ADA/ACCF/AHA issue position statement

"Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials"; click here to access.

PhRMA issues guiding principles on DTC advertising

Click here to access.

Patient safety reporting guidelines

From the Washington Post article:

Like the clinical practice assessments, the new guidelines address three key concerns: Are the measures important?; Are they valid?; and Are they useful for the intended goal of improving safety? These three key areas are addressed in an assessment tool with about 30 questions.

The proposed guidelines are published in the Nov. 7 issue of the Journal of the American Medical Association.

Click here to access the WP article. Click here to access the JAMA article (sub. req.).

More on anemia drugs

From the L.A. Times article:

The largest group of U.S. cancer doctors said Monday that Medicare has gone too far in restricting the use of anemia drugs made by Amgen Inc. and Johnson & Johnson and released its own guidelines.

The doctors' recommendations add new warnings about heart risks while saying patients can safely use higher doses than Medicare allows. The guidelines, based on a three-year review of clinical trials, are being published by the American Society of Clinical Oncology, an association of cancer doctors, and the American Society of Hematology, a group of blood experts.

Click here to access the article.

New AACVPR/ACC/AHA Guidelines

From the Washington Post article:

Experts in cardiac care have issued new "performance measures" meant to boost patient enrollment in cardiac rehabilitation programs.

They say too many heart attack patients aren't getting the benefit of this form of care.

Click here to access the article.

AMA Therapeutic Insights released (eCME activity)

From the PRNewswire press release:

The AMA is collaborating with recognized disease experts, national data providers and medical specialty groups to incorporate unique drug therapy information, disease prevalence and practice guidelines into an educational delivery format. The prescribing data included in AMA Therapeutic Insights are provided by IMS Health. The data are fully compliant with federal privacy standards and do not contain any patient identifiable information.

Physicians interested in continuing medical education can access AMA Therapeutic Insights to earn AMA PRA Category 1 Credit(TM) that can be applied toward the Physician Recognition Award (PRA).

Click here to read the press release. Click here to access AMA Therapeutic Insights.

New TIA diagnostic protocol

From the ACEP News Release:

A new emergency department diagnostic protocol shows potential for saving money and time, as well as for dramatically reducing the number of hospital admissions for patients diagnosed with transient ischemic attack (TIA), or stroke. The study appears online in the Annals of Emergency Medicine ("An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial").

"Because TIAs tend to be so predictive of future, more serious strokes, many within a couple of days, emergency physicians hospitalize most TIA patients," said lead study author Michael A. Ross, MD, of William Beaumont Hospital in Royal Oak, Michigan. "By managing TIA patients using an accelerated diagnostic protocol in the emergency department, we were able to cut most patients' length of stays and costs in half without compromising their 90-day clinical outcomes. Besides freeing up inpatient beds, this should lead to greater patient satisfaction."

Click here to read the entire news release.

A piece of Dr. Reece's mind

Great essay by Richard Reece, M.D. published today in HealthLeaders Media. Doctor Reece discusses the complex issues that arise with pay for performance (P4P). He presents, methinks, very valid questions and truths relative to this whole issue of P4P, an excerpt:

Compelling doctors to follow guidelines and enforcing their compliance is not as easy as it might seem. Whose guidelines? Keep in mind there are more than 2,000 guidelines floating around out there. You may find them at the National Guideline Clearinghouse website (www.guideline.gov). These guidelines depend on both evidence and opinion and are neither infallible nor a substitute for clinical judgment.

Doctors are mortal and may have a hard time keeping all these guidelines in mind. Small wonder that adherence to guidelines and outcomes vary. As I outline above, patient behavior outside of the office and hospital settings is an important factor in healthcare outcomes. Doctors can’t be held solely--or even primarily--responsible for outcomes, and rewarding or punishing them for outcomes may be overly simplistic. Doing so in the confined hospital setting may make P4P advocates “feel good,” and it is a good place to start, but P4P may not lead to better long-term outcomes.

We all know those people who won't quit smoking, who won't exercise, etc., even after they've endured life-saving procedures. Click here to read this important essay (you have register).

Practice guidelines published in American Family Physician

The latest issue of American Family Physician includes two practice guidelines:

Updated CDC Guidelines for the Treatment of STDs
Diagnosis and Management of Cough

Did you know that, on average, a family physician sees a patient every day with a cough? (Can't help myself, please note the Cough guidelines byline is that of Laura Coughlin...coincidence?).
:)
Click here to access these guidelines.

Simple measures...

An article in the Baltimore Sun discusses the findings of a study just published in the New England Journal of Medicine on the impact that simple infection control measures had on reducing Michigan hospital infection rates. It's not always a knowledge deficit, folks, health care is delivered in an environment (with its own culture) and the systems need to be in place to optimize the quality of care provided. Involve everyone on the health care team -- yes, provide them with the knowledge, but set up the systems so that they have the skills, resources, and tools to apply that knowledge!

Anemia drugs - emerging information and an FDA Alert!

Due to the results of studies recently published in the New England Journal of Medicine (as reported in the New York Times), the National Kidney Foundation will be convening a panel of experts to review whether or not current anemia treatment guidelines for kidney dialysis patients need to be updated. The studies published in the NEJM indicated that aggressive treatment of anemia in kidney patients resulted in more deaths than expected. From the NYT's article:

"The foundation’s panel will probably meet in January or early February and could release new treatment recommendations for public review a few weeks later, the foundation said.

The anemia panel consists of 15 nephrologists who meet under the auspices of the foundation, a private nonprofit group based in New York that provides financing for kidney researchers. The panel is one of several panels sponsored by the foundation that make recommendations about how to improve treatment for kidney patients.

But some scientists complain that Amgen has until now had too much influence on the creation of the foundation’s guidelines. The most recent version of the anemia guidelines, released earlier this year, encourages more aggressive treatment than the Food and Drug Administration recommends."

The FDA has, in fact, issued an alert on this topic. CME Providers who are in the process of planning CME activities on this topic need to read this alert!

Pay for performance (P4P) -- the UK experience

I've finally (and thankfully) gotten a chance to read the web article by Robert Galvin: "Pay-For-Performance: Too Much Of A Good Thing? A Conversation With Martin Roland." Health Affairs, September/October 2006; 25(5): w412-w419.

Galvin interviews Martin Roland, an advisor to the "world’s most ambitious P4P program," the United Kingdom’s Quality and Outcomes Framework (QOF). Roland discusses the unexpected results and findings of the QOF and offers some advice to the United States. Even though the UK and US health care delivery systems differ, it is still very worthwhile information. One important point that Roland makes is that exception reporting "was introduced on the basis that if you have some form of evidence-based guideline, nobody would ever suggest that it should be applied to all patients. So, for example, if you’ve got a diabetic who’s dying of cancer, you’re not going to try and get his cholesterol down."

I encourage all who are involved in CME to read this important article; check with your medical librarian to see if your institution already subscribes to Health Affairs (or this article can be purchased online for a nominal fee).

What a boost to primary care in the UK!

What are the most beneficial and cost-effective preventive services?

According to a study performed by the National Commission on Prevention Priorities they are:

1. Aspirin chemoprophylaxis
2. Childhood immunization series
3. Tobacco-use screening and brief intervention

See the full results of this study at the AAFP website "Practice Guidelines:
Partnership for Prevention Ranks Preventive Services." Be certain to check out Table 2 which depicts current utilization rates (the current tobacco-use screening and brief intervention national utilization rate is only 35%) and the additional quality-adjusted life years saved if utilization rates were at 90%.

"CME" intervention on DVT prophylaxis in France

An Archives of Internal Medicine article by French doctors reports that provider education on evidence-based guidelines for the prevention of DVT was successful. What made the difference? As reported in the heartwire article, the lead author, Doctor Elodie Sellier (University Hospital, Grenoble, France) states that the decrease in DVTs (from 12.8% preintervention to 7.8% postintervention) was due primarily to an increase in the use of graduated compression stockings. Furthermore:

"Rates of minor bleeding and thrombocytopenia were similar in the two patient groups, and no major bleeding was observed, note Sellier et al, suggesting that the educational intervention reduced the incidence of DVT without compromising patient safety."

Sellier E, et al. Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post–Acute Care Patients. Arch Intern Med. 2006;166:2065-2071.

Just curious, do articles like this get into the CME literature database even if there are no keywords like "continuing medical education"?

CDC releases guidance on drug-resistant infections

In an effort to stem the continuing rise of drug-resistant infections, the Centers for Disease Control has issued the "Management of Multidrug-Resistant Organisms in Healthcare Settings" guidelines. These guidelines were developed by experts in collaboration with the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC). The guidelines recommend the followings steps for hospitals and healthcare facilities:

• Ensure that prevention programs are funded and adequately staffed.
• Carefully track infection rates and related data to monitor the impact of prevention efforts.
• Ensure that staff use standard infection control practices and follow guidelines regarding the correct use of antibiotics.
• Promote best-practices with health education campaigns to increase adherence to established recommendations.
• Design robust prevention programs customized to specific settings and local needs.

CME Providers, what a great opportunity for you -- contact your Infection Control folks!

NIH senior scientists allege that Eli Lilly

provided financial support for the development of sepsis guidelines in order to market their product, Xigris. From the Boston Globe article:

"'Dr. Peter Q. Eichacker , a senior investigator in NIH's critical care medicine department and primary author of the paper, said patients and physicians deserve guidelines that are free of industry bias and based on 'the best research and clinical experience available.'

Instead, Eichacker and his co authors wrote, pharmaceutical companies see medical guidelines as 'a potentially powerful vehicle for promoting their products.'

Lilly, in a prepared statement, said it was 'proper' to provide funding for the Surviving Sepsis Campaign. `'We do not believe that Lilly had any role in the development of guideline content, beyond funding the initiative,' the company said. 'The campaign worked independently and autonomously, and our funding for these grants was openly disclosed.'"

Apparently this drug has been hotly debated ever since the FDA approved it in 2001 "based largely on a single late-stage study showing it extended survival by 28 days."