Institute for Healthcare Improvement (IHI)

Author in the Room: Trends in Opioid Prescribing in US EDs

February 2008 Author in the Room^® Teleconference

 

Author: Mark J. Pletcher, MD, MPH

 

Article: "Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments"

 

Summary Points:

• Doctors appear to prescribe opioids less often to blacks and Hispanics/Latinos than they do to whites in the emergency department. 
• These differences do not appear to be explained by differences in type or severity of pain.

Author in the Room: Improving Patient Safety by Taking Systems Seriously

March 2008 Author in the Room^® Teleconference

 

Author: Stephen M Shortell, PhD

 

Article: "Improving Patient Safety by Taking Systems Seriously"

Summary Points:

• To make real progress in patient safety will require redesigning the underlying system of care such that health care professionals and institutions providing a continuum of services from prevention to hospice can address multiple conditions and episodes over time. A "culture of systems" must be established.
• Competing priorities, professional autonomy, solo and small physician practices, disciplinary silos, misaligned financial incentives, and inadequate feedback about performance all undermine efforts to create safe health care systems.
• A number of strategic, cultural, technical, and structural barriers need to be addressed to ensure safer care. This includes the need for patient safety organizations to gather information across the continuum of care and provide both rapid feedback to practitioners and analyze trends over time.

Author in the Room: Strategies for Sustaining Weight Loss

April 2008 Author in the Room^® Teleconference

 

Author: Dr. Laura P. Svetky, MD, MHS

 

Article: "Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial"

 

Summary Points:

• Weight loss is feasible and long-term weight loss is possible.
• Ongoing personal contact and technology-based interventions were effective but the overall benefits were small.
• The role of providers is to reinforce the message that weight loss can prevent and treat multiple chronic conditions. Even small amounts of weight loss can lead to significant health benefits.  
• Our focus should be on long-term healthy life style changes rather than dieting, which is by its very nature short term.

Author in the Room: Atherosclerosis in Diabetes Patients

May 2008 Author in the Room^® Teleconference

 

Authors: Barbara V. Howard, PhD, and W. James Howard, MD

 

Article: "Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial"

 

Summary Points:

• Reducing LDL-C and SBP to lower targets resulted in regression of carotid atherosclerosis and decrease in LV mass in individuals with type 2 diabetes.
• Clinical event rate was low in both groups and did not differ longer term follow-up. It will be necessary to determine whether the aggressive targets result in favorable risks or benefits.
• More emphasis should be placed on reaching conventional targets for both LDL-C and SBP in diabetic patients.
• More trials are needed to evaluate targets for lipids and BP rather than specific treatment regimens.

Author in the Room: Combined Screening with Ultrasound and Mammography

June 2008 Author in the Room^® Teleconference

 

Author: Wendie A. Berg, MD, PhD

 

Article: "Combined Screening with Ultrasound and Mammography vs. Mammography Alone in Women at Elevated Risk of Breast Cancer"

 

Summary Points:

• Adding a single screening ultrasound examination to screening mammography in women at increased risk of breast cancer with at least heterogeneously dense breasts increases the cancer detection rate from 50 percent to 78 percent.
• The risk of a biopsy for a benign lesion in our series was 1 in 40 for women undergoing mammography versus 1 in 10 for women undergoing mammography combined with ultrasound screening.
• Using the standardized technique and interpretive criteria developed for this study, other radiologists and facilities with similar equipment and experience should expect similar results.​

Author in the Room: Association Between Depressive Symptoms and Diabetes

July 2008 Author in the Room^® Teleconference

 

Author: Sherita Hill Golden, MD, MHS

 

Article: "Examining a Bidirectional Association Between Depressive Symptoms and Diabetes"

 

Summary Points:

• People with symptoms of depression are more likely to engage in diabetes-producing health behaviors, including eating more, exercising less, and smoking more. As a consequence, they were more obese.
• People with elevated symptoms of depression had a 42 percent increased risk of developing Type 2 diabetes over 3 years. This was partially explained by unhealthy behaviors.
• People with treated Type 2 diabetes had a 52 percent increased risk of developing depressive symptoms over 3 years. This suggests that individuals with diabetes should be monitored for development of depression.

Author in the Room: Effectiveness of Home Blood Pressure Monitoring Web Communication and Pharmacist Care on Hypertension

​August 2008 Author in the Room^® Teleconference

 

Author: Beverly Beth Green, MD, MPH

 

Article: "Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: The e-BP Randomized Controlled Trial"

 

Summary Points:

• If blood pressure (BP) control could be improved, many deaths from cardiovascular and renal disease could be prevented. 
• The Chronic Care Model was used to design an intervention that empowered patients to be more involved in their own care using home BP monitoring, a patient shared electronic medical record, and Web-based pharmacist assistance.
• The group of patients that received BP monitors and training to use an existing patient website (with encouragement to send their BP numbers to their physician) had a modest decrease in systolic blood pressure, but BP control did not significantly improve. The group that received BP monitors, web training, and web-based pharmacy assistance had greater decreases in BP and were almost two times as likely to have controlled BP.

Author in the Room: Antidepressant-Associated Sexual Dysfunction

September 2008 Author in the Room^® Teleconference

 

Author: H. George Numberg, MD

 

Article: "Sildenafil Treatment of Women with Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial"

 

Summary Points:

• Emergent sexual dysfunction (SD) is a principal reason for a three-fold increased risk of non-adherence that leads to increased relapse, recurrence, and poor disease management outcomes.
• Selective phosphodiesterase-type 5 inhibitors (PDE5Is), limited to studies in men, have demonstrated evidence based data to support broad-based and clinically meaningful treatment efficacy.
• In an intention-to-treat analysis, women treated with sildenafil showed significant improvement in adverse sexual effects compared with those taking placebo.
• Evidence shows that selective phosphodiesterase type 5 inhibitors are effective in both sexes for patients who have been effectively treated for depression but need to continue on their medication to avoid relapse or recurrence.

Author in the Room: Symptomatic Pelvic Floor Disorders in Women

October 2008 Author in the Room^® Teleconference

 

Author: Ingrid E. Nygaard, MD, MS

 

Article: "Symptomatic Pelvic Floor Disorders in Women"

 

Summary Points:

• The three primary pelvic floor disorders include urinary and fecal incontinence, and pelvic organ prolapse.
• In a national population-based sample, nearly one-quarter of US women reported at least one symptomatic pelvic floor disorder: overall, 15.7 percent experienced moderate to severe urinary incontinence, 9.0 percent experienced fecal incontinence at least monthly, and 2.9 percent experienced symptomatic pelvic organ prolapse (a bulge in the vagina they could see or feel). 
• Older women, overweight and obese women, and multiparous women were more likely to report a pelvic floor disorder.

Author in the Room: Stress Testing to Document Ischemia Prior to Elective PCI

November 2008 Author in the Room^® Teleconference

 

Author: Rita Redberg, MD, MSc

 

Article: "Stress Testing to Document Ischemia Prior to Elective PCI”

 

Summary Points:

• A majority (55.5 percent) of Medicare patients with stable coronary artery disease who underwent an elective percutaneous coronary intervention (PCI) did not have a recommended stress test performed to document ischemia.
• The rate of stress testing before elective PCI shows significant geographic variation, from a low of 22 percent in Fresno, California, to a high of 71 percent in Rochester, Minnesota.
• Patient characteristics (female sex, age of 85 years or older, and having co-existing illnesses) and physician characteristics (physicians who performed a higher volume of PCI procedures) were associated with lower rates of stress testing.