June 2020 Learning Network Resources

Blogs, Issue Briefs, Opinion Pieces and More…

  • Study Examines Whether Blood Test Can Identify Early Cancers. National Cancer Institute. June 2020
    “In the first study of its kind, a blood test combined with imaging tests detected tumors—some at an early stage—in women without a history of cancer or any symptoms. The blood test identified breast, lung, and colorectal cancers, for which there are recommended screening tests. But it also identified seven other cancer types for which no screening tests exist.”
  • OPTIMISE trial demonstrates safety of deprescribing for older adults. Lown Institute. May 2020.
    “For frail older adults, taking several blood pressure medications can lead to dizziness, falls, and other adverse drug events, making this medication a potentially good one to deprescribe (discontinue or reduce the dose). However, clinicians or family members may avoid deprescribing a blood pressure medication because they fear that patients’ blood pressure will rise dangerously. For those who are uneasy about deprescribing hypertension medications for older adults, the OPTIMISE trial results may put their mind at ease.”
  • The American Academy of Orthopaedic Surgeons Expands Choosing Wisely® List. Cision. May 2020
    “The Academy’s Choosing Wisely list was expanded after careful consideration and review, using the most current evidence about management and treatment options. AAOS routinely develops evidence-based clinical guidelines and appropriate use criteria as valuable tools to advance the physician-patient communications process and enhance the diagnosis and treatment of musculoskeletal conditions. Each of the recommendations now included on the list came out of those clinical practice guidelines.”

Journals

  • Mostaghim M, et alt. Penicillin – getting prescribing right for children. Australian Prescriber. June 2020
    “Evidence supporting optimal penicillin prescribing remains limited for children compared to adults. Dose recommendations available in the product information provide guidance which has often been superseded by regularly updated, evidence-based sources, such as Therapeutic Guidelines. Prescribers should have access to evidence and updated guidelines to make decisions for children. Cooperation between regulators, pharmaceutical companies and software vendors is needed to improve this and support appropriate use of penicillins and other antimicrobials in the community.”
  • Yamamoto JM. Thyroid function testing and management during and after pregnancy among women without thyroid disease before pregnancy. CMAJ. June 2020
    “Current patterns of practice for TSH testing and management may contribute to overdiagnosis and overtreatment of women during pregnancy and post partum. Clinical practice guidelines are needed to give clinicians a stepwise approach, based on the best existing evidence, for deciding whether and when TSH testing should occur. Guidance is also needed as to when it is appropriate to initiate treatment in pregnancy and continue treatment in the postpartum period.”
  • Hilal T, et alt. Choosing Wisely® in Hematology: Have We Made a Difference? Health Economics. June 2020
    “Decreasing overuse of resources is a cultural change in perspective for practitioners and patients alike. We believe that healthcare delivery is transitioning from being volume-based to value-based. As we continue to support the Choosing Wisely® campaign, we need to implement strategies to document and measure the influence of our value-based recommendations on physician practices, patient care and attitudes, and healthcare costs.”
  • Wang T, et alt. Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review. JAMA Surgery. June 2020
    “This review demonstrates variable deimplementation of 4 low-value surgical procedures in patients with breast cancer. Addressing specific patient-level, clinician-level, and system-level barriers to deimplementation is necessary to encourage shared decision-making and reduce overtreatment.”
  • Paltiel O. Limiting surveillance imaging for patients with lymphoma in remission: a mixed methods study leading to a Choosing Wisely recommendation. BMJ Quality & Safety. May 2020
    “Prior to ratification of a local CW recommendation to limit surveillance imaging in lymphoma, we aimed to assess: (A) performance characteristics of surveillance FDG-PET/CT; (B) rates, clinical consequences and costs of false positives (FP); and (C) patients and professionals’ attitudes towards overuse. Acceptance of CW recommendations to limit overuse may be enhanced by quantitative data on consequences and costs of surveillance imaging, supplemented by qualitative data on patient and physician attitudes.”
  • Kansagra AP. Collateral Effect of Covid-19 on Stroke Evaluation in the United States. The New England Journal of Medicine. May 2020
    “The decrease in the use of stroke imaging from the prepandemic epoch to the early-pandemic epoch was seen across all age, sex, and stroke severity subgroups (Table S1); this suggests a decrease in the number of evaluations both in patients with severe strokes and in nonelderly patients who may have been at low risk for Covid-19 complications. Decreases in the numbers of patients who underwent stroke imaging were seen in most states and across a range of hospital volumes (Fig. S3 and Table S2). These decreases suggest that differences in regional incidences of Covid-19 were not the primary cause of decreased use of stroke imaging.”
  • ‘‘’Choosing Wisely’ in Breast Cancer Surgery: Drivers of Low Value Care.” Annals of Surgical Oncology. May 2020
    “Ultimately, unnecessary care translates into high-cost, low-value treatment for our patients and the healthcare system. Incorporating evidence into practice is more likely when new findings align with provider’s clinical experience, multidisciplinary goals, stakeholder engagement at the level of professional communities, and support patient preferences and autonomy. As a surgical community, we are in continual pursuit to tailor treatment to our breast cancer patients while protecting them from unnecessary harm. Achieving these aims will likely require commitment and sustained effort to successfully tackle the facilitators of low-value cancer care and barriers to reducing its use.”
  • Watson JD, et alt. Aortic Aneurysm Screening Using Duplex Ultrasound – Choosing Wisely Who to Examine. Seminar in Vascular Surgery. May 2020
    “The noninvasive vascular laboratory plays a critical role in screening patients at risk for abdominal aortic aneurysm (AAA) development. One-time duplex ultrasound screening reduces aneurysm-related mortality due to rupture and is cost-effective. Population screening based on AAA risk factors is recommend as it allows for proactive, elective repair of aneurysms at risk for rupture, and surveillance of smaller aneurysms for enlargement. Utilization of societal screening guidelines, such as those published by the Society for Vascular Surgery, can be employed by vascular laboratories to justify individual patient screening, aid primary care physicians to refer patients for testing, and encourage integrated medical health care systems to build prompts in patient electronic health records to ensure compliance with a AAA screening program.”
  • Zadro JR. Has physical therapists’ management of musculoskeletal conditions improved over time? Brazilian Journal of Physical Therapy. May 2020
    “Possible explanations for this trend include the growing need for clinical innovation, challenge of keeping up to date with evidence, increased exposure to treatments of unknown value, belief that evidence is not relevant to practice, and possible limitations of the data. Strategies to help physical therapists replace non-recommended care with recommended care are discussed.”

Media Coverage

  • People Have Stopped Going to the Doctor. Most Seem Just Fine. NY Times. June 2020
    “Many institutions are using this difficult time in our nation’s history to make changes. The health care system should do the same. The pandemic has given us a glimpse of a world in which business as usual in our health care system was upended. It has also provided an opportunity to start up again in a healthier and more financially responsible way. Reflexively returning to the status quo may be good for our bottom line, but it won’t serve our patients well.”
  • Is It Safe Yet To Get Your Physical Or A Dental Checkup? NPR. June 2020.
    “For most routine checkups, the decision about whether to start getting preventive care again should be easy, Palumbo says: “The people that are at highest risk of COVID or poor outcomes from COVID are also the ones that … are going to benefit the most also from these routine procedures, so we have to recognize that these things still do need to happen. It’s better to treat something sooner than later, so it is still important to continue their care even while this is going on.”
  • Healthy people shouldn’t take daily aspirin to prevent heart disease, review finds. CNN Health. June 2020
    “Millions of Americans who’ve never had cardiovascular disease could still be taking a daily aspirin to prevent heart disease without a physician’s recommendation, despite the updated guidance that said it may be unnecessary and possibly risky, the study noted. Given the range of different interventions now available to prevent cardiovascular disease such as statins, blood pressure medication and help quitting smoking and losing weight, the findings of the research called in question the use of aspirin as a preventative.”
  • ASCP to Collaborate with ASCLS and ASM in Choosing Wisely Campaign. Yahoo News. June 2020
    “By request from the ABIM Foundation, ASCP has collaborated in working with the American Society for Clinical Laboratory Science (ASCLS) and the American Society for Microbiology (ASM) as they participate in the Choosing Wisely initiative.”

July Webinar

Stay tuned for a conversation between the Choosing Wisely Campaign’s physician consultant, Dr. Lisa Letourneau, and physician assistant and professor Carl Toney as they discuss working with diverse communities to support appropriate care during a pandemic. Look for the video on Choosing Wisely’s Workplace, Youtube channel or find it on social media by searching #CWDuringCOVID.