Institute for Healthcare Improvement (IHI)

Author in the Room: Computed Tomography Screening and Lung Cancer Outcomes

April 2007 Author in the Room^® Teleconference

 

Author: Peter B. Bach, MD

 

Article: "Computed Tomography Screening and Lung Cancer Outcomes"

 

Summary Points:

• Screening and other prevention approaches involve subjecting very large numbers of people to an intervention, with the expectation that a few will benefit, but most will not (as they would have never developed the condition anyway). 
• In general, screening for diseases such as cancer will uncover some reservoir of abnormalities that appear to be precursors to clinical disease but are not yet causing disease.
• We really have no evidence to support screening for lung cancer right now with any technology.
• We really should be advocating for our patients to help them understand why they shouldn't have this test until we know that it is more likely to hurt them or help them.

Author in the Room: Acute Treatment of Migraine

May 2007 Author in the Room^® Teleconference

 

Author: Jan L. Brandes, MD

 

Article: "Sumatriptan-Naproxen for Acute Treatment of Migraine"

Summary Points:

• Evidence from two replicate RDBPC trials showed sumatriptan-naproxen as a fixed dose combination was superior in treating an attack of migraine when compared to sumatriptan alone, naproxen alone, or placebo.
• Most importantly, given that migraine attacks in adults are 4 to 72 hours in duration, the fixed dose combination of suma-naproxen was significantly more effective that sumatriptan monotherapy or naproxen monotherapy in providing a 24 hour sustained pain free response.
• Patients using the fixed dose combination therapy were less likely to use rescue medication or to have headache recurrence, and did not experience any penalty in side effects using the combination.

Author in the Room: Aspirin Dose for the Prevention of Cardiovascular Disease

June 2007 Author in the Room^® Teleconference

 

Author: Steven R. Steinhubl, MD

 

Article: "Aspirin Dose for the Prevention of Cardiovascular Disease"

Summary Points:

• While aspirin is generally a safe drug, and extremely effective, with over 50 million US adults taking it everyday for cardiovascular disease prevention, even a very small incidence of side-effects can have major implications. Consistent with this, one study found that the most common medication leading to an adverse event requiring hospitalization was aspirin for cardiovascular disease prevention.
• In terms of preventing heart attacks, strokes or cardiovascular deaths, no clinical trial has identified an aspirin dose more efficacious than 75 to 81mg daily.
• Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk. For example, in the US alone, if everyone took 325mg of aspirin daily instead of 81mg, based on observational data, this could translate into nearly 1 million additional major bleeding complications a year.

Author in the Room: Folic Acid for Prevention of Colorectal Adenomas

July 2007 Author in the Room^® Teleconference

 

Authors: Bernard Cole, PhD, and Robert S. Sandler, MD

 

Article: "Folic Acid for Prevention of Colorectal Adenomas"

Summary Points:

• Folic acid supplementation is not useful for preventing colorectal adenomas.
• Folic acid supplementation may be harmful through increasing colorectal adenomas.
• Practitioners and patients should wait for strong evidence before initiating therapies given the potential for waste and unintended adverse consequences.

Author in the Room: Acute Emotional Stress and Cardiac Arrhythmias

August 2007 Author in the Room^® Teleconference

 

Author: Roy C. Ziegelstein, MD

 

Article: "Acute Emotional Stress and Cardiac Arrhythmias"

 

Summary Points:

• Episodes of emotional stress, especially when sudden, severe, and unexpected, may have significant adverse effects on the heart.
• Acute emotional stress can increase sympathetic stimulation of the heart and can alter brain activity in a way that makes the heart more susceptible to rhythm disturbances.
• Since episodes of emotional stress are almost inevitable in life, part of a healthy lifestyle is learning how to deal effectively with stress.

Author in the Room: HPV Vaccine in Young Women with Preexisting Infection

September 2007 Author in the Room^® Teleconference

 

Author: Douglas R. Lowy, MD

 

Article: "HPV Vaccine in Young Women with Preexisting Infection"

 

Summary Points:

• The HPV vaccine has been shown to work very well in preventing new (incident) infection and disease caused by the HPV types targeted in the vaccine.
• This study shows that HPV vaccination does not hasten clearance of existing (prevalent) infection with the HPV types targeted by the vaccine (HPV16 and 18).
• It is most cost-effective to administer the vaccine before patients are exposed to HPV, because the vaccine is effective in preventing new infection but does not appear to be effective in treating established infection.

Author in the Room: Effectiveness of Teaching Quality Improvement to Clinicians

October 2007 Author in the Room^® Teleconference

 

Author: Romsai T. Boonyasai, MD, MPH

 

Article: "Effectiveness of Teaching Quality Improvement to Clinicians"

 

Summary Points:

• Quality improvement (QI) curricula are often effective in improving learners’ QI-related participation, attitudes, and knowledge.
• QI curricula are less often associated with clinical improvements.
• Clinical improvements occur more often when learners engage in multiple small cycles of change, and when they have individualized coaching in QI, access to their performance data, and access to predeveloped QI tools.

Author in the Room: Invasive MRSA Infections in the US

November 2007 Author in the Room^® Teleconference

 

Author: Monina Klevens, DDS, MPH

 

Article: "Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the United States"

Summary Points:

• The magnitude of MRSA infection is significant, demonstrating that it is a major health care and public health issue.
• The majority of invasive MRSA infections are healthcare-associated; hospitals and other health care facilities should make MRSA prevention a priority.
• MRSA skin infections are common in the community and rarely become life threatening or invasive.

Author in the Room: Using Pedometers to Increase Physical Activity

December 2007 Author in the Room^® Teleconference

 

Author: Dena M. Bravata, MD, MS

 

Article: "Using Pedometers to Increase Physical Activity and Improve Users' Health"

Summary Points:

• Pedometer users increase their physical activity. They walked 2000 steps per day more than people who do not use a pedometer.  2000 steps is equivalent to about 1 mile per day or about 100 calories per day.
• Having a daily step goal is important for increasing physical activity with a pedometer. Pedometer users with any goal — either 10,000 steps per day or an individualized step goal — increase their physical activity whereas those pedometer users without a goal do not.
• Pedometer users lose weight and lower their blood pressure. 
• Pedometer interventions that take place in the workplace are less likely to result in improvements in physical activity than interventions that took place in non-workplace settings. This is because the people who chose to participate in workplace interventions already had relatively high baseline physical activity which suggests that workplace interventions should target sedentary employees.

Author in the Room: Treatment of Acute Sinusitis

January 2008 Author in the Room^® Teleconference

Author: Ian George Williamson, MD

Article: "Antibiotics and Topical Nasal Steroid for Treatment of Acute Sinusitis"

Summary Points:

• Antibiotics are not so effective in the routine treatment of cases of acute sinusitis even when of probable bacterial origin, and should therefore be used more judiciously and with greater caution.
• Expectations should not necessarily be for antibiotics but balanced risk assessments and symptom advice are still important.
• Findings of lack of efficacy for antibiotics should drive a research agenda which aims to identify subgroups that might benefit from their use and/or other types of treatment.