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  • New Prevention Guidelines for Falls and Fractures—Looking Beyond the Letters

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    JAMA Intern Med. 2018; doi: 10.1001/jamainternmed.2018.1809
  • Incremental Benefits and Harms of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

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    JAMA Intern Med. 2018; doi: 10.1001/jamainternmed.2018.0310
  • An Examination of Deintensification Recommendations in Clinical Practice Guidelines: Stepping Up or Scaling Back?

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    JAMA Intern Med. 2018; 178(3):414-416. doi: 10.1001/jamainternmed.2017.7198

    In light of initiatives to decrease use of unnecessary services, this article examines whether current guidelines for diabetes and cardiovascular disease preferentially recommend intensification rather than deintensification of care.

  • JAMA Internal Medicine March 1, 2018

    Figure: Variation in the Share of Intensification vs Deintensification Recommendations

    Guidelines for cardiovascular disease management included ischemic heart disease, hypertension, hyperlipidemia, heart failure, atrial fibrillation, acute coronary syndrome, myocardial infarction, and cognitive or mental health sequelae. The evidence strength of the recommendations was based on the evidence ratings provided by the guideline developers. Recommendations were drawn from the following guidelines (N = 22 total guidelines). American Diabetes Association (n = 1): Standards of Medical Care in Diabetes—2016 (2016). Eighth Joint National Committee (n = 1): Management of High Blood Pressure in Adults. American Geriatrics Society (n = 1): Improving the Care of Older Adults With Diabetes Mellitus: 2013 Update (2013). Veterans Health Administration (n = 2): Diagnosis and Management of Hypertension in the Primary Care Setting (2014); Management of Dyslipidemia for Cardiovascular Risk Reduction (2014). US Preventive Services Task Force (n = 6): Screening for Coronary Heart Disease With Electrocardiography (2012); Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer (2014); Screening for High Blood Pressure in Adults (2015); Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus (2015); Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (2015; draft); Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication (2015; draft). American College of Cardiologists/American Heart Association (n = 9): Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease (2011); Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women (2011); Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Physicians); Assessment of Cardiovascular Risk (2013); Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013); Management of Heart Failure (2013); Management of Patients With Atrial Fibrillation (2014); Management of Adult Patients With Supraventricular Tachycardia (2015; only for the recommendations related to atrial fibrillation); Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease (2016). American College of Physicians (n = 3): Diagnosis and Management of Patients With Stable Ischemic Heart Disease (2012; jointly issued with the American College of Cardiologists/American Heart Association); Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus (2012); Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging (2015).
  • Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program

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    JAMA Intern Med. 2018; 178(1):116-122. doi: 10.1001/jamainternmed.2017.6369

    This Special Communication reviews the most recent transfusion practice guidelines, discusses campaigns to reduce or eliminate overuse of transfusions, and presents a blueprint for developing a patient blood management program.

  • JAMA Internal Medicine January 1, 2018

    Figure 1: Image Used for “Why Give 2 When 1 Will Do?” Campaign to Emphasize the Importance of Single-Unit Red Blood Cell (RBC) Transfusions in Hemodynamically Stable Patients Who Are Not Bleeding

    The image was displayed as a screensaver on workstations across the health system. This recommendation is backed by Choosing Wisely guidelines. ABIM indicates American Board of Internal Medicine.
  • JAMA Internal Medicine January 1, 2018

    Figure 2: Leveraging the Electronic Medical Record to Promote Evidence-Based Transfusion Practice

    A, When a red blood cell (RBC) order is placed, an interruptive best practice advisory (BPA) is triggered if the preceding hemoglobin value is ≥7 g/dL or has not been measured in the previous 24 hours. After acknowledging the BPA, the clinician can either cancel the order or proceed by choosing a reason to override the BPA and transfuse RBCs. These reasons are taken from the health system’s transfusion guidelines. B, The proportion of single-unit RBC orders and double unit RBC orders in a typical monthly report for a clinical service (Department of Surgery) showing rates of compliance with transfusion guidelines for individual clinicians compared with their peers. The length of the bar represents the number of RBC units ordered for the month. C, The proportion of RBC orders with a preceding hemoglobin (HGB) level of <7, 7-7.9, and ≥8 g/dL in a typical monthly report for a clinical service (Department of Surgery) showing rates of compliance with transfusion guidelines for individual clinicians compared with their peers.
  • Using Risk Stratification to Reduce Medical Errors in Cervical Cancer Prevention

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    JAMA Intern Med. 2017; 177(10):1411-1412. doi: 10.1001/jamainternmed.2017.3999

    This Viewpoint posits that safely and effectively implementing consensus guidelines for Papanicolou and human papillomavirus testing for cervical cancer prevention requires accurate risk stratification of patients.

  • Going Beyond Guideline-Concordant Opioid Therapy to Improve Patient Safety

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    JAMA Intern Med. 2017; 177(9):1272-1272. doi: 10.1001/jamainternmed.2017.3030
  • Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care: A Cluster-Randomized Clinical Trial

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    JAMA Intern Med. 2017; 177(9):1265-1272. doi: 10.1001/jamainternmed.2017.2468

    This randomized clinical trial compares a multicomponent intervention (including a nurse care manager, electronic registry, data-driven academic detailing, and electronic decision tools) with electronic decision tools alone to improve adherence to opioid-prescribing guidelines.

  • Guidance for Modifying the Definition of Diseases: A Checklist

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    JAMA Intern Med. 2017; 177(7):1020-1025. doi: 10.1001/jamainternmed.2017.1302

    This Special Comunication from the Guidelines International Network Preventing Overdiagnosis Working Group proposes a checklist for considering changes to disease definitions.

  • JAMA Internal Medicine June 1, 2017

    Figure 2: Proportion of Physicians Who Recommend Breast Cancer Screening Categorized by Which Guidelines Physicians Report Trusting the Most

    ACOG, American Congress of Obstetricians and Gynecologists; ACS, American Cancer Society; USPSTF, US Preventive Services Task Force. aDenotes statistically significant (P < .05) differences based on most trusted organizational guideline.
  • Physician Breast Cancer Screening Recommendations Following Guideline Changes: Results of a National Survey

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    JAMA Intern Med. 2017; 177(6):877-878. doi: 10.1001/jamainternmed.2017.0453

    This study used a survey to investigate physician recommendations for breast cancer screening in light of recent guideline changes.

  • Quality of Cancer Surveillance Clinical Practice Guidelines: Specificity and Consistency of Recommendations

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    JAMA Intern Med. 2017; 177(5):701-709. doi: 10.1001/jamainternmed.2017.0079

    This retrospective cross-sectional analysis examines the specificity and consistency of recommendations for surveillance after active treatment across cancer guidelines.

  • Conflict of Interest in Seminal Hepatitis C Virus and Cholesterol Management Guidelines

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    JAMA Intern Med. 2017; 177(3):352-357. doi: 10.1001/jamainternmed.2016.8439

    This document review evaluates adherence to the Institute of Medicine standards for limits on commercial conflicts of interest, guideline development, and evaluation of evidence by a 2013 cholesterol management guideline and a 2014 hepatitis C virus management guideline.

  • Financial Conflicts of Interest and the Centers for Disease Control and Prevention’s 2016 Guideline for Prescribing Opioids for Chronic Pain

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    JAMA Intern Med. 2017; 177(3):427-428. doi: 10.1001/jamainternmed.2016.8471

    This study identifies levels of support for the 2016 Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain and whether financial relationships with opioid manufacturers are associated with opposition to the guidelines.

  • Use of CT and Chest Radiography for Lung Cancer Screening Before and After Publication of Screening Guidelines: Intended and Unintended Uptake

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    JAMA Intern Med. 2017; 177(3):439-441. doi: 10.1001/jamainternmed.2016.9016

    This study evaluates the use of computed tomography and chest radiography for lung cancer screening before and after publication of the National Lung Screening Trial screening guidelines.

  • 2016 Update on Medical Overuse: A Systematic Review

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    JAMA Intern Med. 2016; 176(11):1687-1692. doi: 10.1001/jamainternmed.2016.5381

    This structured review identifies and highlights the 10 original research articles most likely to reduce overuse of medical care.

  • Access to Prescription Opioids— Primum Non Nocere : A Teachable Moment

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    JAMA Intern Med. 2016; 176(9):1251-1252. doi: 10.1001/jamainternmed.2016.3926

    This Teachable Moment discusses the how the Centers for Disease Control and Prevention guidelines for opioid prescribing can play a major role in limiting the impact of this epidemic.

  • Diagnosis and Management of Menopause: The National Institute of Health and Care Excellence (NICE) Guideline

    Abstract Full Text
    JAMA Intern Med. 2016; 176(8):1205-1206. doi: 10.1001/jamainternmed.2016.2761

    This Evidence to Practice report highlights the menopause guidelines recently published by the National Institute of Health and Care Excellence and suggests directions for full implementation.