November 2020 Learning Network Resources

Tuesday, December 15th @ 4PM EST

Join us for a webinar on the Intersection of Trust and Choosing Wisely with speakers Richard Baron, MD, President, CEO, American Board of Internal Medicine, and Daniel Wolfson, VP, COO, American Board of Internal Medicine Foundation. Register here.

Blogs, Issue Briefs, Opinion Pieces and More…

  • More than a third of older adults are prescribed potentially inappropriate drugs, study finds. Lown Institute. October 2020
    “In the study, PIMs were associated with greater health care utilization (potentially due to adverse drug events) and higher costs of care. The authors found that older adults prescribed a PIM were more likely to go to the emergency room (26% more likely) or to be hospitalized (17% more likely) compared to those were not prescribed a PIM, adjusting for other patient characteristics. Older adults prescribed a PIM also spent more than those without a PIM on prescription drugs ($128 more) and spent more in total health care costs ($458 more), even controlling for chronic conditions and other patient factors.”
  • The Upside to Fewer Cancer Screenings in 2020. Elemental. October 2020
    “It is understandable that dire alarms are going off in the cancer care community about lives that may be lost because of the Covid-related decline in screening for breast, prostate, colon, and lung cancer. But the data make clear that for some of these cancers, screening is a double-edged sword. This temporary screening decline (which is already starting to normalize) provides an opportunity for researchers to measure not only the benefits of screenings, but also the costs.”
  • Report on neuroimaging of preterm infants reviews modalities, timing, prognostic value. AAP News. October 2020
    “However, as the AAP Choosing Wisely campaign identified, evidence is insufficient that routine brain MRI at term-equivalent age improves long-term outcomes, and the results’ effects on an individual family are uncertain. Communication between the NICU inpatient team and the pediatric outpatient providers regarding neuroimaging results and follow-up plans is recommended.”
  • Powers BW, et alt. De-adopting Low-Value Care – Evidence, Eminence, and Economics. JAMA. October 2020
    “This Viewpoint describes 3 forces that govern the de-adoption of low-value care—evidence, eminence, and economics—and applies his framework to identify and prioritize policies that could be used to speed de-adoption.”

Journals

  • Cortina CS, et alt. De-Escalation of Local-Regional Therapy for Older Breast Cancer Patients. Current Breast Cancer Reports. November 2020
    “Select older patients with breast cancer may benefit from the omission of axillary staging, less aggressive breast surgery, and shorter courses or total omission of radiation therapy. Current studies aim to continue to define the appropriate criteria for which older patients can benefit from de-escalation of local-regional therapy.”
  • Kamm AM, et alt. An Interdisciplinary Approach to Safe Opioid Prescribing and Administration for Surgical Patients at an Academic Medical Center. Journal of Clinical Nursing. November 2020
    “Effective pain management for surgical patients must be individualized. Safe opioid prescribing should involve an interdisciplinary approach with all members of the team undergoing assessment of their opioid knowledge and prescribing habits, easily accessible training tools, and opioid calculators in the electronic medical record.”
  • Gammon RR, et alt. Maintaining adequate donations and a sustainable blood supply: Lessons learned. Transfusion. November 2020
    “Collecting and maintaining a blood supply robust enough to handle disasters and transfusion‐dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.”
  • Akinboyo IC, et alt. Principles, policy and practice of antibiotic stewardship. Seminars in Perinatology. October 2020
    “Antibiotic stewardship is a quality improvement and patient safety initiative focused on optimizing antibiotic use to improve patient outcomes, limit the emergence of antibiotic resistance, and adverse drug effects. Here, we discuss the Centers for Diseases Control and Prevention Core Elements of Antibiotic Stewardship—leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education—as they apply to the care of patients in the neonatal intensive care unit. Specifically, we consider neonatal intensive care unit-specific data and unique practices to frame some of the important targets necessary for successful antibiotic stewardship implementation in this setting.
  • Chaun-Chou S, et alt. High‐deductible health plans and low‐value imaging in the emergency department. Health Services Research. October 2020
    “Though HDHP switches decreased ED utilization, they had no significant effect on low‐value imaging use after patients have decided to seek ED care.”
  • Kreizenbeck, KL, et alt. A pilot study to increase adherence to ASCO Choosing Wisely recommendations for breast cancer surveillance at community clinics. Journal of Clinical Oncology. October 2020
    “While adherence to recommendations regarding high-cost imaging was high, wide variation in tumor marker adherence among providers and high baseline adherence for advanced imaging suggests that interventions targeting surveillance testing may wish to focus primarily on tumor markers and provider outreach.”
  • Milford K, et alt. Unnecessary ultrasounds in children with undescended testes: An interrogation of the impact of the Choosing Wisely campaigns and clinical practice guidelines. Paediatrics & Child Health. October 2020
    “Despite clinical practice guidelines and Choosing Wisely campaign recommendations, significant numbers of children with UDT still undergo US. Transient changes in sub-specialty guideline adherence are observed. Strategies to improve sustained guideline awareness in referring clinicians need to be considered.”

Media Coverage

  • What you need to know about cold and flu season in the time of COVID-19. THE STAR. November 2020
    “Choosing Wisely Canada and The College of Family Physicians of Canada have created guidance for when an in-person examination may be important to assess if symptoms are caused by viral illness or a bacterial infection. Right now, patients with cold and flu symptoms are more anxious than in previous years. Primary care providers are equipped to support patients. Although the cold and flu season is very different this year, you are not on your own. Talk to your primary care provider about how to manage your symptoms.”
  • Shared Decision-Making Influences PSA Testing Rates. Medscape. November 2020
    “Men with high health literacy are more likely than others to get PSA testing, and shared decision-making conversations reduce this likelihood only slightly, a new study suggests. Men with low health literacy, however, are more likely to get PSA screening when optimal shared decision-making is present compared with no discussion, the study team reports in the journal Cancer.”