, knowledge and beliefs of clinicians and patients, periodic supply shortfalls, as well as financial reasons.
• Because zoster and its attendant neurologic complication of postherpetic neuralgia are common and serious among the elderly, it seems prudent to recommend zoster vaccine. The potential impact of vaccination on the burden of the disease in this population is significant.

Author in the Room: Antirheumatic Drugs

March 2011 Author in the Room^® Teleconference

 

Author: Gabriela Schmajuk, MD

 

Article: "Factors Associated with the Receipt of Disease-Modifying Antirheumatic Drugs Among Patients with Rheumatoid Arthritis"

 

Summary Points:

• One third of Medicare managed care patients diagnosed with rheumatoid arthritis (RA) are not receiving disease-modifying antirheumatic drugs (DMARDs).
• There is variation in DMARD receipt based on “accidental factors”: sociodemographics, geographic location, and health plan.
• Since DMARD use is the main way to affect outcomes in RA, these patient groups and the physicians treating them are reasonable target for quality improvement interventions.

Author in the Room: Axillary Dissection and Breast Cancer

April 2011 Author in the Room^® Teleconference

 

Author: Monica Morrow, MD

 

Article: "Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial"

 

Summary Points:

• Axillary dissection is a major cause of morbidity after breast cancer surgery.
• In women who have 3 or fewer sentinel nodes and are have breast conserving surgery, removal of only the sentinel nodes produces local axillary control in 99 percent of cases.
• Axillary dissection does not contribute to survival.
• In women with T1 and T2 clinically node negative BR CA who are undergoing lumpectomy and whole breast radiation, removal of sentinel nodes only is an appropriate management strategy.

Author in the Room: Cardiovascular Disease in Hypertensive Persons

May 2011 Author in the Room^® Teleconference

 

Authors: Lydia A Bazzano, MD, PhD, and Angela M. Thompson

 

Article: "Antihypertensive Treatment and Secondary Prevention of Cardiovascular Disease Events Among Persons Without Hypertension: A Meta-analysis"

 

Summary Points:

• Cardiovascular disease (CVD) risk increases beginning at systolic blood pressure levels of 115 mmHg and the use of antihypertensive medications among patients with a history of CVD or diabetes and without hypertension has been debated.
• Among patients with clinical history of  CVD but with blood pressure lower than 140/90 mmHg, antihypertensive treatment was associated with decreased risk of stroke, congestive heart failure, composite CVD events, and all-cause mortality.  
• Additional randomized trial data are necessary to assess these outcomes in patients without CVD events.