Institute for Healthcare Improvement (IHI)

Author in the Room: Depression Screening for Patients with Cardiovascular Disease

December 2008 Author in the Room^® Teleconference

 

Authors: Brett D. Thombs, PhD, and Roy Ziegelstein, MD

 

Article: "Depression Screening for Patients with Cardiovascular Disease"

 

Summary Points:

• Depression is a common and serious condition in patients with heart disease; therefore health care workers should inquire about symptoms of depression in their heart disease patients.     
• Our recent systematic review shows that there is not sufficient evidence at this time to call for routine screening for depression in patients with heart disease.
• Additional research is needed to determine the optimal model(s) of care that will allow depression to be appropriately diagnosed and treated in patients with heart disease, particularly at times when these patients are being cared for primarily by heart disease experts rather than by experts in depression diagnosis and treatment.

Author in the Room: Effect of Glycemic Index or High Fiber Diet on Type 2 Diabetes

January 2009 Author in the Room^® Teleconference

 

Author: David J.A. Jenkins, MD, PhD

 

Article: "Effect of a Low Glycemic Index or a High Cereal Fiber Diet on Type 2 Diabetes: A Randomized Trial"

 

Summary Points:

• Drugs such as the alpha glucosidase inhibitor, acarbose, which reduce the rate of digestion and absorption of carbohydrate and so flatten the post-prandial glycemic response have been shown to improve diabetes control, reduce the risk of developing hypertension and lower the risk for cardiovascular disease.
• Can a selection of more slowly digested carbohydrate foods achieve qualitatively similar benefits to drugs? Current data suggest that selection of diets containing low glycemic intake foods have modest benefits in reducing HbA1C even in type 2 diabetes patients treated with one to three antihyperglycemic medications.
• Foods with a low glycemic index include many traditional study foods such as dried peas, beans, lentils, intact grain breads, pasta, oats, barley, parboiled rice, and temperate climate fruits and berries. Low glycemic index starchy foods are digested less readily in vitro.
• Other effects include a tendency for higher HDL, lower CRP values and greater weight loss in the per protocol completers (i.e., those who completed the study with no change in medications).

Author in the Room: Resistance Training in Patients with Peripheral Arterial Disease

February 2009 Author in the Room^® Teleconference

 

Author: Mary McDermott, MD

 

Article: "Treadmill Exercise and Resistance Training in Patients with Peripheral Arterial Disease"

 

Summary Points:

• Supervised treadmill exercise improves walking performance for patients with peripheral arterial disease (PAD), whether or not the patient has classic symptoms of intermittent claudication.
• Supervised lower extremity strength training improves quality of life, stair climbing ability, and treadmill walking performance for PAD patients with and without intermittent claudication.
• Supervised treadmill walking exercise improves brachial arterial flow mediated dilation in patients with PAD, suggesting a global cardiovascular health benefit.

Author in the Room: Smoking Cessation in Patients with Psychiatric Illness

March 2009 Author in the Room^® Teleconference

 

Author: Steven A. Schroeder, MD

 

Article: "Smoking Cessation in Patients with Psychiatric Illness"

 

Summary Points:

• Smoking is extremely common among persons with mental illness and exerts a huge toll in terms of morbidity and mortality.
• We are now in the midst of a culture change. Formerly smoking was an integral part of the mental health culture and smoking cessation was not deemed pertinent. Now it is evolving into an important component of mental health and wellness.
• Most smokers who have mental illness would like to quit, and many are able to do so using the standard smoking cessation techniques used for the general population. There is still much more to know, but we know enough to encourage persons with mental illness to stop smoking and to provide them the tools to do so.

Author in the Room: Self-Care of Physicians Caring for Patients at the End of Life

April 2009 Author in the Room^® Teleconference

 

Author: Michael K. Kearney, MD

 

Article: "Self-Care of Physicians Caring for Patients at the End of Life"

 

Summary Points:

• Burnout and compassion fatigue are fundamentally different phenomena. Understanding the difference is helpful for effective intervention.
• Investments in self-awareness and self-care are sound business strategies that can be expected to reduce staff turnover and increase patient satisfaction.  
• Mindfulness meditation and reflective writing have both been shown to increase self-awareness and self-care. They are among a number of strategies that can be built into clinical practice to prevent burnout and compassion fatigue.  

Author in the Room: Factors Related to Hypertension Treatment Adherence

May 2009 Author in the Room^® Teleconference

 

Author: Lisa A. Cooper, MD

 

Article: "Patient and Physician Factors Related to Hypertension Treatment Adherence"

 

Summary Points:

• Cardiovascular disease accounts for 35 percent of the excess mortality in African Americans, in large part because of hypertension.
• Racial disparities in physicians’ clinical decision making and in quality of care for cardiovascular disease have been documented extensively; studies also show racial differences in patient-physician communication, particularly when the patient and physician come from different racial backgrounds, and unconscious racial biases among physicians.
• A categorical approach that lumps patients of particular cultural backgrounds into groups and outlines their characteristics values, customs, and beliefs may lead to over-simplication and stereotyping. Instead, an understanding of broad cultural concepts and skills that emphasize a patient-centered approach are preferred. This approach takes into account the individual patients’ explanatory model, illness agenda and behaviors, and social context, and attitudes and skills with regard to negotiating treatment. It also includes participatory behaviors such as asking open-ended questions, using reflective listening, and avoiding arguments in which one tries to change the patient’s views.
• Systematic reviews of interventions to improve patient adherence to treatments for hypertension show that simplifying dosing regimens is most effective; using motivational strategies such as home monitoring, small-group training, counseling by a nurse or other professional, and reminder calls for patients are somewhat effective; and patient education alone is not effective. Quality improvement strategies for hypertension management show team change interventions that include assignment of some responsibilities to a health professional other than the patient’s physician (such as a nurse or pharmacist) are associated with the largest reductions in blood pressure. Improvement in patient-physician communication is linked  to improved outcomes for mental health; more studies are needed that examine how patient-physician communication may improve hypertension control and other physiologic measures.

Author in the Room: Acute Rhinosinusitis

June 2009 Author in the Room^®Teleconference

 

Author: Peter Hwang, MD

 

Article: "Diagnosis and Treatment of Acute Rhinosinusitis"

 

Summary Points:

• There are now published consensus guidelines for the diagnosis and treatment of acute rhinosinusitis.
• Acute viral rhinosinusitis and acute bacterial rhinosinusitis can be difficult to distinguish in the first 10 days of symptoms.
• Radiologic imaging is often “positive” in both viral and bacterial etiologies of acute sinusitis and therefore cannot be used to distinguish the two.
• Oral antibiotics, when prescribed appropriately, confer a higher rate of partial or complete resolution of acute sinusitis symptoms compared to placebo. However, it should be noted that the spontaneous rate of resolution of acute bacterial rhinosinusitis may be as high as 40 percent to 60 percent.
• Adjunctive therapies such as topical and oral decongestants may offer symptomatic relief but have not been proven to shorten the duration of illness.

Author in the Room: Therapy for Persistent Insomnia

July 2009 Author in the Room^® Teleconference

 

Author: Charles M. Morin, PhD

 

Article: "Cognitive-Behavior Therapy, Singly and Combined with Medication, for Persistent Insomnia"

 

Summary Points:

• Cognitive Behavioral Therapy (CBT) is an effective treatment for chronic insomnia and can help reduce medication treatment for this condition.
• Clinicians can be successfully trained in CBT.
• CBT works well alone for insomnia and, while medication treatment may help early in the course of this condition, it does not have advantages for long-term use.

Author in the Room: Risk Factors Associated with Incident Hypertension in Women

August 2009 Author in the Room^® Teleconference

 

Author: John P. Forman, MD, MSc

 

Article: "Diet and Lifestyle Risk Factors Associated with Incident Hypertension in Women"

 

Summary Points:

• At an individual level, combining healthy lifestyle factors may substantially reduce the risk of developing hypertension; according to the findings of the study, women who followed 6 healthy factors had nearly an 80 percent reduction in risk.
• At a population level, a large fraction of all new cases of hypertension could hypothetically be prevented if all individuals in the population followed combinations of healthy lifestyle factors; according to the findings of the study, this fraction may is 78 percent.
• Given that hypertension is a leading cause of preventable death in the population, and given that the majority of hypertension may be preventable through lifestyle modification, efforts should be intensified to improve lifestyle as a means of improving public health.

Author in the Room: Disclosure and Communicating with Patients after Medical Errors

September 2009 Author in the Room^® Teleconference

 

Author: Thomas H. Gallagher, MD

 

Article: "A 62-Year-Old Woman with Skin Cancer Who Experienced Wrong-Site Surgery"

 

Summary Points:

• Errors and adverse events are common, and disclosure of these events to patients is recommended but often does not take place.
• Physician fear of litigation inhibits disclosure, but so does physicians’ lack of confidence in their communication skills and concern that disclosure might be harmful to the patient.
• Important future developments in the field include linking disclosure with offers of compensation, and using performance improvement tools to enhance the disclosure process.