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Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

by jmiller on February 2, 2017

“In studies conducted before the initiation of food fortification in the United States in 1998, folic acid supplementation provided protection against neural tube defects. Newer postfortification studies have not demonstrated a protective association but have the potential for misclassification and recall bias, which can attenuate the measured association of folic acid supplementation with neural tube defects”  (JAMA, Jan 10)  Click here to read full text.

Clinical Guideline: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians

by jmiller on February 2, 2017

“ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.”  (Ann Intern Med, Jan)   Click here to read full text.

In the news: Use of CT and chest radiography for lung cancer screening before and after publication of screening guidelines, intended and unintended uptake

by jmiller on February 2, 2017

“The National Lung Screening trial (NLST) released its main findings in 2011,concluding that the use of low-dose findings in 2011, concluding that the use of low-dose computed tomography (CT) to screen for lung cancer reduced lung cancer deaths by 20% compared with chest radiography.  The subsequent publication of new lung cancer screening (LCS) guidelines may raise the public’s awareness of the clinical application of low-dose CT in screening, leading to increased demand for screening not only by individuals who meet the eligibility criteria recommended for LCS but also by those who do not.  The first finding show a high rate of incidental findings (41%), a low rate of detection of lung cancer, and all for a highly resource-intensive program.  From the data reported, we calculate that for every 1000 people screened, 10 will be diagnosed with early-stage lung cancer (potentially curable), and 5 with advanced-stage lung cancer (incurable); 20 will undergo unnecessary invasive procedures (bronchoscopy and thoracotomy) directly related to the screening; and 550 will experience unnecessary alarm and repeated CT scanning.  Screening should be limited to patients most likely to benefit. (JAMA Intern Med, early online)  Click here to read full-text.

Intraoperative “micro breaks” with targeted stretching enhance surgeon physical function and mental focus

by jmiller on January 17, 2017

Congratulations to Drs. Park and Zahiri for their work published in the prestigious Annals of Surgery (February issue).  The article concludes “Many surgeons are concerned about career-ending or limiting musculoskeletal pain.  Intraoperative targeted stretching micro breaks may represent a practical, effective means to reduce surgeon pain, enhance performance, and increase mental focus without extending operative time.”  Click here to read full-text.

Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout

by jmiller on January 16, 2017

“The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations.   To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders.  Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives fact this challenge with a disillusioned physician workforce.  This article (Mayo Clin Proc, Jan) suggests nine organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at the Mayo Clinic.”  Click here to read full article.

Statin use for the primary prevention of cardiovasular disease in adults: USPTF Recommendation Statement

by jmiller on January 16, 2017

“The USPSTF recommends initiating use of low-to-moderate dose statins in adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors ((dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation).  The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older.”  Click here to read full text.

Consumer preferences and online comparison toos used to select a surgeon

by jmiller on January 16, 2017

“The public reporting of physician quality is mandated by the US federal government and made accessible through the website Physician Compare.  However, this is only one of several that provide physician ratings to consumers. Despite the widespread availability of this information, little is known about how consumers use it to make decisions regarding health care, particularly when selecting a surgeon.  Overall, individual ratings websites were used infrequently by respondents.  However a crowdsourcing website ( that contains only patient reviews, but not outcome data, was the site most visited by respondents.”  (JAMA Surg, Jan)    Click here to read full article.

Key prinicples in quality and safety in radiology

by jmiller on January 16, 2017

“Concepts are introduced that re keys to identifying, understanding, and utilizing certain quality tools with the aim of making process improvements.  Challenges, opportunities, and change drivers can be mapped from the radiology quality perspective.  Best practices, informatics, and benchmarks can profoundly affect the outcome of quality improvement initiative.”      (AJR, March 2017)   Click here to read full text.



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