patient care

In this instructional video, Drs. Cynthia Armand and Elizabeth Loder discuss the clinical presentation and pathophysiology of migraine and treatment options for patients.

This video provides essential and useful information for any clinician caring for patients with this common condition. Newer acute and preventive therapies — including triptans, gepants, ditans, and injectable monoclonal antibodies — are discussed, as are the importance of a patient-centered approach and the need to tackle challenges of access to these newer agents.

Author/s:

Armand, C.E., Loder, E., Ropper, A. H.

Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19

Bethie Seay — Tue, 30 Nov 2021 06:00:00 +0000

Date Added:

November 30, 2021

Journal/Publication:

Clinical Infectious Diseases

Publication Date:

November 15, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1093/cid/ciab953

PMID (1):

34791102

Recommendations from the Infectious Disease Society of America regarding prevention of COVID-19 infection in health care professionals.

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Background: Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.

Objective: Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19.

Methods: IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.

Results: The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included.

Conclusions: Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Author/s:

Lynch, J. B., Davitkov, P., Anderson, D. J., Bhimraj, A., Cheng, V. C. C., Guzman-Cottrill, J., Dhindsa, J., Duggal, A., Jain, M. K., Lee, G. M., Liang, S. Y., McGeer, A., Varghese, J., Lavergne, V., Murad, M. H., Mustafa, R. A., Sultan, S., Falck-Ytter, Y., Morgan, R. L.

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Devin Evans — Wed, 11 Nov 2020 06:00:00 +0000

Date Added:

November 11, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

November 10, 2020

URL:

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-5938

Keywords

chronic kidney disease

type 2 diabetes

Kidneys

PMID (1):

33166222

MeSH

delivery of health care

Integrated

This is a new guideline from the Kidney Disease – Improving Global Outcomes (KDIGO) group on management of diabetes in people with chronic kidney disease. James W. Mold, MD, MPH

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Description: The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed a clinical practice guideline in 2020 for the management of patients with diabetes and chronic kidney disease (CKD).

Methods: The KDIGO Work Group (WG) was tasked with developing the guideline for diabetes management in CKD. It defined the scope of the guideline, gathered evidence, determined systematic review topics, and graded evidence that had been summarized by an evidence review team. The English-language literature searches, which were initially done through October 2018, were updated in February 2020. The WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of the recommendations. Expert judgment was used to develop consensus practice points supplementary to the evidence-based graded recommendations. The guideline document underwent open public review. Comments from various stakeholders, subject matter experts, and industry and national organizations were considered before the document was finalized.

Recommendations: The guideline includes 12 recommendations and 48 practice points for clinicians caring for patients with diabetes and CKD. This synopsis focuses on the key recommendations pertinent to the following issues: comprehensive care needs, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches.

Author/s:

Navaneethan, Sankar D., Zougas, Sophia, Caramori, M.L., Chan, Juliana C.N., Heerspink, Hiddo J.L., Hurst, Clint, Liew, Adrian, Michos, Erin D., Olowu, Wasiu A., Sadusky, Tami, Tandon, Nikhil, Tuttle, Katherine R., Wanner, Christoph, Wilkens, Katy G., Lytvyn, Lyubov, Craig, Jonathan C., Tunnicliffe, David J., Howell, Martin, Tonelli, Marcello, Cheung, Michael, Earley, Amy, Rossing, Peter, De Boer, Ian H., Khunti, Kamlesh

Persistent Value of the Stethoscope in the Age of COVID-19

Brian Desmarais — Mon, 22 Jun 2020 15:09:57 +0000

Date Added:

June 22, 2020

Journal/Publication:

The American Journal of Medicine

Publication Date:

June 19, 2020

URL:

Persistent Value of the Stethoscope in the Age of COVID-19

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2020.05.018

Keywords

MeSH

Physician-Patient Relations

severe acute respiratory syndrome coronavirus 2

An interesting review of the history and future of the stethoscope including tips for disinfecting one. James W. Mold, MD, MPH

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Abstract

The stethoscope has long been at the center of patient care as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth™ transmission, and computer algorithm diagnostic support. However, despite these advancements, the ever-changing climate of infection prevention, especially in the wake of the COVID-19 pandemic, has led many to question the stethoscope as a vector for infectious diseases. Stethoscopes have been reported to harbor bacteria with contamination levels comparable to a physician's hand. Although disinfection is recommended, stethoscope hygiene compliance remains low. In addition, disinfectants may not be completely effective in eliminating microorganisms. Despite these risks, the growing technological integration with the stethoscope continues to make it a highly valuable tool. Rather than casting our valuable tool and symbol of medicine aside, we must create and implement an effective method of stethoscope hygiene to keep patients safe.

•Stethoscopes are clinically valuable and integral to the doctor-patient connection

•Technological advancement will augment the utility of the stethoscope

•The stethoscope has high utility for assessment of COVID-19 patients

•Pathogen contamination in light of COVID-19 is a concern for the stethoscope

•Innovations in stethoscope hygiene will allow safe auscultation

Author/s:

Vasudevan, R.S., Horiuchi, Y., Torianni, F.J., Cotter, B., Maisel, S.M., Dadwal, S.S., Gaynes, R., Maisel, A.S.

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Brian Desmarais — Mon, 19 Aug 2019 14:21:14 +0000

Date Added:

August 19, 2019

Journal/Publication:

JN Learning

Publisher:

Journal of the American Medical Association

Publication Date:

August 15, 2019

URL:

Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Type:

Clinical Decision Aids

Format:

Web Page

MeSH

Prognosis

patient care

This 37 ½ minute audiotape provides guidance regarding how to talk with patients about prognosis. James W. Mold, MD, MPH

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Interview with Joanna Paladino, MD, author of Communication Strategies for Sharing Prognostic Information With Patients: Beyond Survival Statistics

Ten tips for advancing a culture of improvement in primary care

Brian Desmarais — Thu, 20 Jun 2019 13:12:16 +0000

Date Added:

June 20, 2019

Journal/Publication:

BMJ Quality and Safety

Publication Date:

October 31, 2018

URL:

Ten tips for advancing a culture of improvement in primary care

Type:

Practice Management Research Results

Format:

Article

DOI (1):

10.1136/bmjqs-2018-008451

Keywords

MeSH

Personal Satisfaction

Based upon their successful improvement efforts, this academic family practice identified 10 keys to success. James W. Mold, MD, MPH

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Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tipsto healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.

Author/s:

Kiran, T., 'Ramji, N.', Derocher, M.B., Girdhari, R., Davie, S., Lam-Antoniades M.

Screening for Pancreatic Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Tracy Ashby — Mon, 11 Feb 2019 06:00:00 +0000

Date Added:

February 11, 2019

Journal/Publication:

AHRQ Evidence Synthesis

Publisher:

U. S. Preventative Services Task Force

Publication Date:

February 1, 2019

Issue:

181

URL:

Screening for Pancreatic Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

The incidence of pancreatic cancer has been increasing significantly, possibly related to the increasing incidence of obesity. This is a summary of what was known about the risk factors and available screening tests as of 2015. The Abstract and pages 5-9 contain most of the useful information.

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Objective: We conducted a systematic evidence review to support the U.S. Preventive Services Task Force (USPSTF) in updating their recommendation on screening for pancreatic cancer. Our review addresses the following Key Questions (KQs):
1. Does screening for pancreatic adenocarcinoma improve cancer morbidity or mortality or all-cause mortality; and 1a) Does screening effectiveness vary by clinically relevant subpopulations (e.g., by age group, family history of pancreatic cancer, personal history of new-onset diabetes, or other risk factors)?
2. What is the diagnostic accuracy of screening tests for pancreatic adenocarcinoma?
3. What are the harms of screening for pancreatic adenocarcinoma?
4. Does treatment of screen-detected or asymptomatic pancreatic adenocarcinoma improve cancer mortality, all-cause mortality, or quality of life?
5. What are the harms of treatment of screen-detected pancreatic adenocarcinoma?
Data Sources: We searched Cochrane Central Register of Controlled Trials, Medline, and PubMed, and reference lists of relevant systematic reviews. We searched for articles published from 2002 to October 3, 2017, and updated our search on April 27, 2018. We also searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP), for relevant ongoing studies.
Study Selection: We reviewed 19,596 abstracts and 824 articles against specified inclusion criteria. Eligible studies included those written in English and conducted in adults age 18 years or older with or without risk factors for pancreatic cancer. For key questions on screening, we included imaging-based screening protocols. For key questions on treatment, we included studies of adults with screen-detected or asymptomatic pancreatic adenocarcinoma.

Data Analysis: We conducted dual, independent critical appraisal of all provisionally included studies and abstracted study details and results from fair- and good-quality studies. Because of the limited number of studies and the population heterogeneity, we provided a narrative synthesis of results and used summary tables to allow for comparisons across studies. After confirming that the yield of different imaging modalities was similar across studies, we calculated a pooled diagnostic yield across studies and produced forest plots to illustrate the range of effects seen across studies. For harms of screening (KQ3) and harms of treatment (KQ5), we stratified results by procedural and psychosocial harms.
Results: We included 13 unique prospective cohort screening studies (24 articles) reporting results for 1,317 people. Studies were conducted in the U.S., Canada, and Europe, and all screening populations except one small comparison group were exclusively in persons at elevated familial or genetic risk for pancreatic cancer. No studies reported on the effect of screening for pancreatic adenocarcinoma on cancer morbidity, mortality, or all-cause mortality (KQ1); and no studies reported on the effectiveness of treatment for screen-detected pancreatic adenocarcinoma (KQ4).

Thirteen fair quality studies reported on the diagnostic accuracy of screening tests for pancreatic adenocarcinoma (KQ2). Across these studies, 18 cases of pancreatic adenocarcinoma were detected.. Twelve of 18 cases (66.7%) were detected at stage I or II or classified as “resectable.” Pooled yield for all screening tests to detect pancreatic adenocarcinoma on initial screening in high-risk populations was 7.8 per 1000 (95% confidence interval, 3.6 to 14.7); and for total yield including both initial and repeat screening, it was 15.6 per 1000 (95% CI, 9.3 to 24.5).

Harms of screening for pancreatic adenocarcinoma
Procedural harms of screening were evaluated in eight screening studies (n=675); psychological harms were assessed in two studies (n=277). Details on the assessment of harms were variably reported. In two studies (n=277) in which 150 individuals received ERCP as a diagnostic followup test, 15 people (10%) reported acute pancreatitis, nine of which required hospitalization. No evidence of increased worry, distress, depression, or anxiety after screening was reported, compared to before screening.

Harms of treatment of screen-detected pancreatic adenocarcinoma
Of the 57 people who underwent surgery across all studies, six studies (n=32 people receiving surgery) assessed harms of treatment of screen-detected pancreatic adenocarcinoma (KQ5), with 7 harms detected in two studies. Methods of assessing harms were variably reported. Harms included one person experiencing stricture to the hepaticojejunal anastomosis at 11 months after surgery, one with unspecified post-operative complications, 2 with post-operative fistula and 3 cases of diabetes. In the two studies that systematically assessed harms in all surgical patients (n=12 people receiving surgery), no harms were reported.

Limitations: No randomized trials of screening were identified. The body of evidence includes observational screening studies with limited sample sizes and focused on populations with known familial risk, many with a substantial proportion of people with known genetic mutations. No studies included a clinical followup or unscreened comparison group, limiting assessment of diagnostic accuracy. Of those studies that reported harms of screening or treatment, limitations included inadequate description of the methods of assessing harms, including whether all participants were systematically assessed.

Conclusions: Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the clinical impact of screening is not well documented. There is insufficient evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.

Author/s:

Henrikson, Nora B., Bowles, Erin J. Aiello, Blasi, Paula R., Morrison, Caitlin C., Nguyen, Matt, Pillarisetty, Venu G., Lin, Jennifer S.

Guide to Enhancing Referrals and Consultations Between Physicians

Tracy Ashby — Fri, 01 Feb 2019 06:00:00 +0000

Date Added:

February 1, 2019

Publisher:

The College of Family Physicians of Canada

Publication Date:

October 1, 2009

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

referral and consultation

patient care

physicians

MeSH

physicians, family

referral and consultation

patient care

This is a summary of consultation and referral best practices from the College of Family Physicians of Canada.

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Access to care is a challenge for many of our patients. The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (Royal College) recognize that every possible measure must be taken to help ensure access to timely and quality medical and other health care service.
As part of ongoing efforts, the CFPC and the Royal College released a conjoint paper in 2006, to address the issue of intra-professional relationships between physiciansi. This paper identifies a number of issues and recommendations to improve patient care and professional satisfaction. The referral-consultation process is chief among the areas addressed in follow up to this conjoint paper.
There is growing knowledge and many new approaches developing in various regions of the country to improve the referral-consultation processes of care between referring and consulting physicians.
This guide on enhancing referrals and consultations between physicians is not intended to replace instruments already in place. It is complementary and may also help fill gaps where there are few or no tools in place to support good referrals and consultations, both within as well as between community and hospital settings. It is hoped that physicians will find this reference to be a valuable addition to practice.

Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care

Tracy Ashby — Fri, 02 Nov 2018 05:00:00 +0000

Date Added:

November 2, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

October 1, 2018

URL:

Six Building Blocks

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

This is an opportunity for your practice to earn $2,500 for participating in a project to improve management of opioids.

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Most patients taking opioids for chronic pain are managed by primary care providers and their staff. Many practices are looking for help in managing their patients using chronic opioid therapy. To meet this need, AHRQ funded the Six Building Blocks project through grant number R18HS0237850. Additional funding was provided by Washington State Department of Health subcontract (HED23124) of Cooperative U17CE002734, funded by the Centers for Disease Control and Prevention.