CME/CE: Guidance on Implementing Antibiotic Stewardship

CME/CE: Guidance on Implementing Antibiotic Stewardship

As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria, hospitals and healthcare systems have been called upon by the White House to implement antibiotic stewardship programs by 2020. The goal of the plan is to ensure the appropriate use of antibiotics and reduce the growing emergence of resistance. A previous guideline on antibiotic stewardship was released in 2007 and focused on the development of programs rather than on specific evidence-based strategies that have been shown to be beneficial in ensuring that such programs are effective and sustainable. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have recently published a new guideline in Clinical Infectious Diseases that emphasizes the use of various interventions depending on local resources, issues, and expertise.   The Foundation In total, IDSA and SHEA issued 28 recommendations in the new guideline. All of these recommendations stand on their own, complete with a section of literature that supports the recommendation. The guideline was based on a review of hundreds of  stewardship-focused papers that examined different strategies, “We included new studies as much as possible,” says Tamar Barlam, MD, who co-authored the update with Sara Cosgrove, MD. “For example, several recent studies show that a shorter course of antibiotics appears to be just as effective as a longer course,” she says. “A shorter but equally effective course would theoretically provide less opportunity for side effects or the emergence of resistance.” Dr. Barlam notes that the IDSA/SHEA writing committee started with a recommendation they feel should be the first step in running an antibiotic stewardship program. “Pre-authorization, prospective audit and...
CME/CE: Bariatric Surgery & Mental Health

CME/CE: Bariatric Surgery & Mental Health

Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common. To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.   Taking a Closer Look For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27...
Video CME/CE: Understanding the Righteous Mind – With ZDoggMD

Video CME/CE: Understanding the Righteous Mind – With ZDoggMD

Read all the “front matter” information to the right, watch the video below, then click the link at the bottom right to complete the post-test and obtain credits. Release Date: December 14, 2016 Expiration Date: December 14, 2017   View...
CME/CE: Knee Osteoarthritis: Guidelines for Surgery

CME/CE: Knee Osteoarthritis: Guidelines for Surgery

According to current estimates, 27 million adults in the United States—or more than 10% of the adult population—have clinical osteoarthritis, a condition that ranks among the leading causes of hospitalization. Recent estimates show that approximately 9.9 million adults have symptomatic osteoarthritis (OA) of the knee. With life expectancy rates continuing to rise, it is anticipated that the prevalence of knee OA will increase in the coming years. The number of people older than age 65 is expected to increase to more than 77 million by the year 2040. The burden of OA of the knee is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. OA is the most frequent cause of disability among U.S. adults, and the burden is increasing due to the rising disease prevalence as well as higher expectations among patients to receive effective treatment. OA is the leading indication for joint replacement surgery. About 905,000 knee and hip replacements were performed in 2009, costing the healthcare system $42.3 billion. These estimates factor together direct medical, long-term medical, home modification, and nursing home costs.   OA Risk Factors & Disease Clinical studies have identified several factors that increase risks for developing OA of the knee to the point that surgery is required. These include joint degeneration over time due to hereditary vulnerability, large body mass, certain occupations, past joint traumas, and prior intraarticular damage. Knee OA also takes an emotional and physical toll on patients. Older adults with OA of the knee tend to visit their physicians more frequently and experience more functional limitations than others in the same age group....
CME/CE: Disparities in Older Patients with Diabetes

CME/CE: Disparities in Older Patients with Diabetes

Studies show that the prevalence of type 2 diabetes among adults aged 65 and older in the United States ranges between 20% and 25%. However, controversy has surrounded the most appropriate approaches to treating and managing diabetes in older adults, particularly with regard to identifying therapeutic targets for A1C and the control of other cardiovascular risk factors. In addition, research suggests there are disparities in risk factor control among racial and ethnic minorities with diabetes when compared with whites who have the disease. “Diabetes continues to be a major public health problem among older racial and ethnic minorities,” says Hermes J. Florez, MD, MPH, PhD. There are important factors to consider when managing this older patient group and developing treatment targets. These include the potential for adverse effects when using pharmacologic treatment, risks for hypoglycemia, and individual comorbidities, among other factors.   A Closer Look For a study published in Diabetes Care, investigators assessed data from the Atherosclerosis Risk in Communities (ARIC) study (2011–2013), which involved non-institutionalized, community-dwelling older adults with diabetes. The cross-sectional analysis involved more than 5,000 participants aged 67 to 90 with and without diagnosed diabetes who attended the fifth visit of the ARIC study. The authors evaluated the prevalence of glycemic, lipid, and blood pressure (BP) control overall and by race. The study also investigated correlates of meeting treatment targets and whether or not racial differences in risk factor control could be explained by demographic and clinical characteristics. Stringent risk factor targets were defined as having an A1C of less than 7%, an LDL cholesterol (LDL-C) level of less than 100 mg/dL, and a BP...
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