News You Can Use

Preoperative medical testing in medicare patients undergoing cataract surgery

by jmiller on April 16, 2015

“Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics.  Furthermore, the results showed no difference in the prevalence of testing as compared with 20 years ago, before the introduction of guidelines stating that routine properative testing for cataract surgery was not necessary.  (NEJM, April 16). Click here to read full text.

New hypertension guidelines: One size fits most?

by jmiller on April 10, 2015

“The report of the panel appointed to the eight Joing National Committee on prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8) is more evidence-based and focused than its predecessors, outlining a management strategy that is simpler and, in some instances, less aggressive.  It has both strengths and weaknesses.  This article reviews the major components.  Click here to read full text.

Should patients stop taking aspirin for primary prevention?

by jmiller on April 10, 2015

“Based on the current available evidence, the US Food and Drug Administration recently issued a Consumer Update that does not support aspirin for primary prevention and warns patients about the risk of serious bleeding complications.  Moreover, current guidelines and consensus panels for aspirin in primary prevention differ from one another, making it challenging for clinicians to determine which patients would benefit. One message is clear in the most current clinical guidelines, namely, that routine use of aspirin for primary prevention is not recommended.”  (Cleve Clin J, April)  Click here to read full-text.

Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions

by Medical Staff Office on March 27, 2015

Women with germline mutations in the cancer susceptibility genes, BRCA1 or BRCA2, associated with Hereditary Breast and Ovarian Cancer syndrome, have up to an 85% lifetime risk of breast cancer and up to a 46% lifetime risk of ovarian, tubal and peritoneal cancers.    The article addresses lynch/Hereditary Non-Polyposis Colorectal Cancer (HNPCC) syndrome as well.  This commentary provides guidance on identification of patients who may benefit from assessment for the presence of a hereditary breast and/or gynecologic cancer syndrome.  (Gynecol Oncol, April 2014)  Click here to read full text.

Screening for Vitamin D deficiency in adults: U.S. Preventive Services Task Force Recommendation Statement

by Medical Staff Office on March 27, 2015

The USPSTF concluded that the current evidence is insufficient to asssess the balance of benefits and harms of screening for Vitamin D deficiency in asymptomatic adults. (Ann Intern Med, Jan)  Click here to read full text.

Postoperative delirium in older adults: best practice statement from the American Geriatrics Society

by Medical Staff Office on March 27, 2015

This practice guideline (J Am Coll Surg, Feb) reviews risk factors; diagnosis; delirium screening; intraoperative measures to prevent delirium; medication as risk factors for postoperative delirium; pharmacologic prevention nonpharmacologic prevention and treatment ; medical evaluation; pharmacological treatment; and implementation of these guidelines. Click here to read full-text.

Sciatica

by jmiller on March 27, 2015

This review article (NEJM, March 25) provides an update on the anatomy of the sciatic nerve; symptoms and examination findings’ imaging and electrological testing; nonspinal causes; conservative treatment; surgical treatment caused by lumbar disk disease; surgical techniques; and  guidelines and systematic reviews.  Click here to read full text.

Application of “Less is More” to low back pain DDDD

by jmiller on March 3, 2015

“An initiative of the National Physicians Alliance, the project titled “Promoting Good Stewardship in Clinical Practice”, developed a list of the top 5 activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources.  One of the top 5 recommendations was “Don’t do imaging for low back pain within the first 6 weeks unless red flags are present.”  This article presents data that support this recommendation.  (Arch Intern Med, July 2012) Click here to read full-text

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