Quality patient care: making evidence-based, high value choices
Gespeichert in:
| Weitere Verfasser: | , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pennsylvania
Elsevier
[2016]
|
| Schriftenreihe: | Medical clinics of North America
volume 100, number 5 (September 2016) |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | xviii Seiten, Seite 971-1155 Illustrationen |
| ISBN: | 9780323462600 |
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| 245 | 1 | 0 | |a Quality patient care |b making evidence-based, high value choices |c editors Marc Shalaby, Edward R. Bollard |
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| 700 | 1 | |a Shalaby, Marc |0 (DE-588)1116373416 |4 edt | |
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Datensatz im Suchindex
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| adam_text | Titel: Quality patient care
Autor: Shalaby, Marc
Jahr: 2016
Quality Patient Care: Making Evidence-Based, High Value Choices
Contents
Preface: A Convergence of Themes: Making Evidence-Based, High Value Choices xvii
Marc Shalaby and Edward R. Bollard
Cardiovascular Testing in Asymptomatic Patients: Carotid Duplex, Cardiac Stress
Testing, Screen for Peripheral Arterial Disease 971
David J. Aizenberg
Approximately one-third of deaths in the United States are from cardio-
vascular disease. Managing modifiable risk factors is paramount to
reducing risk of heart disease and stroke. It is logical to try to identify
patients with silent disease that may predispose them to significant
morbidity and mortality. Unfortunately, it is unclear if routine screening
for the presence of carotid stenosis, coronary artery disease, and periph-
eral arterial disease is beneficial. Many of these tests are expensive. This
review explores the evidence behind screening tests, costs associated
with the tests, and the implications of positive screening for each of the
3 listed conditions.
Evidence-Based Recommendations for the Evaluation of Palpitations in the
Primary Care Setting 981
Joel Wilken
Palpitations are a symptom of many cardiac and noncardiac conditions.
The patient s history, physical examination, appropriately directed labora-
tory tests, and basic electrocardiogram are helpful in evaluating palpita-
tions and may be essential to finding a diagnosis. There are many
outpatient options for the evaluation of palpitations caused by a presumed
cardiogenic cause. These evaluation tools include Holter monitor, event
monitor, transtelephonic electrocardiographic monitor, treadmill exercise
stress test, echocardiography, and electrophysiologic studies. Most pa-
tients can be evaluated as an outpatient, but there are reasons, such as
hemodynamic compromise, that may require admission to an inpatient
setting to complete the diagnostic workup.
Utility of Echocardiogram in the Evaluation of Heart Murmurs 991
Padmanabhan Premkumar
Valvular heart disease is a common condition in today s patient popula-
tion. Accurate characterization of vital cardiac structures has become
crucial to early diagnosis and varied treatment options. The advent of
ultrasound technology has had a large impact in cardiovascular medicine,
particularly in the assessment of valvular heart disease. Today its versa-
tility and availability have allowed it to become one of the most frequently
ordered imaging tests for cardiovascular indications. Despite the tremen-
dous evidence that suggests that clinical examinations are still standard
of care, a large volume of referrals for echocardiograms suggests
differently!
xii Contents
Avoiding Unnecessary Preoperative Testing 1003
Matthew H. Rusk
Given the low-risk nature of cataract surgery, no preoperative testing is
indicated unless the patient needs it for another reason. Although elec-
trocardiograms may have a role in preoperative testing in patients at
high risk of cardiovascular disease, or if the procedure carries with it
significant operative risks, they are often unnecessary. Urinalysis and
coagulation studies should not be routine because they have not shown
any value in predicting complications. Although these tests are not
individually expensive, the aggregate cost is substantial. As good stew-
ards of the medical system, physicians need to use these tests more
judiciously.
The Cost-Effective Evaluation of Uncomplicated Headache 1009
Marilyn Katz
Headaches remain one of the most common reasons for patients to seek
acute care. It is important to assess whether the headache meets criteria
for a primary (uncomplicated) versus a secondary headache, due to an
underlying condition. A thorough history and physical examination are
imperative when assessing the nature of the headache and to rule out
red-flag features, which are signs and symptoms of dangerous causes.
This will help determine if imaging studies are warranted. Management
of uncomplicated headache should include treatment of the acute head-
ache and an action plan for reducing the frequency and severity of future
headaches.
The Cost-Effective Evaluation of Syncope 1019
Steven Angus
Syncope is a common clinical problem that carries a high socioeconomic
burden. A structured approach in the evaluation of syncope with special
emphasis on a detailed history, comprehensive physical examination
that includes orthostatic vital signs, and an electrocardiogram, proves to
be the most cost-effective approach. The need for additional testing and
hospital admission should be based on the results of the initial evaluation
and use of risk-stratification tools that help identify those syncope patients
at highest risk for poor outcomes.
Evidence-Based Evaluation and Management of Chronic Cough 1033
Andreas Achilleos
Chronic cough is common and has a significant impact on the wellbeing
of patients and the use and cost of health care services. Traditionally
the approach to chronic cough in patients who are nonsmokers and
are not taking an angiotensin-converting enzyme inhibitor has focused
on the diagnosis and management of the upper airway cough syn-
drome, asthma, and reflux disease. The evaluation of patients with
chronic cough-frequeottyinvoives trials of empirie therapy for these
3 cortditionSv ChroolcfCough may, be..perpetuated by abnotmalities
of the cough reflex and sensitization of its afferent and. centrad
components.
Contents xiii
The Approach to Occult Gastrointestinal Bleed 1047
Edgar R. Naut
Occult gastrointestinal bleeding is not visible and may present with a pos-
itive fecal occult blood test or iron deficiency anemia. Obscure bleeding
can be overt or occult, with no source identified despite an appropriate
diagnostic workup. A stepwise approach to this evaluation after negative
upper and lower endoscopy has been shown to be cost effective. This in-
cludes repeat endoscopies if warranted, followed by video capsule endos-
copy (VCEE) if no obstruction is present. If the VCE is positive then specific
endoscopic intervention may be possible. If negative, patients may un-
dergo either repeat testing or watchful waiting with iron supplements.
The Role of Esophagogastroduodenoscopy Surveillance for Patients with Barrett
Esophagus 1057
Kerri Palamara
Approximately 10% to 15% of patients who experience chronic gastro-
esophageal reflux disease have Barrett esophagus, which is associated
with an increased risk of esophageal adenocarcinoma. If symptoms
persist after 8 weeks of adhering to treatment and lifestyle modifica-
tions, or if alarm symptoms develop, patients should be referred for
screening upper endoscopy. Those with evidence of Barrett esophagus
with dysplasia should be monitored in an endoscopic surveillance pro-
gram, and those with high-grade dysplasia should consider surgical
treatment.
The Evidence-Based Evaluation of Iron Deficiency Anemia 1065
Eliana V. Hempel and Edward R. Bollard
Anemia is a prevalent disease with multiple possible etiologies and resul-
tant complications. Iron deficiency anemia is a common cause of anemia
and is typically due to insufficient intake, poor absorption, or overt or
occult blood loss. Distinguishing iron deficiency from other causes of ane-
mia is integral to initiating the appropriate treatment. In addition, identifying
the underlying cause of iron deficiency is also necessary to help guide
management of these patients. We review the key components to an
evidence-based, cost-conscious evaluation of suspected iron deficiency
anemia.
Indications and Usefulness of Common Injections for Nontraumatic Orthopedic
Complaints 1077
Robert K. Cato
Pain related to various musculoskeletal conditions is a common patient
complaint, and one that is often difficult to remedy. In addition to oral
analgesics and physical therapy, local injections (most commonly of
corticosteroids) are a common intervention and have been for decades.
However, in most cases, the literature is full of poor-quality studies,
making the true utility of these injections questionable. This article re-
views some of the literature studying these injections with the goal of
providing clinicians the information to make evidence-based, high-value
etafiteeaa; .. •
xiv Contents
Utilization and Safety of Common Over-the-Counter Dietary/Nutritional
Supplements, Herbal Agents, and Homeopathic Compounds for Disease
Prevention 1089
Ruchir Trivedi and Marissa C. Salvo
Dietary supplements are commonly used by patients as part of their med-
ical care plan. Often clinicians may not be aware of their use, because pa-
tients do not always consider these to be medications. All clinicians need
to continually ask patients about their use of dietary supplements when
collecting a medication history. Dietary supplements and prescription
medications often share similar enzymatic pathways for their metabolism.
These interactions may lead to severe adverse reactions. This article re-
views available evidence for a variety of dietary supplements in select dis-
ease categories.
Cancer Screening in Older Adults 1101
Ashley H. Snyder, Allison Magnuson, and Amy M. Westcott
When screening for cancer in older adults, it is important to consider the
risks of screening, how long it takes to benefit from screening, and the pa-
tient s comorbidities and life expectancy. Delivering high-value care re-
quires the consideration of evidence-based screening guidelines and
careful selection of patients. This article considers the impact of cancer.
It explores perspectives on the costs of common cancer screening tests,
illustrates how using life expectancy can help clinicians determine who will
benefit most from screening, and provides tools to help clinicians discuss
with their older patients when it may be appropriate to stop screening for
cancer.
Symptom Control at the End of Life 1111
Margaret Kreher
Symptom control at the end of life is an identified ongoing gap in end-
of-life care. Increased demand for high-quality symptom control; limited
supply of specialty trained clinicians; lack of consistent high-quality
evidence-based interventions; and education deficits among clinicians,
patients, and families in end-of-life processes contribute to this gap.
High-value end-of-life care is centered on high-quality communication
about goals of care. This article reviews primary palliative care concepts
of communication and symptom control to provide a framework for
primary care physicians to use in the care of patients at the end of life.
Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients? 1123
Jennifer Baldwin and Jaclyn Cox
The high prevalence of dyspnea at the end of life carries with it significant
health and economic burden. Given the complex mechanism of dyspnea,
management should be tailored to the individual patient experience and
the underlying disease process. No clear role for supplemental oxygen
has been established in the treatment of dyspnea in patients without
hypoxemia, and providers should consider the negative effects of oxygen
supplementation. Symptom controlwith medications, exercise, behavioral
therapy, treatment of associated anxiety, and the use of fans may be more
Contents xv
effective and less costly than oxygen therapy. Further research is needed
in the assessment and treatment of this symptom to more effectively treat
patients.
The Role of Intravenous Fluids and Enteral or Parenteral Nutrition in Patients
with Life-limiting Illness 1131
Meghan E. Lembeck, Colette R. Pameijer, and Amy M. Westcott
The decision of whether or not to use artificial nutrition or hydration is one
with which many health care providers, patients, and families struggle.
These decisions are particularly challenging in the setting of life-limiting
illness, which is often associated with a prolonged decline because of
medical advances in these patient populations. A patient-centered and
family-centered approach helps to attain high-quality care in this special
population.
Index
1143
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