WIHI - A Podcast from the Institute for Healthcare Improvement

Episodes of emotional stress, especially when sudden, severe and unexpected, may have significant adverse effects on the heart. Acute emotional stress can increase sympathetic stimulation of the heart and can alter brain activity in a way that makes the heart more susceptible to rhythm disturbances. Since episodes of emotional stress are almost inevitable in life, part of a healthy lifestyle is learning how to deal effectively with stress to make them less likely to lead to adverse effects; relaxation therapy, yoga, meditation, and other ways of responding to stress may be important for individuals to become familiar with to accomplish this.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Folic acid supplementation is not useful for preventing colorectal adenomas. Folic acid supplementation may be harmful through increasing colorectal adenomas. Practitioners and patients should wait for strong evidence before initiating therapies given the potential for waste and unintended adverse consequences

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

While aspirin is generally a safe drug, and extremely effective, with over 50 million US adults taking it everyday for cardiovascular disease prevention, even a very small incidence of side-effects can have major implications. In terms of preventing heart attacks, strokes or cardiovascular deaths no clinical trial has identified an aspirin dose more efficacious than 75 to 81mg daily. Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk.

Evidence from two replicate RDBPC trials showed sumatriptan-naproxen as a fixed dose combination was superior in treating an attack of migraine when compared to sumatriptan alone, naproxen alone, or placebo. Most importantly, given that migraine attacks in adults are 4 to 72 hours in duration, the fixed dose combination of suma-naproxen was significantly more effective that sumatriptan monotherapy or naproxen monotherapy in providing a 24 hour sustained pain free response. Patients using the fixed dose combination therapy were less likely to use rescue medication or to have headache recurrence, and did not experience any penalty in side effects using the combination.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Screening and other prevention approaches involve subjecting very large numbers of people to an intervention, with the expectation that a few will benefit, but most will not (as they would have never developed the condition anyway). In general screening for diseases such as cancer will uncover some reservoir of abnormalities that appear to be precursors to clinical disease but are not yet causing disease. We really have no evidence to support screening for lung cancer right now with any technology. We really should be advocating for our patients to help them understand why they shouldn't have this test until we know that it is more likely to hurt them or help them.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Half of all heart attacks and strokes occur among those with normal cholesterol levels and 15-20% occur among those with no major risk factors at all. The major breakthroughs in understanding cardiovascular disease over the past decade include insights about inflammation and genetics. Each of these can easily be ascertained with either a simple blood test (hsCRP for inflamamtion) or a simple question about parental history of Myocardial Infarction. By incorporating these two new measures into how we think about risk, a new risk tool was derived known as the "Reynolds Risk Score". This is a win-win for everyone as it allows us to better target therapies, avoid toxicity, and improve overall prevention strategies for heart disease.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Screening for falls is as simple as asking the patient if she's fallen in the past year. For patients who have not fallen, ask about gait or balance problems (e.g. "Do you have a walking or balance problem?"). Most older patients who have a history of falls in the past year, or a gait/balance problem, have at least a 50% chance of falling in the coming year. You may want to do a more thorough evaluation on these patients. To make screening easy for new patients, add into your pre-visit questionnaire questions that ask about a history of falls and/or gait/balance problems. Or, have your office staff ask these questions routinely when patients are being checked in.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

The long term use of alendronate for up to 10 years is safe. Those who discontinued treatment at 5 years lost bone mass compared to those who continued but the bone loss was only moderate. Rates of fracture were similar among those who continued verses those who discontinued except for clinical vertebral fractures which, although relatively uncommon, were higher in those who discontinued treatment. Results suggest that after 5 years of alendronate, many women may discontinue therapy for up to 5 years. Although, those at high risk of clinical vertebral fracture may benefit by continuing.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.