Institute for Healthcare Improvement (IHI)

Author in the Room: Hearing Deficits in the Older Patient

April 2012 Author in the Room® Teleconference

 

Author: James T. Pacala, MD, MS

 

Article: Hearing Deficits in the Older Patient

 

Summary Points:

• Age related hearing loss is extremely common and under recognized by most healthcare providers.
• There are many effective methods of detection of hearing loss that are easy and efficient.
• While the main stay of treatment is amplification, there remain many challenges to effective hearing aid use.

Author in the Room: Should a Healthy 55-Year-Old Man Be Treated with a Statin?

May 2012 Author in the Room® Teleconference

 

Authors and Articles:

 

Michael Blaha, MD, MPH, suggests that the available data do support treatment:

Statin Therapy for Healthy Men Identified as “Increased Risk”

Rita Redberg, MD, MSc, suggests that the available data do not support treatment.

Healthy Men Should Not Take Statins

 

Summary Points:

 

Summary Points from Dr. Michael Blaha:

• High-quality literature supports statins for reduction of first heart attack and stroke, in addition to a mild decrease in all-cause mortality over 3 to 5 years.
• The key to efficient use of statins in primary prevention is risk stratification.
• We must demand high-quality evidence for benefit and for harm in a potentially beneficial medication class such as statins.
• Physicians should adhere to national guidelines to guide statin use in primary prevention. 

 

Summary Points from Dr. Rita Redberg:

• Drugs given to asymptomatic persons should help them to feel better and live longer.
• Statins do not meet these criteria.
• Lifestyle is a cornerstone of primary prevention

Author in the Room: Diagnosis and Treatment of Depression in Adults with Comorbid Medical Conditions

April 2012 Author in the Room® Teleconference

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Author: Mary A. Whooley, MD

 

Article: Diagnosis and Treatment of Depression in Adults with Comorbid Medical Conditions

 

Summary Points:

• Depression screening has no benefit unless it is combined with team-based management.
• Self-management strategies (behavioral activation and exercise) improve depression.
• “TEAMcare” can improve both depression and chronic medical conditions.

Author in the Room: Benefits and Harms of CT Screening for Lung Cancer

 

Authors and Articles:

 

Peter B. Bach, MD, MAPP

Benefits and Harms of CT Screening for Lung Cancer

 

George T. O’Connor, MD, MS

Accompanying Editorial

 

Summary Points:

• Three randomized trials have examined CT screening for lung cancer's impact on lung cancer mortality: one showed a benefit, the other two did not but were smaller studies.
• CT screening does not appear to reduce mortality from causes other than lung cancer.
• There are still a lot of uncertainties regarding the risks and how to mitigate them.

Author in the Room: Antiretroviral Treatment for Adult HIV Infection: 2012 Recommendations

August 2012 Author in the Room® Teleconference
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Authors: Melanie A. Thompson, MD, and Paul A. Volberding, MD 

 

Article: Antiretroviral Treatment of Adult HIV Infection: 2012 Recommendations of the International Antiviral Society–USA Panel

  
Summary Points:

• Antiretroviral treatment is recommended and should be offered to all persons with HIV, regardless of CD4 cell count.
• Particular attention should be paid to the design of an antiretroviral regimen for persons with concurrent conditions such as viral hepatitis, opportunistic infections, and other medical diseases because of the potential for drug interactions.
• Monitoring of entry into and retention in HIV care, adherence to antiretroviral therapy, and quality of care indicators is recommended and should be used to increase care engagement and quality.

 

Author in the Room: Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals

August 2012 Author in the Room® Teleconference

 

Author: Philip Greenland, MD

 

Article: Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals

 

Summary Points:

• In comparison to other competing biomarkers and risk factors, coronary artery calcium (CAC) is currently the most potent risk marker of subclinical CHD.
• CAC was shown in several observational studies to improve the prediction of risk beyond traditional risk factors.
• In this JAMA paper CAC outperformed various competing risk assessment markers among asymptomatic people at intermediate risk for CHD.  Whether CAC should be used in routine clinical practice, however, is still a matter of personal opinion or further research.

Author in the Room: Controlling Urban Epidemics of West Nile Virus Infection

August 2012 Author in the Room® Teleconference

 

Author: Robert W. Haley, MD

 

Article: Controlling Urban Epidemics of West Nile Virus Infection

 

Summary Points:

• Epidemics of West Nile viral disease have become a serious medical and public health challenge that will be with us for the foreseeable future.
• Ultra-low volume (ULV) aerial spraying of urban areas, guided by surveillance of mosquito trap positivity and human cases, is necessary and cost-effective to prevent chronic neurologic disability and death.
• Complete, accurate and timely diagnosis of West Nile viral disease in an epidemic is vitally important to spare patients needless prolonged antimicrobial therapy and build support for public health control measures.

Author in the Room: Strategies to Help a Smoker Who Is Struggling to Quit

November 2012 Author in the Room® Teleconference

 

Author: Nancy A. Rigotti, MD

 

Article: Strategies to Help a Smoker Who Is Struggling to Quit

 

Summary Points:

• Treat tobacco use like the chronic disease that it is. Don't give up if your first few efforts do not succeed.
• Medications and brief counseling are each effective, but combining the two is most effective.
• Guide smokers to free national resources like the tobacco quit lines (1-800-QUIT-NOW).
• New noncombustible tobacco products are coming.

Author in the Room: Evidence-Based Management of Behavioral Symptoms in Dementia Using Nonpharmacologic Approaches

December 2012 Author in the Room® Teleconference

 

Authors: Laura N. Gitlin, PhD, Helen C. Kales, MD, and Constantine G. Lyketsos, MD, MHS

 

Article: Evidence-Based Management of Behavioral Symptoms in Dementia Using Nonpharmacologic Approaches

 

Summary Points:

• Attending to behavioral symptoms is part of comprehensive dementia care and requires ongoing long-term management
• Use six steps to systematically prevent, assess, manage, eliminate, or reduce behavioral symptoms
• Use a combination of nonpharmacologic approaches
• Keep trying; nonpharmacologic approaches are relatively adverse free
• Create a health professional team to offset time needed for provision of nonpharmacologic approaches

 

Author in the Room: Management of Gout: A 57-Year-Old Man with a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency

January 2013 Author in the Room® Teleconference

 

Author: Robert H. Shmerling, MD

 

Article: Management of Gout: A 57-Year-Old Man with a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency

 

Summary Points:

• We now have new treatments and guidelines for the treatment of gout.
• Appropriate use of therapeutics for gout, both new and old, will provide optimal outcomes for the rising number of patients with this common disease.