Institute for Healthcare Improvement (IHI)

Daniel Hoody “One of the initial barriers was some skepticism …”

Amanda Brosnan “Framing the questions in a positive light got people to think more positively …”

Allison Reid “I continued a cadence of meeting weekly …”

Alison Chetlen “That’s something that I can absolutely fix …”

Doug Bonacum describes how SBAR solved an important problem he was seeing.

Author in the Room: Estrogen and Urinary Incontinence

March 2005 Author in the Room^® Teleconference

 

Author: Susan L. Hendrix, DO

 

Article: "Effects of Estrogen with and Without Progestin Therapy on Urinary Incontinence"

 

Summary Points:

• Hormone replacement therapy (HRT) should not be the treatment of choice for post-menopausal women with urinary incontinence.
• Post-menopausal women taking HRT should be regularly monitored for signs and symptoms of urinary incontinence.
• Post-menopausal women on HRT who develop urinary incontinence should be weaned off HRT.
• Post-menopausal women who elect to start HRT should be warned about the risks of developing urinary incontinence.

Author in the Room: Hypertension Treatment

April 2005 Author in the Room^® Teleconference

 

Author: Jackson T. Wright, Jr., MD, PhD, FACP

 

Article: "Outcomes in Hypertensive Black and Nonblack Patients Treated With Chlorthalidone, Amlodipine, and Lisinopril"

 

Summary Points:

• Thiazide-type diuretics are safe and effective for the treatment of blood pressure in both blacks and non-blacks.
• The effects of thiazide-type diuretics in reducing blood pressure and clinical outcomes overwhelm the observed adverse metabolic affects of those medications.
• A standardized and inexpensive approach to initial blood pressure management is possible and should be adopted.
• Methods of monitoring and improving antihypertensive use are warranted

Author in the Room: Children with Elevated Blood Lead Levels

May 2005 Author in the Room® Teleconference

 

Author: Alex R. Kemper, MD, MPH, MS

 

Article: "Follow-up Testing Among Children with Elevated Screening Blood Lead Levels"

 

Summary Points:

• About half the children (six years and younger) with elevated blood lead levels did not receive follow-up testing.
• Non-white children, and those living in urban as well as high-risk lead settings, were less likely to receive follow-up testing compared to their counterparts.
• Follow-up testing for children with high blood lead levels is essential for managing lead poisoning and for maximizing cognitive development.
• Interventions are needed to overcome disparities in care.

Author in the Room: Update on Tuberculosis

June 2005 Author in the Room^® Teleconference

 

Author: Henry M. Blumberg, MD

 

Article: "Update on the Treatment of Tuberculosis and Latent Tuberculosis Infection"

 

Summary Points:

• Tuberculosis is a public health problem. The responsibility for prescribing an appropriate regimen and ensuring that treatment is completed is assigned to the public health program or the treating physician, not the patient.
• Directly observed therapy is recommended for all patients being treated for active TB. This will necessitate the need for greater collaboration between the treating physician and the public health department.
• Initial therapy for newly diagnosed patients with tuberculosis consists of a 4-drug regimen, including isoniazid, rifampin, pyrazinamide and ethambutol.
• Testing for latent TB infection should be targeted at those who are at increased risk of progression to active TB.
• Despite its limitations, the tuberculin skin test remains the most commonly used test for the diagnosis of latent TB infection; newer diagnostic tests for latent TB infection are on the horizon.
• Active tuberculosis should be excluded before beginning treatment for latent tuberculosis infection.
• Nine months of isoniazid is the preferred therapy for the treatment of latent TB infection.

Author in the Room: Combined Vaccines

July 2005 Author in the Room^® Teleconference

 

Author: Michael E. Pichichero, MD

 

Article: "Combined Tetanus, Diphtheria, and 5-Component Pertussis Vaccine for Use in Adolescents and Adults"

 

Summary Points:

• The combined tetanus, diphtheria, and 5-component pertussis vaccine is needed.
• There has been a 300 percent increase of pertussis among US adolescents in the last three years.
• The combined tetanus, diphtheria, and 5-component pertussis vaccine is safe, as the reactions are the same as the tetanus vaccine.
• Universal use recommended: On June 30, 2005, the American Academy of Pediatrics (ASAP), America Academy of Family Physicians (AFAR), and the Advisory Committee on Immunization Practices (ACID) all recommended the universal use of the combined tetanus, diphtheria, and 5-component pertussis vaccine or its competitor vaccine for adolescents.