Evidence-Based Medicine
May 9, 2013
Negative Side of Supply-Side Economics
Three poignant cases where over-supply (of docs) leads to over-testing or over-treating FirstGoodwin JS, Singh A, Reddy N, Riall TS, Kuo Y-K. "Overuse of Screening Colonoscopy in the Medicare Population." Arch Intern Med Published online May 9, 2011. doi:10.1001/archinternmed.2011.212Conclusions A large proportion of Medicare patients who undergo screening colonoscopy do so more frequently than recommended. Current Medicare regulations... Read more Tags: over test, over treat, ER, screening, follow-up, frequency, test Read more articles about: cost-effectiveness Apr 23, 2013
Antibiotic Inappropriateness
Lower Respiratory Tract Infections and Inappropriate Antibiotic Use Primum non nocere The evidence is overwhelming! We must reduce the use of antibiotics in patients suspected of having virus "infections" such lower respiratory tract infections, acute bronchitis (another name for "cough" [1]) or sinusitis, if not mild otitis media or middle ear infection. In such situations, antibiotics have no value and they can be harmful, if not making... Read more Tags: evidence-based practice, sinusitis, URI, bronchitis, lower respiratory tract infection, inappropriate antibiotic use, antibiotic, antibiotic therapy, antibiotic prescriptions, emergence of, resistant bacterial strains Read more articles about: antibiotic use/overuse Mar 4, 2013
Congestive Heart Failure: Diagnosis, Staging and Therapeutic Options
The Nationally accepted congestive heart failure (CHF) Clinical Guidelines have changed in the following important ways• Changes in the underlying conceptualization of the heart failure syndrome.• Recognition of the need for early and accurate detection of heart failure.• A new standard for staging disease severity and identifying reversible causes.• Emphasis on the need for prompt titration of lifesaving neurohormonal antagonists.• Recognition... Read more Tags: congestive heart failure, managed care, preventing readmissions Read more articles about: Evidence-Based Medicine Jan 17, 2013
Antibiotics, Sensible Use; Injudicious Overuse
It's easier to prescribe antibiotics in a cold, sinsitis or bronchitis than to explain why not. (It takes less time, it's expected, it's someone else's money and diagnostic confusion from partial or inappropriate treatment will likely be someone else's problem.) Advisory "If you're suffering from a cold, the flu, or another virus, there are things you can do to help relieve the symptoms, but taking antibiotics will not help. Antibiotics only... Read more Tags: antibiotic, indiscriminate use, antibiotic resistance, antibiotic pressure, ESKAPE pathogens, antibiotic overuse, need for an antibiotic, the number one problem facing the medical community Read more articles about: antibiotic use/overuse Oct 17, 2012
Vitamin Insufficiency or Expensive Urine
You want the best health and well-being for yourself and loved ones, but vitamins and supplements, are no panacea. Furthermore, know that the law does not require proof they work. And, overdoses and conflicts with real medicines do occur (so they cannot be taken with impunity). Nevertheless, well-designed studies do indicate a modest benefit. Here's one, for instance, that states:14 641 middle-aged and older men were studied during a mean of... Read more Tags: vitamins, minerals, supplements, vit D, vitamin D, immune function, asthma, transparency, clinical benefit, risk vs. benefit Read more articles about: benefit vs. harm Sep 28, 2012
Failing Complicated Care, What's Next?
Are we prepared to care for people with chronic or complex conditions like those with comorbidities? The more chronic conditions, the greater the likelihood of the following : "unnecessary hospitalizations; adverse drug events; duplicative tests; conflicting medical advice; and, most important, poor functional status and death.1-5 Approximately 65% of total health care spending is directed at the approximately 25% of US population who have... Read more Tags: chronic disease, functional status, drug cost, death, adverse drug events, care management, coordination, incentive, surgical rates, Deyo, pineal fusion, back, fee-for-service, FFS Read more articles about: chronic disease management Sep 9, 2012
Comparative-Effectiveness Research (CER)
Increasingly, the cost of care is unnecessarily dear, rising exponentially while the return on investment is falling precipitously. What can be done about improving the value of health care? Even as we "embrace advances in health care, we must remember that a number of what were thought to be advances turned out to not be beneficial, or even to be harmful." Nevertheless, a recent Institute of Medicine report gives reform its legs by auguring... Read more Tags: comparative effectiveness research, CER, best practices, evidence-based research, measure and manage, health insurance Read more articles about: cost-effectiveness Jan 8, 2013
Patient-Centered Care
Achieving patient-centered care is difficult, yet essential; paternalism is, of course, out. The editorial, "Patient-Centered Care; What Is the Best Measuring Stick?" by Drs. Lin and Dudley (Archives of Internal Medicine), begins with an apropos quote of Sir William Osler: "The good physician treats the disease; the great physician treatsthe patient who has the disease." It continues by establishing a fundamental point of contention in the... Read more Tags: Patient-Centered Care, paternalism, Hawthorne effect, outcome, type II diabetic Read more articles about: compliance / adherence Jan 3, 2013
Cost-effectiveness of Total Knee Arthroplasty in the US
The number of U.S. total knee arthroplasty (TKA) procedures, an effective, established operation, is huge and it is more cost-effective to do TKA in patients with end-stage osteoarthritis than to treat the patient medically, regardless of the hospital TKA volume. Nevertheless, the larger volume hospitals enjoy the better C:E in part because they have lower cost ratios. There were approximately 500,000 TKAs in 2006 For which the direct medical... Read more Tags: Total knee arthroplasty, TKA, hip, knee, osteoarthritis, obesity, price increases, cost-effective, cost-effectiveness ratio, efficacy, cost-benefit, quality-adjusted life year, QALY, quality-adjusted life expectancy, QALE Read more articles about: cost-effectiveness Jan 1, 2013