Institute for Healthcare Improvement (IHI)

Author in the Room: Effectiveness of Collaborative Care for Adults with Alzheimer's

June 2006 Author in the Room^® Teleconference

 

Author: Christopher Callahan, MD

 

Article:  "Effectiveness of Collaborative Care for Older Adults with Alzheimer Disease in Primary Care"

 

Summary Points:

• Primary care practices have standard protocols to offer a patient with Alzheimer Disease and their caregivers.
• The quality of care of many geriatric syndromes, including Alzheimer Disease, can be improved by implementing a collaborative care model.
• Similar to many geriatric syndromes, medication may be useful, but it is not enough. Medications are one part of a package of care.

Author in the Room: Tamoxifen versus Raloxifene on Risk for Invasive Breast Cancer

July 2006 Author in the Room^® Teleconference

 

Author: Victor G. Vogel, MD, MHS

 

Article: "The Effects of Tamoxifen versus Raloxifene on the Risk of Developing Invasive Breast Cancer and Other Disease Outcomes: The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 Trial" 

Summary Points:

• Raloxifene is as effective in reducing the risk of invasive breast cancer in postmenopausal women who are at increased risk of the disease.
• The safety profile of raloxifene is more favorable than tamoxifen with fewer hysterectomies, uterine malignancies, serious thrombotic events, and cataracts.
• Both physicians and patients are familiar with raloxifene and its use for preventing and treating osteoporosis, and there is a long experience with its use in healthy women.

Author in the Room: Helping Patients Stop Smoking

August 2006 Author in the Room^® Teleconference

 

Authors: David Gonzales, PhD, and Stephen Rennard, MD

 

Article: "Helping Patients Stop Smoking: Varenicline vs. Bupropion"

 

Summary Points:

• There is a new and novel pharmaceutical approach to treating nicotine addiction that helps smokers quit by specifically targeting nicotine receptors.
• Efficacy for varenicline was three to four times that of placebo and twice that of bupropion at the end of 12 weeks of treatment, but abstinence rates in all groups declined after drug treatment ended.
• The launch of a new smoking cessation medication will likely drive patient demand for smoking cessation services. Medical practices should be prepared to respond to this demand by having a clear, systematic approach to smoking cessation.

Author in the Room: Screening for Intimate Partner Violence

September 2006 Author in the Room^® Teleconference

 

Author: Harriet L. MacMillan, MD, MSc, FRCP(C)

 

Article: "Approaches to Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial"

 

Summary Points:

• Even though we have long assumed that clinicians should ask patients directly about intimate partner violence, this study shows that self-complete methods for soliciting such information are preferred by women and may be more efficient.
• The prevalence rate for intimate partner violence differs by setting and population and varies significantly from approximately 4 percent to approximately 18 percent.
• While this study provides evidence on the best methods to solicit information on intimate partner violence, it doesn’t tell us if collecting this information improves outcomes for women exposed to such violence. A randomized controlled trial evaluating the effectiveness of screening women for intimate partner violence in health care settings is currently underway.

​

Author in the Room: Treatment of Acute Otitis

October 2006 Author in the Room^® Teleconference

 

Author: David Mark Spiro, MD, MPH

 

Article: "Wait-and-See Prescription for the Treatment of Acute Otitis"

 

Summary Points:

• Wait-and-See Prescription (WASP) is a viable approach to managing children with acute otitis media. Compared with the standard prescription group, the WASP group filled the antimicrobial prescription much less frequently and had equivalent clinical outcomes.
• Within the WASP group, fever and ear pain were associated with filling the prescription, demonstrating that parents are able to make appropriate care decisions when given clear guidance.
• In the management of acute otitis media, important points for clinicians are first to make right diagnosis and then to provide sufficient analgesia. Adequate pain control allows parents to better manage their sick child and use antimicrobials judiciously while also reducing the risk of medical side effects and antibiotic resistance.

Author in the Room: Fish Intake, Contaminants, and Human Health

November 2006 Author in the Room^® Teleconference

 

Author: Dariush Mozaffarian, MD, DrPH

 

Article: "Fish Intake, Contaminants, and Human Health: Evaluating the Risks and the Benefits"

Summary Points:

• For the general population, the health benefits of fish intake far outweigh the risks.
• Women of childbearing age, nursing mothers and young children should
  eat up to two servings of fish per week as the benefits of fish intake
  still outweigh the risks.
• Given the magnitude of the benefits, physicians should regularly give dietary advice to patients for cardiovascular disease prevention.

Author in the Room: PSA Screening Among Elderly Men

December 2006 Author in the Room^® Teleconference

 

Author: Louise C. Walter, MD

 

Article: "PSA Screening Among Elderly Men with Limited Life Expectancies"

Summary Points:

• Most cancer screening guidelines do not recommend screening elderly persons in poor health who have limited life expectancies because the harms of screening (which occur immediately) outweigh the potential benefits (which occur many years in the future).
• PSA screening rates among elderly men with limited life expectancies should be much lower than current practice to avoid harming these men with unnecessary tests and procedures.
• Guidelines should be more explicit about how life expectancy is defined and provide tools to help clinicians identify men with poor prognoses who are most likely to be harmed by PSA screening, considering both age and the presence of severe disease.

Author in the Room: Results from the Fracture Intervention Trial Long-term Extension

January 2007 Author in the Room^® Teleconference

 

Author: Dennis M. Black, PhD

 

Article: "The Effects of Continuing or Stopping Alendronate after Five Years of Treatment: Results from the Fracture Intervention Trial Long-term Extension (FLEX)" 

Summary Points:

• The long-term use of alendronate for up to 10 years is safe.
• Those who discontinued treatment at 5 years lost bone mass compared to those who continued, but the bone loss was only moderate. Rates of fracture were similar among those who continued versus those who discontinued except for clinical vertebral fractures which, although relatively uncommon, were higher in those who discontinued treatment.
• Results suggest that after 5 years of alendronate, many women may discontinue therapy for up to 5 years. Although, those at high risk of clinical vertebral fracture may benefit by continuing.

Author in the Room: Screening for Patient Falls

February 2007 Author in the Room^® Teleconference

 

Author: David Ganz, MD, MPH

 

Article: "The Rational Clinical Exam: Will My Patient Fall?"

 

Summary Points:

• Screening for falls is as simple as asking the patient if she's fallen in the past year. For patients who have not fallen, ask about gait or balance problems (e.g., "Do you have a walking or balance problem?").
• Most older patients who have a history of falls in the past year, or a gait/balance problem, have at least a 50 percent chance of falling in the coming year. You may want to do a more thorough evaluation on these patients.
• To make screening easy for new patients, add into your pre-visit questionnaire questions that ask about a history of falls and/or gait/balance problems. Or, have your office staff ask these questions routinely when patients are being checked in.

 

Author in the Room: Algorithms for Assessing Cardiovascular Risk in Women

March 2007 Author in the Room^® Teleconference

 

Author: Paul M. Ridker, MD, MPH

 

Article: "Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score"

 

Summary Points:

• Half of all heart attacks and strokes occur among those with normal cholesterol levels and 15 percent to 20 percent occur among those with no major risk factors at all.
• The major breakthroughs in understanding cardiovascular disease over the past decade include insights about inflammation and genetics. Each of these can easily be ascertained with either a simple blood test (hsCRP for inflamamtion) or a simple question about parental history of myocardial infarction.
• By incorporating these two new measures into how we think about risk, a new risk tool was derived known as the Reynolds Risk Score. 
• This is a win-win for everyone as it allows us to better target therapies, avoid toxicity, and improve overall prevention strategies for heart disease.