October 2019 Learning Network Resources

Upcoming Webinars and Discussions

Tuesday, November 19 at 4:00PM EST

Join our Choosing Wisely Learning Network webinar for a discussion of opioid education and outreach with speaker Stevie Sy, Pharm D from Mountain Pacific Quality Health.

Watch a recording of this webinar.

New Resources

Blogs, Issue Briefs, Opinion Pieces and More…

  • Berwick D. Elusive Waste : The Fermi Paradox in US Health Care. JAMA. October 2019
    “In large measure, the challenge of removing waste from US health care and reinvesting that harvest where it could do much more good is not a technical one. It is a political one. In short, removing waste from US health care will require both awakening a sleepy status quo and shifting power to wrest it from the grip of greed.”
  • Leis JA, Soong C. De-adoption of Routine Urine Culture Testing—A Call to Action. JAMA Internal Medicine. September 2019
    “Prescriptions for urinary tract infection (UTI) rank among the top indications for antibiotics worldwide. Although true UTI does occur frequently, overdiagnosis and overtreatment are also well-recognized problems. Because clinicians often obtain urine cultures in patients without localizing urinary symptoms, positive culture results, by definition, will reflect asymptomatic bacteriuria rather than infection.


Journals

  • Shrank WH, Rogstad TL, Parekh N. JAMA. Waste in the US Health Care System – Estimated Costs and Potential for Savings. October 2019
    “In this review based on 6 previously identified domains of health care waste, the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste. Implementation of effective measures to eliminate waste represents an opportunity to reduce the continued increases in US health care expenditures.”
     
  • Gilbert-Welch H, Kramer BS, Black WC. Epidemiologic Signatures in Cancer. The New England Journal of Medicine. October 2019
    “The authors use 40 years of data on cancer incidence and mortality to produce curves that show changes in cancer incidence (decreasing, increasing, or staying stable) and the effect of early detection efforts on cancer incidence and that help to distinguish treatment advances from overdiagnosis.”
     
  • Royuela A, Abad C, Vicente A, Muriel A, Romera R, Fernandez BM, Corres J, Bustos PF, Ortega A, Heras-Mosteiro J, Latorre RG, Zamora J. Implementation of a Computerized Decision Support System for Computed Tomography Scan Requests for Nontraumatic Headache in the Emergency Department. The Journal of Emergency Medicine. October 2019
    “Nontraumatic headache is a frequent complaint in the emergency department (ED). Cranial computed tomography (CT) is a widely available test for the diagnostic work-up, despite the risk of exposure to ionizing radiation. We sought to develop and evaluate a cranial CT request computerized decision support system (CDSS) for adults with their first presentation of unusual severe nontraumatic headache in the ED. In nontraumatic headache among adults seen in the ED, CDSS decreased the cranial CT request rate but the diagnostic yield did not improve.”
     
  • Mahoney GK, Henk HJ, McCoy RG. Severe Hypoglycemia Attributable to Intensive Glucose-Lowering Therapy Among US Adults With Diabetes.Mayo Clinic. September 2019
    “Intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia. However, intensive treatment was equally prevalent among US adults, irrespective of clinical complexity. Patients at risk for hypoglycemia may benefit from treatment deintensification to reduce hypoglycemia risk and treatment burden.”
     
  • Johnson DP, Lee V, Gourishankar A, Rajbhandari P, Schefft M, Genies M. Things We Do For No Reason™: Routine Blood Culture Acquisition for Children Hospitalized with Community-Acquired Pneumonia. Journal of Hospital Medicine. September 2019
    “Implementing a more targeted approach to blood culture acquisition for hospitalized children with CAP will hopefully increase the yield of true bacterial pathogens that alter management decisions. A targeted approach for the child in the opening vignette would have saved him from the pain of unnecessary phlebotomy (repeat culture), exposure to vancomycin as a nephrotoxic agent, and an additional hospital day.”


Media Coverage

  • First Guideline to Say Colon Cancer Screening Is Not for All. Medscape. October 2019
    “For the first time, a guideline recommends that screening for colorectal cancer should not be routinely recommended for all adults aged 50 to 79 years, but instead should be limited to individuals with an elevated level of risk.”
     
  • It’s not just opioids: What doctors want you to know about benzos. CNN. October 2019
    “Agarwal believes that, as with opioids, the medical community and patients should pay more attention to how and why benzodiazepines are prescribed.”
     
  • Rx for Doctors: Stop With the Urine Tests. The New York Times. October 2019
    “In patients who have none of the typical symptoms of a urinary tract infection — no painful or frequent urination, no blood in the urine, no fever or lower abdominal tenderness — lab results detecting bacteria in the urine don’t indicate infection and thus shouldn’t trigger treatment.”