Think twice about nebulizers for asthma attacks

MDIs with spacers are as effective as nebulizers for delivering beta-agonists and less likely to cause adverse effects. Practice changer: Stop ordering nebulizers to deliver beta-agonists to patients over age 2 with mild or moderate asthma exacerbations. A metered-dose inhaler (MDI) with a spacer produces the same benefits with fewer adverse effects

Prescribing an antibiotic? Pair it with probiotics

Recommend that patients taking antibiotics also take probiotics, which have been found to be effective both for the prevention and treatment of antibiotic-associated diarrhea (AAD). Stength of recommendation: A: Based on a systematic review and meta-analysis of randomized controlled trials

It's time to use an age-based approach to D-dimer

"An age-adjusted D-dimer cutoff--rather than the conventional 500 mcg/L value--is a better way to rule out VTE in patients over 50."Use an age-adjusted D-dimer cutoff (patient's age in years [multiplied by] 10 mcg/L) for patients over age 50 years when evaluating for venous thromboembolism (VTE); it reduces false positives without substantially increasing false negatives

Development of Learning Objectives to Guide Enhancement of Chronic Disease Prevention and Management Curricula in Undergraduate Medical Education

Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner’sChronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic dis-ease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees iden-tified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective

Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices

Time to try this warfarin alternative?

Dabigatran appears to be as effective as warfarin in preventing stroke and thromboembolism in patients with atrial fibrillation—and is easier to use

BP meds: This simple change improves outcomes

For patients with uncontrolled hypertension, a switch to bedtime dosing is advisable

Connecting the Dots with Diabetes Prevention: From Analytics to Virtual Engagement

Type 2 diabetes can be prevented through effective interventions that are underutilized in clinical care. There are opportunities to improve preventive care by leveraging health IT solutions including clinical decision support and tools to facilitate population health activities and patient engagement. This webinar will review a successful example of an initiative at one health system to optimize health IT to promote diabetes prevention, and discuss key lessons learned. Agenda AMA\u27s commitment to chronic disease prevention The state of the type 2 diabetes epidemic Evidence and clinical guidelines for preventive interventions Example of a successful EHR optimization to support diabetes prevention Emerging digital solutions Presentation: 47:30 ©2019 American Medical Association. All Rights Reserve

Consider this strategy for upper gastrointestinal bleeds

Do not order transfusions of red blood cells for patients with acute upper gastrointestinal bleeding unless their hemoglobin level <7 g/dL. A: Based on a single randomized controlled trial (RCT) consistent with other RCTs on recommendations for transfusion