News You Can Use

A 2-hour diagnostic protocol for possible cardiac chest pain in the Emergency Department and commentary: Rapid evaluation of chest pain in the Emergency Department

by jmiller on January 24, 2014

From JAMA, (Jan), concludes: “Using the accelerated diagnostic protocol in the experimental pathway almost doubled the proportion of patients with chest pain discharged early.  Clinicians could discharge approximately 1 of 5 patients with chest pain to outpatient follow-up monitoring in less than 6 hours.  The diagnostic strategy could be easily replicated in other centers because no extra resources are required.  Click here to read full-text.

Advance Directives in the Operating Room: Revised Statement – American College of Surgeons

by jmiller on January 24, 2014

The American College of Surgeons (Bull Am Coll Surg, Jan)  has issued a revised statement from its original 1994 policy on Advance Directies in the operating room.  Basically, there is now a requirement that a “reconsideration discussion” should occur as early as practical after a decision is made to have surgery to clarify patient’s wishes.  “Policies that lead either to the automatic enforcement of all DNR orders or to disregarding or automatically cancelling such orders do not sufficiently support a patient’s right to self- determination.” Click here  to read full text..

Opiod prescribing: A systematic review and critical appraisal of guidelines for chronic pain

by jmiller on January 24, 2014

This early online publication from Annals of Internal Medicine concludes: “Despite limited evidence and variable development methods, recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug-drug and drug-disease interacitons; and use of risk assessment tools, treatment agreements, and urine drug testing.”  Click here to read full-text.

Prevention of diabetes with Mediterranean diets and accompanying ‘Summaries for Patients’ “Does the Mediterranean diet prevent diabetes?”

by jmiller on January 10, 2014

Article (Ann Intern Med, Jan 7) concludes: A Mediterranean diet enriched with EVOO but withoug energy restrictions reduced diabetes risk among persons with high cardiovascular risk.  The PREDIMED trial provides strong evidence that long-term adherence to a Mediterranean diet supplemented with EVOO without energy restrictions, which is high in monounsaturated fat and bioactive polyphenols, results in a substantial reduction in the risk for type 2 diabetes among older persons with high cardiovascular risk.  Click here to read full-text.

Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force

by jmiller on December 27, 2013

This systematic review (Ann Intern Med, Dec 17) concludes: “Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD.  Two trials found a small, borderline-significant benefit from multi-vitamin supplements on cancer in men only and no effect on CVD.  (Click here to read full-text)

Strategies for optimizing staff safety in a Radiology Department (Practice Policy and Quality Initiatives)

by jmiller on December 12, 2013

“Employees in a radiology department are exposed to multiple risks, including injuries due to radiation exposure, poor ergonomics, or repetititve stress; those caused by wearing lead aprons or moving heavy equipment for portable studies; and needle sticks resulting in exposure to body fluids.  Strategies to mitigate or prevent such risks include ergonomics inititatives for radiologists and technologists, appointment of a radiation safety officer to ensure compliande with radiation dose guidelines and policies, and use of equipment that prevents exposure to body fluids.” This is an excellent review of safety issues.   (Radiographics, Oct)  Click here to read full text.

Contextual issues influencing implementation and oucomes associated with an integrated approach to managing pain, agitation and delirium in adult ICUs

by jmiller on December 12, 2013

This has been a very “hot” topic here at AAMC…  This study (Critical Care Mdicine, Sept) was designed to identify which contextual factors facilitates/hinder the implementation of the awakening, breathing, coordination, delirium and early mobility (ABCDE) bundle for guidance in future study.  “Successful implementation of the elements of the ABCDE cn result in significant improvements in ICU partient care. The results of this study highlight specific structural and cultural elements of ICUs and hospitals that can positively and negatively influence the implementation of complex bundles like the ABCDE bundle.  Click here to read full text.

Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents

by jmiller on December 12, 2013

This article (Jama, Oct 7) concludes “among patients undergoing noncardiac surgery within 2 years of coronary stent placement, major adverse cardiac events (MACE) were associated with emergency surgery and advanced cardiac disease but not stent type and or timing of surgery beyond 6 months after stent implementation.  Guideline emphasis on stent type and surgical timing for for drug eluting stents and bare metal stents. should be reevaluated.  (click here for full-text)

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