“Since originally drafted in 2013, the algorithm has been updated as new therapies, management approaches, and important clinical data have emerged. The 2016 edition includes a new section on lifestyle therapy as well as discussion of all classes of obesity, antihyperglycemic, lipid-lowering, and antihypertensive medications approved by the FDA through December 2015. (Endocrine Pract, Jan 2016) Click here to read full text.
News You Can Use
“Effect of hospitalist workload on the quality and efficiency of care” and editorial “Hospital workload: the search for the magic number”by jmiller on January 13, 2016
Hospitalists per patient is a frequently visited topic for literature searches. The article concludes, “Increasing hospitalist workload is associated with clinically meaningful increases in LOS and cost. Although our findings should be validated in different clinical settings, our results suggest the need for methods to mitigate the potential negative effects of increased hospitalist workload on the efficiency and cost of care. The average hospitalist workload was a census of approximately 15 patients per day. Higher workloads were associated with significant inefficiencies; each additional patient per physician was associated with an increase in mean length of stay of 2 full days and in hospital costs of $262. (Jama, May 2014) Click here to read full text.
“A conceptual framework for appropriateness in surgical care: reviewing past approaches and looking ahead to patient-centered shared decision-making”by jmiller on December 14, 2015
Concludes, “It is our belief that encouraging patient engagement and ensuring high-quality shared surgical decision-making will result in fewer inappropriate procedures. There is evidence that patients who engage in high-quality decision-making are not only more likely to play a more active role in behaviors that will ensure a positive surgical outcome but are also less likely to choose surgery that will not benefit them. These patients may elect to choose alternative treatments or nonsurgical therapies.” (Anesthesiology, Dec) Click here to read full-text.
“A randomized trial of intensive versus standard blood-pressure control” and “Redefining blood-pressure targets – SPRINT starts the marathon”by jmiller on December 14, 2015
“Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (NEJM, Nov. 26) Click here to read full-text.
Evidence for a standardized preadmission showering regimen to achieve maximal antiseptic skin surface concentrations of chlorhexidine gluconate, 4%, in surgical patients” and editorial “Chlorhexidine gluconate, 4%, showers and surgical site infection reduction”by jmiller on December 14, 2015
Concludes, “A standardized preadmission shower regimen that includes 18 ml of aqueous chlorhexidine gluconate, 4%, per shower; a minimum of 2 sequential showers; and a 1-minute pause before rinsing results in maximal skin surface concentrations of chlorhexidine gluconate that are sufficient to inhibit of kill gram-positive or gram-negative surgical wound pathogens. This showering regimen corrects deficiencies present in current non-standardized preadmission shower protocols for patients undergoing elective surgery. (JAMA Surg, Nov.) Click here for full-text.
“Understanding variation in 30-day surgical readmission in the era of accountable care: effect on the patient, surgeon and surgical subspecialties” and editorial “Variation reduction to reduce readmission: a figment of imagination or reality of the future?”by jmiller on December 14, 2015
The article concludes, “Readmission occurred in more than 1 in 10 patients, with considerable variation across surgical subspecialties. Variation in readmission was overwhelmingly owing to patient-level factors while only a minority of the variation was attributable to factors at the surgical subspecialty and individual surgeon levels. The invited commentary reveals “that variability is primarily due to the common cause of patient-related factors (including race/ethnicity, insurance status, comorbidity, complications, and length of stay) rather than surgeon-or surgical subspecialty-specific factors.” (JAMA Surg, Nov.) Click here to read full-text.
Medicine Dept. Grand Rounds: featuring Dr. Seth Martin: PCSK9 Inhibitors: A new era in lipid management, Dec. 16, 5:30 – dinner; 6:00 presentation.by jmiller on December 7, 2015
Click here to read Dr. Martin’s Editorial in the April 28th online first publication in Ann Intern Med: PCSK9 Inhibitors: A new era in lipid-lowering treatment.
Also, read featured review: “Effects of proprotein convertase subtilisin/Kexin type 9 antibodies in adults with hypercholesterolemia: A systematic review and meta-analysis.
Practice guidelines for perioperative blood management: an updated report by the ASA task force on perioperative blood managementby jmiller on November 13, 2015
“The purposes of these updated Guidelines are to improve the perioperative management of blood transfusion and adjuvant therapies and to reduce the risk of adverse outcomes associated with transfusions, bleeding or anemia. The updated ASA practice guidelines differ from those published by other organizations in that: they include greater use of pharmacologic therapies to minimize blood transfusions, such as erythropoietin for the anemic patient, prothrombin complex concentrates for urgent reversal of warfarin, and intraoperative antifibrinolytic therapy during selected cardiac and noncardiac procedures having a high risk for bleeding. They advocate the use of transfusion algorithms, especially those based on thromboelastographic testing, blood-ordering schedules, and restrictive transfusion strategies. Why does this statement differ from existing guidelines? These ASA guidelines differ from the existing guidelines because they provide new evidence obtained from recent scientific literature along with findings from new surveys of expert consultants and randomly selected ASA members. Click here to read full-text.