Guideline adherence in chronic obstructive pulmonary disease management | Opioid therapy among veterans | Alternative vaccination schedules
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November 20, 2014
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Guideline adherence in chronic obstructive pulmonary disease management
Evidence-based electronic ordersets improve compliance with clinical practice guidelines and reduce the total dose of corticosteroid administered in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease. The American Journal of Medicine (6/2014) Share: Email
 
Clinical Updates
Opioid therapy among veterans
Prescription opioids, once largely reserved for the treatment of severe acute pain and end-of-life cancer pain, are now routinely used by primary care physicians for the treatment of moderate to severe chronic non-cancer pain. Partly in response, the American Pain Society, the American Academy of Pain Medicine and the Department of Veterans Affairs have published guidelines and consensus statements to assist clinicians. The authors report that guideline-concordant care is rare in primary care, varies by patient/provider characteristics and has undergone few changes over time. Over a 10-year period, on average, patients received no more than 40% of recommended indicators. The Journal of Pain (11/2014) Share: Email
 
Alternative vaccination schedules
The Advisory Committee on Immunization Practices provides a recommended vaccine schedule for children ≤ 6 years. Of the 222,628 children in this study, 25% followed an alternative schedule. These children were less likely to be up-to-date on vaccinations at 9 months of age (15%) compared with those following the recommended vaccine schedule (90%). Intentional deviation leads to poor vaccination coverage, leaving children vulnerable to infection and increasing the potential for vaccine-preventable disease outbreaks. (Full-text Access is time limited) The Journal of Pediatrics (10/2014) Share: Email
 
Improving teen driving with supervised practice
Quantity and diversity of parent-supervised practice are associated with teens' driving performance. This study demonstrates that it is possible to improve the diversity of practice through a Web-based behavioral intervention. Quantity of practice may be more difficult to change due to practical constraints and a ceiling effect imposed by mandated minimum quantities of practice. Journal of Adolescent Health (11/2014) Share: Email
 
Measuring the effectiveness of COPD screening tools
Chronic obstructive pulmonary disease (COPD) is frequently misdiagnosed or undiagnosed, which can delay disease management interventions. This cluster-randomized study sought to determine whether using the COPD Population Screener (COPD-PS) questionnaire, with or without a handheld spirometer (copd-6), can increase COPD diagnosis and related clinician actions in primary care patients aged ≥ 40 years. Findings indicate office-based assessment by primary care physicians can significantly increase COPD diagnosis. (Available for CME Credit) American Journal of Preventive Medicine (11/2014) Share: Email
 
Non-cardiac surgery after percutaneous coronary intervention
This review aimed to summarize the data pertinent to managing patients after percutaneous coronary intervention in the perioperative period and explore future perspectives. The American Journal of Cardiology (11/15/2014) Share: Email
 
Additional training needed about skilled nursing facilities
The authors tested internal medicine residents about knowledge of skilled nursing facilities -- do they know enough to send their geriatric hospital patients to the appropriate facility? Orchestrating a good transfer requires first-, second- and third-year residents to have knowledge of what care can be provided from various skilled nursing facilities (SNFs). Basic knowledge of care available at SNFs was lacking, even in those physicians with a higher level of training. Efforts to increase their training improved some performance, but not all. (Free abstract only.) Journal of the American Medical Directors Association (11/2014) Share: Email
 
Medical News
CDC: Heart disease still leading cause of death in the U.S.
The overall mortality rate from heart disease dropped nearly 4% annually from 2000 to 2010, but the rate of deaths tied to hypertension and irregular heartbeat climbed 1.3% and 1%, respectively, CDC researchers reported in the Journal of the American Medical Association. Heart disease remains the top cause of death in the U.S., killing more than 7 million people during the 11-year period, CDC lead researcher Matthew Ritchey said. HealthDay News (11/17) Share: Email
Studies link asthma to higher heart attack, stroke risk
Patients with active asthma were 70% more likely to suffer a heart attack than those without asthma, according to a study presented at the American Heart Association meeting. Another study presented at the same meeting found that daily intake of asthma drugs was associated with 60% greater odds of heart attack or stroke compared with people without asthma. HealthDay News (11/17) Share: Email
USPSTF cites lack of evidence on accuracy, efficacy of early speech screening
The U.S. Preventive Services Task Force noted in a draft recommendation that there is inadequate evidence to assess the benefits and harms of early speech and language screening and intervention in pediatric patients aged 5 and younger. They also said there is insufficient evidence on the accuracy of instruments used in primary care to screen for speech and language delays. PhysiciansBriefing.com/HealthDay News (11/18) Share: Email
Business Practice News
ICD-10 conversion costs lower than expected
The estimated cost of ICD-10 conversion for small physician practices ranged between $1,900 and $5,900, significantly lower than a previous estimate of $22,560 to $105,506, researchers reported in the Journal of AHIMA. The findings demonstrate that ICD-10 conversion is highly attainable among small practices and less burdensome than previously thought, AHIMA CEO Lynne Thomas Gordon said. Healthcare Informatics online (11/14) Share: Email
Report IDs states that require most clinicians to ease shortages
A report by the Kaiser Family Foundation identifies 6,100 primary care health provider shortage area designations in the U.S. The report also identified the 15 states that require the most clinicians to relieve shortages, with Florida topping the list at 916 practitioners. BeckersHospitalReview.com (11/18) Share: Email
Patient's Perspective
Poll: Most parents consider vaccination a priority in day care
Data from the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health revealed 74% of responding parents would consider removing their children from day care if other students did not have updated vaccinations. Researchers also found 41% of parents thought that children who don't have all the recommended shots should not be allowed to attend day care. HealthDay News (11/18) Share: Email
Editor's Note
AJMPlus will not publish Nov. 27
In observance of the Thanksgiving holiday, AJMPlus will not publish on Nov. 27. Publication will resume Dec. 4. Share: Email
SmartQuote
It is always our own self that we find at the end of the journey. The sooner we face that self, the better."
-- Ella Maillart,
Swiss travel writer Share: Email
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