CME: Analyzing Inappropriate Antibiotic Use

CME: Analyzing Inappropriate Antibiotic Use

In recent years, there has been increased attention on the overprescribing of antimicrobials due to a surge in drug-resistant bacteria and superbugs. Current estimates show that about 2 million Americans are sickened and another 23,000 die from drug-resistant infections each year. These issues persist despite quality improvement efforts and the launching of campaigns to fight the problem. According to published research, antibiotics are used in approximately 56% of inpatients who are cared for in hospitals in the United States. However, antibiotic use is deemed inappropriate in nearly half of these cases. The inappropriate use of antibiotics can contribute to significant health issues, including antibiotic resistance, clinical failure, adverse drug events, and excessive costs. In a retrospective study published in Infection Control & Hospital Epidemiology, Gregory A. Filice, MD, and colleagues sought to detail the relationship between diagnostic errors and inappropriate antimicrobial treatment courses. The authors analyzed 500 randomly selected inpatient cases at the Minneapolis VA Medical Center in which an antimicrobial course was prescribed between October 2007 and September 2008. Four reviewers who were board-certified in internal medicine and infectious diseases then assessed the accuracy of the initial provider diagnosis for the condition that led to the antimicrobial course and whether or not the course was appropriate.   Misdiagnoses Common Study results showed that initial provider diagnoses were correct in more than half of cases the cases assessed, but many were incorrect or had diagnostic accuracy that was undeterminable. In 6% of cases, the initial provider’s diagnosis was a sign or symptom rather than a syndrome or disease. “Overall, only 58% of patients received a correct diagnosis,” says Dr....
CME: Pneumonia & CVD: Making the Link

CME: Pneumonia & CVD: Making the Link

Studies have shown that patients with respiratory tract infections (RTIs) often have higher risk for cardiovascular events than those without RTIs. However, these studies have mostly assessed risk within the first few months after an RTI. Investigations that have assessed long-term risk have had conflicting results. By better characterizing the short- and long-term risks of CVD after an RTI, clinicians may be able to clarify whether these infections are risk factors for CVD and help explain the short- and long-term morbidity and mortality among patients with RTIs. Assessing Risk For a study published in JAMA, Sachin Yende, MD, MS, and colleagues examined community-based cohorts from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities study (ARIC). “CHS enrolled patients older than 65 from 1989 to 1994, and we have follow-up data for about 15 years,” explains Dr. Yende. “The ARIC study enrolled patients aged 45 to 65 from 1987 to 1989, and has similar follow-up data.” To determine if the risk of CVD varied over 10 years following hospitalization for pneumonia, the authors identified pneumonia hospitalizations in the CHS and ARIC cohorts. These individuals were then matched with patients without pneumonia and monitored for the development of CVD. Risk was assessed within the 30 days of hospitalization, from 30 to 90 days, from 90 days to 1 year, and then annually thereafter. The researchers also sought to determine if any associations between pneumonia and CVD risk persisted after adjusting for traditional and cardiovascular risk factors. Persistent CVD Risk “Our study confirmed that the risk of CVD events is indeed higher among patients who have had pneumonia when...
2016’s Best & Worst States for Doctors to Work

2016’s Best & Worst States for Doctors to Work

In order to help doctors make the most informed decisions regarding where to practice, WalletHub’s analysts compared the 50 states and the District of Columbia across 11 key metrics. Find out where your state falls. Source: WalletHub Best States to Work  Overall Rank State Total Score Opportunity & Competition Rank Medical Quality Rank  1  Mississippi  70.7  1  17  2  Iowa  69.28  3  9  3  Minnesota  66.54  17  1  4  North Dakota  65.81  5  10  5  Idaho  65.41  4  15  6  Texas  65.27  13  4  7  Kansas  65.26  8  6  8  Wisconsin  64.61  23  2  9  Tennessee  64.59  6  14 10 Alabama 63.36 11 12 Worst States to Work  Overall Rank State Total Score Opportunity & Competition Rank Medical Quality Rank  10 Maine 41.40  41 47  9 Delaware 41.03 42 43  8 Massachusetts 40.62 46 29  7 Vermont 40.25 49 13  6 New Jersey  38.30 45 39  5 Connecticut  38.14 44 38  4 Maryland  37.42 43 4644  3 Rhode Island  31.63 50 5146  2 New York  29.56 48 3551 1 District of Columbia 27.81 51 35     Source:...
CME: Pregnant Women With Zika Have Fetal Abnormalities

CME: Pregnant Women With Zika Have Fetal Abnormalities

CREDITS ♦  Physicians: 0.25 AMA PRA Category 1 Credit(s) ™ ♦  Release Date: March 10, 2016 ♦  Expiration Date: March. 10, 2018 Estimated time for completion 15.00 minutes There is no fee for this activity. To Receive CME Credit To Receive CME Credit In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, correctly answer all the questions in the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching Brief® articles has been validated through an independent expert peer review process. Learning Objectives Upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study 2. Review the relevance and significance of the study in the broader context of clinical care Disclosures Molly Walker, Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco, Reviewer, and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.The staff of Projects In Knowledge®, Inc. and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. Accreditation This activity has...
CME: More Data Connect Zika and Guillain-Barre Syndrome

CME: More Data Connect Zika and Guillain-Barre Syndrome

CREDITS ♦  Physicians: 0.25 AMA PRA Category 1 Credit(s) ™ ♦  Release Date: Feb. 29, 2016 ♦  Expiration Date: Feb. 28, 2018 Estimated time for completion 15.00 minutes There is no fee for this activity. To Receive CME Credit In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, correctly answer all the questions in the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching Brief® articles has been validated through an independent expert peer review process. Learning Objectives Upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study 2. Review the relevance and significance of the study in the broader context of clinical care Disclosures Molly Walker, Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco, Reviewer, and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.The staff of Projects In Knowledge®, Inc. and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. Accreditation This activity has been planned and implemented...
CME: Antibiotic Ups Cure Rate in Skin Abscess

CME: Antibiotic Ups Cure Rate in Skin Abscess

CREDITS ♦  Physicians: 0.25 AMA PRA Category 1 Credit(s) ™ ♦  Release Date: Mar. 04, 2016 ♦  Expiration Date: Mar. 04, 2018 Estimated time for completion 15.00 minutes There is no fee for this activity. To Receive CME Credit In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, correctly answer all the questions in the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching Brief® articles has been validated through an independent expert peer review process. Learning Objectives Upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study 2. Review the relevance and significance of the study in the broader context of clinical care Disclosures Charles Bankhead, Staff Writer, F Perry Wilson, MD, MSCE; Assistant Professor, Section of Nephrology, Yale School of Medicine, Reviewer, and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.The staff of Projects In Knowledge®, Inc. and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. Accreditation This activity has been...
CME: Urine TB Test Cuts Mortality in Patients With HIV

CME: Urine TB Test Cuts Mortality in Patients With HIV

CREDITS ♦ Physicians: 0.25  AMA PRA Category 1 Credit(s) ™ ♦ Release Date: Mar. 09, 2016 ♦ Expiration Date: Mar. 09, 2018 Estimated time for completion 15.00 minutes There is no fee for this activity. To Receive CME Credit In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, correctly answer all the questions in the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching Brief® articles has been validated through an independent expert peer review process. Learning Objectives Upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study 2. Review the relevance and significance of the study in the broader context of clinical care Disclosures Michael Smith, North American Correspondent, Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco, Reviewer, and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.The staff of Projects In Knowledge®, Inc. and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. Accreditation This activity has been...
CME: Trials Show Malaria Safely Treatable in Pregnant Women

CME: Trials Show Malaria Safely Treatable in Pregnant Women

CREDITS: Physicians: 0.25  AMA PRA Category 1 Credit(s)™ Release Date: Mar. 10, 2016 Expiration Date: Mar. 10, 2018 Estimated time for completion 15.00 minutes There is no fee for this activity. Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching Brief® articles has been validated through an independent expert peer review process. Learning Objectives Upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study 2. Review the relevance and significance of the study in the broader context of clinical care Disclosures Molly Walker, Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco, Reviewer, and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. The staff of Projects In Knowledge®, Inc. and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. Accreditation This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Projects In Knowledge and MedPage Today. Projects In Knowledge is accredited by the ACCME to provide continuing medical education for physicians. Designation of Credit Projects In Knowledge®, Inc. designates this enduring material for a...
A New View Debates Antibiotics for Appendicitis

A New View Debates Antibiotics for Appendicitis

Here’s what Jane E. Brody, New York Times Personal Health columnist, had to say about surgeons who think appendicitis should be treated with an operation. “This is hardly surprising, because doctors, like many of us, are creatures of habit, and surgeons who don’t operate miss out on a hefty fee.” The article, “A new view of appendicitis,” began with a story about a woman who went to Europe and on the way developed perforated appendicitis. Somehow this anecdote morphed into a discussion about the treatment of simple appendicitis. Ms. Brody referred to the Finnish randomized controlled trial published back in June 2015 that found that 27% of patients who were treated with antibiotics eventually required surgery. When this study first came out I pointed out its flaws—only 5.5% of patients underwent laparoscopic appendectomy; the antibiotic in the study was not commonly used in the United States; patients were followed for only one year. She also cited a review of administrative data from California, which claimed a very low recurrence rate with antibiotics. I had critiqued that paper as well, pointing out that not only is administrative data unreliable for clinical research, the paper covered the years 1997 to 2008 when laparoscopic appendectomy was not yet the standard of care. Also, we do not know how the diagnosis of appendicitis was arrived at for the patients treated with antibiotics. If they didn’t have appendicitis in the first place, then any treatment would have sufficed. “…a review of administrative data from California claims a very low recurrence rate with antibiotics.”   Ms. Brody wrote “People who have had appendectomies, for example,...
Opinion Makers: End of AIDS in Sight?

Opinion Makers: End of AIDS in Sight?

Carlos del Rio, MD, argues that we currently know what’s needed to end the HIV/AIDS pandemic. Not only do we know, but we also have the tools. Dr. del Rio, professor of medicine in the Division of Infectious Diseases at Emory University School of Medicine, sets out the agenda to reach an ambitious goal and believes that even with our knowledge there are still several barriers that must be overcome to reach the goal, and there is much work to be done. Opinion Makers is an exclusive MedPage Today video series, presenting leaders from all areas of medicine, offering their views on current topics in clinical care, research, and policy. Source: MedPage...
Stillbirth May Be Another Zika Complication

Stillbirth May Be Another Zika Complication

Richard Beigi, MD, remarks on what a new recent case report may add to the link between Zika virus and birth defects, and how protect pregnant women. The case study published in PLOS Neglected Tropical Diseases, by Brazilian researcher Manoel Sarno, MD, and colleagues, describes a pregnant woman infected with Zika virus, where fetal ultrasound showed evidence of not only microcephaly and intracranial calcifications, but hydrops fetalis (a heart condition). The infant was stillborn at 32 weeks gestation and an autopsy found evidence of Zika virus in the brain and spinal fluids, but not the heart, lung, liver, or placenta. Source: MedPage...
Teen Girls on Long-Acting Contraceptives Skip Condoms

Teen Girls on Long-Acting Contraceptives Skip Condoms

F. Perry Wilson, MD, MSCE, examines the association between use of long-acting reversible contraceptives and lower condom usage among teenage girls. Unwanted pregnancies prevented but not STDs. A study in JAMA Pediatrics demonstrated that the use of long-acting reversible contraceptives was associated with lower condom usage among teenage girls. In this 150-second analysis, MedPage Today clinical reviewer F. Perry Wilson, MD, examines the data and the future of IUDs in adolescents. Source: MedPage Today...
Long After Ebola ‘Cure,’ Neuro Effects Linger

Long After Ebola ‘Cure,’ Neuro Effects Linger

Lee A. Norman, MD, MHS, MBA, discusses the possible Ebola survivor syndrome, the questions it raises about the virus’s persistence, and the implications of a post-Ebola syndrome. Most Ebola survivors had neurologic abnormalities more than 6 months after the initial infection, according to research to be presented in April at the American Academy of Neurology. Researchers from the National Institute of Neurological Disorders and Stroke examined symptoms from 82 Ebola survivors in Liberia and found that most had neurologic symptoms, such as weakness, tremors, headache, memory loss, and/or muscle pain. Some had developed serious psychiatric illnesses. Lee A. Norman, MD, MHS, MBA, is senior vice president and chief medical officer at the University of Kansas Hospital in Kansas City. Source: MedPage...

The effect of probiotics on CD4 counts among people living with HIV: a systematic review.

Beneficial microbes 2016 3 25() 1-8 Abstract Probiotics are defined by the WHO as ‘live microorganisms which when administered in adequate amounts confer a health benefit on the host’. Ongoing research has shown probiotics provide benefits to humans, including protection and restoration of the gastrointestinal and other mucosal tracts. As human immunodeficiency virus (HIV) activates gut-associated lymphoid tissue (GALT), several studies have investigated the effect of probiotics on CD4 cell count and related outcomes among those living with HIV. These studies are summarised here. Manuscripts were identified using the search terms ‘probiotics’, ‘synbiotics’, ‘HIV’, and ‘CD4’, and were reviewed for relevance and inclusion of CD4 count as an immunologic endpoint. Bibliographies of relevant manuscripts were also reviewed for additional studies matching inclusion and exclusion criteria. The search yielded 91 results; 13 included relevant outcomes. Seven of these studies produced beneficial CD4 outcomes, while the remaining 6 reported on insignificant beneficial or negative CD4 outcomes. The studies summarised here collectively suggest that daily consumption of probiotics over a prolonged period of time may improve CD4 count in people living with...
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