This clinical practice guideline recommends 1: a sleep study for patients with unexplained daytime sleepiness, and 2: polysomnography for diagnostic testing in patients suspected of obstructive sleep apnea. ACP recommends portable sleep monitors in patients without serious comorbidities as an alternative to polysomnography when polysomnography is not available for diagnostic testing. (Ann Intern Med, Aug 5) Click here to read full text.
News You Can Use
Nonsurgical management of urinary incontinence in women: A clinical practice guideline from the American College of Physiciansby jmiller on December 5, 2014
This practice guideline provides six recommendations for the nonsurgical management of urinary incontinence. “Urinary incontinence is a common and important health care problem in women that is underrported and underdiagnosed. Clinicians should use nonpharmacologic management for UI, such as pelvic floor muscle training (PFMT) for stress jurinary incontinence, bladder training for mixed urinary incontinence, because these therapies are effective, have few adverse effects, and are cheaper than pharmacolgic therapies. Although pharmacologic therapy can improve UI and provide complete continence, many patients discontinue medication because of adverse effects. (Ann Intern Med, Sept) Click here to read full text.
Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the ICUby jmiller on December 5, 2014
These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.(Crit Care Med, Jan 2013) Click here to view full-text.
Click here to read full-text on the CDC Guidelines regarding Ebola, including PPE donning and doffing.
These Practice Guidelines (Am Fam Phys, Aug) make the following key points: Treatment of stage A heart failure should focus on reducing modifiable risk factors, including management of hypertension and hyperlipidemia; To prevent symptomatic heart failure, ACE inhibitors and beta blockers hould be used in all patients with stage B or C heart failure who have a reduced ejection fraction; Patients with stage C heart failure and fluid retention should be treated with diuretics in addition to ACE inhibitors and beta blockers. Click here to read full text.
This Sept. “in press” article, (NEJM) concludes “these data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from ebola virus disease are expected to continue increasing from hundreds to thousands per week in the coming months.” Click here to read full-text.
The journal article “Improved Coordination of Care for Patients with Abnormal Chest Imaging: the Rapid Access Chest and Lung Assessment Program” was published in the October 2014 Journal of Clinical Outcomes Management by Stephen Cattaneo, MD; Maria Geronimo, RN; Teresa Putscher, RN; Catherine Brady-Copertino, BSN; and Barry Meisenberg, MD. Read the full article here.
“This system misses all of the intangible factors that help gauge the quality and efficiency of the care being delivered. It focuses physicians on the wrong goals for promoting health, such as how well they code chart to capture higher-value “units”. The Advisory Board Company, a health-care consulting firm, estimates that when hospitals last went on a physician-acquisition binge in the late 1990s, productivity fell as much as 35%.” (WSJ Mar 2013) Click here to read full text.