BOOK
Quality Patient Care: Making Evidence-Based, High Value Choices, An Issue of Medical Clinics of North America, E-Book
Marc Shalaby | Edward R. Bollard
(2016)
Additional Information
Book Details
Abstract
This issue of Medical Clinics, guest edited by Drs. Marc Shalaby and Edward Bollard, is devoted to Quality Patient Care: Making Evidence-Based, High Value Choices. Articles in this issue include: Cardiovascular testing in asymptomatic patients: carotid duplex, cardiac stress testing, screen for PVD; Utility of echocardiogram in the evaluation of heart murmurs; Evidenced-based recommendations for the evaluation of palpitations in the primary care setting; Radiologic evaluation of common orthopedic complaints: low back pain, non-traumatic knee/shoulder/hip pain, and ankle injuries; Indications and usefulness of common injections for non-traumatic orthopedic complaints – shoulder, trochanteric bursa, epidural injections, tennis elbow, and knee; The evidence-based evaluation of chronic cough; Evaluation of uncomplicated headache; Evaluation of syncope; Pre-operative assessment: Cataract surgery, pre-operative EKG testing, screening for cardiopulmonary disease, urinalysis, coagulation studies, other lab assessments; The approach to occult GI bleed; The role of EGD surveillance for patients with Barrett’s esophagus; The evidence-based evaluation of iron deficiency anemia; Cancer screening in the elderly; Utilization and safety of common over the counter dietary/nutritional supplements, herbal agents and homeopathic compounds for disease prevention; Utilization of oxygen for the patient with dyspnea; IV fluids, enteral or parenteral nutrition; and Symptom control at the end of life.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Quality Patient Care:Making Evidence-Based, High ValueChoices | i | ||
| Copyright | ii | ||
| CME Accreditation Page | iii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iii | ||
| TO ENROLL | iii | ||
| METHOD OF PARTICIPATION | iii | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| MEDICAL CLINICS OF NORTH AMERICA | v | ||
| FORTHCOMING ISSUES | v | ||
| November 2016 | v | ||
| January 2017 | v | ||
| March 2017 | v | ||
| RECENT ISSUES | v | ||
| July 2016 | v | ||
| May 2016 | v | ||
| March 2016 | v | ||
| Contributors | vii | ||
| CONSULTING EDITORS | vii | ||
| EDITORS | vii | ||
| AUTHORS | vii | ||
| Contents | xi | ||
| Preface: A Convergence of Themes: Making Evidence-Based, High Value Choices\r | xi | ||
| Cardiovascular Testing in Asymptomatic Patients: Carotid Duplex, Cardiac Stress Testing, Screen for Peripheral Arterial Disease\r | xi | ||
| Evidence-Based Recommendations for the Evaluation of Palpitations in the Primary Care Setting\r | xi | ||
| Utility of Echocardiogram in the Evaluation of Heart Murmurs\r | xi | ||
| Avoiding Unnecessary Preoperative Testing\r | xii | ||
| The Cost-Effective Evaluation of Uncomplicated Headache\r | xii | ||
| The Cost-Effective Evaluation of Syncope\r | xii | ||
| Evidence-Based Evaluation and Management of Chronic Cough\r | xii | ||
| The Approach to Occult Gastrointestinal Bleed\r | xiii | ||
| The Role of Esophagogastroduodenoscopy Surveillance for Patients with Barrett Esophagus\r | xiii | ||
| The Evidence-Based Evaluation of Iron Deficiency Anemia\r | xiii | ||
| Indications and Usefulness of Common Injections for Nontraumatic Orthopedic Complaints\r | xiii | ||
| Utilization and Safety of Common Over-the-Counter Dietary/Nutritional Supplements, Herbal Agents, and Homeopathic Compounds\r | xiv | ||
| Cancer Screening in Older Adults \r | xiv | ||
| Symptom Control at the End of Life \r | xiv | ||
| Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients?\r | xiv | ||
| The Role of Intravenous Fluids and Enteral or Parenteral Nutrition in Patients with Life-limiting Illness\r | xv | ||
| Preface:\rA Convergence of Themes: Making Evidence-Based, High Value Choices | xvii | ||
| Cardiovascular Testing in Asymptomatic Patients | 971 | ||
| Key points | 971 | ||
| INTRODUCTION | 971 | ||
| CAROTID DUPLEX | 972 | ||
| The Disease | 972 | ||
| Possible Interventions | 972 | ||
| Test Characteristics | 972 | ||
| Potential Benefits | 972 | ||
| Potential Harms | 973 | ||
| Guidelines | 973 | ||
| Summary | 973 | ||
| CARDIAC STRESS TESTING | 974 | ||
| The Disease | 974 | ||
| Possible Interventions | 974 | ||
| Test Characteristics | 974 | ||
| Potential Benefits | 975 | ||
| Potential Harms | 975 | ||
| Guidelines | 975 | ||
| Summary | 975 | ||
| SCREEN FOR PERIPHERAL ARTERIAL DISEASE | 976 | ||
| The Disease | 976 | ||
| Possible Interventions | 976 | ||
| Test Characteristics | 976 | ||
| Potential Benefits | 976 | ||
| Potential Harms | 976 | ||
| Guidelines | 976 | ||
| Evidence-based Recommendations for the Evaluation of Palpitations in the Primary Care Setting | 981 | ||
| Key points | 981 | ||
| INTRODUCTION | 981 | ||
| Patient History | 981 | ||
| PATHOPHYSIOLOGY | 982 | ||
| Review of the Related Literature | 983 | ||
| HISTORY AND PHYSICAL EXAMINATION FINDINGS | 984 | ||
| History | 984 | ||
| Physical Examination and Laboratory Tests | 985 | ||
| ADDITIONAL TESTING FOR CARDIAC ARRHYTHMIAS | 986 | ||
| Holter Monitor | 986 | ||
| Transtelephonic Electrocardiographic Monitoring | 986 | ||
| Mobile Cardiac Outpatient Telemetry System | 986 | ||
| Implantable Cardiac Monitors | 987 | ||
| Treadmill Exercise Testing | 987 | ||
| Echocardiography | 987 | ||
| Electrophysiologic Studies | 987 | ||
| Review of the Related Literature | 987 | ||
| DIAGNOSTIC DILEMMA: SUMMARY | 988 | ||
| REFERENCES | 989 | ||
| Utility of Echocardiogram in the Evaluation of Heart Murmurs | 991 | ||
| Key points | 991 | ||
| INTRODUCTION | 991 | ||
| PHYSICAL EXAMINATION | 992 | ||
| ECHOCARDIOGRAPHY AND CLINICAL GUIDELINES | 994 | ||
| COMMON HEART MURMURS | 996 | ||
| Native Valve Stenosis | 996 | ||
| Aortic stenosis | 996 | ||
| Mitral stenosis | 996 | ||
| Native Valve Regurgitation | 997 | ||
| Aortic regurgitation | 997 | ||
| Mitral regurgitation | 998 | ||
| TRANSESOPHAGEAL ECHOCARDIOGRAPHY | 998 | ||
| COST TRENDS IN THE USE OF ECHOCARDIOGRAPHY | 999 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 999 | ||
| REFERENCES | 999 | ||
| Avoiding Unnecessary Preoperative Testing | 1003 | ||
| Key points | 1003 | ||
| INTRODUCTION | 1003 | ||
| PREOPERATIVE TESTING BEFORE CATARACT SURGERY | 1003 | ||
| ROUTINE URINALYSIS IN THE PREOPERATIVE PERIOD | 1004 | ||
| PREOPERATIVE ELECTROCARDIOGRAMS IN PATIENTS UNDERGOING SURGERY | 1005 | ||
| ROUTINE PREOPERATIVE COAGULATION STUDIES | 1006 | ||
| SUMMARY | 1007 | ||
| REFERENCES | 1007 | ||
| The Cost-Effective Evaluation of Uncomplicated Headache | 1009 | ||
| Key points | 1009 | ||
| INTRODUCTION | 1009 | ||
| PATHOPHYSIOLOGY AND CLASSIFICATION | 1009 | ||
| PATIENT HISTORY | 1012 | ||
| PHYSICAL EXAMINATION | 1013 | ||
| IMAGING AND ADDITIONAL TESTING | 1014 | ||
| MANAGEMENT | 1015 | ||
| REFERENCES | 1016 | ||
| The Cost-Effective Evaluation of Syncope | 1019 | ||
| Key points | 1019 | ||
| INTRODUCTION | 1019 | ||
| PATHOPHYSIOLOGY OR CLASSIFICATION | 1020 | ||
| THE HISTORY AND PHYSICAL EXAMINATION | 1021 | ||
| THE HISTORY | 1021 | ||
| THE PHYSICAL EXAMINATION | 1023 | ||
| INITIAL DIAGNOSTIC TESTING | 1024 | ||
| Electrocardiogram | 1024 | ||
| Blood Work | 1024 | ||
| Specific Laboratory Tests | 1024 | ||
| IMAGING AND ADDITIONAL DIAGNOSTIC TESTING | 1025 | ||
| Testing in General | 1025 | ||
| Computed Tomography or MRI | 1025 | ||
| Echocardiography | 1025 | ||
| Tilt Table Testing | 1025 | ||
| Carotid Doppler | 1026 | ||
| Continuous Electrocardiogram Monitoring | 1026 | ||
| Inpatient Telemetry Monitors | 1027 | ||
| Holter Monitor | 1027 | ||
| Loop or Event Recorders | 1027 | ||
| RISK STRATIFICATION | 1028 | ||
| SUMMARY | 1030 | ||
| REFERENCES | 1030 | ||
| Evidence-based Evaluation and Management of Chronic Cough | 1033 | ||
| Key points | 1033 | ||
| INTRODUCTION | 1033 | ||
| CAUSES OF CHRONIC COUGH | 1034 | ||
| Angiotensin-converting Enzyme Inhibitors | 1034 | ||
| Upper Airway Cough Syndrome | 1034 | ||
| Asthma | 1034 | ||
| Gastroesophageal Reflux Disease | 1035 | ||
| Cough Hypersensitivity Syndrome | 1035 | ||
| EVALUATION OF PATIENTS WITH CHRONIC COUGH | 1036 | ||
| History and Physical Examination | 1036 | ||
| Diagnostic Testing | 1037 | ||
| Chest Radiograph | 1037 | ||
| Computed Tomography Scan of the Chest | 1037 | ||
| Computed Tomography Scan of the Sinuses | 1038 | ||
| Pulmonary Function Testing | 1038 | ||
| Sputum Examination | 1038 | ||
| Testing for GERD | 1038 | ||
| TREATMENT OF CHRONIC COUGH | 1039 | ||
| Smoking | 1039 | ||
| Angiotensin-converting Enzyme Inhibitors | 1039 | ||
| Nonsmokers, Not on Angiotensin-converting Enzyme Inhibitors and with Normal Chest Radiographs | 1040 | ||
| Upper Airway Cough Syndrome | 1040 | ||
| Asthma | 1040 | ||
| Gastroesophageal Reflux Disease | 1041 | ||
| Cough Hypersensitivity Syndrome | 1042 | ||
| SUMMARY/FUTURE CONSIDERATIONS | 1042 | ||
| REFERENCES | 1043 | ||
| The Approach to Occult Gastrointestinal Bleed | 1047 | ||
| Key points | 1047 | ||
| INTRODUCTION | 1047 | ||
| ETIOLOGY AND PATHOPHYSIOLOGY | 1048 | ||
| PATIENT HISTORY | 1049 | ||
| PHYSICAL EXAMINATION | 1050 | ||
| INITIAL MANAGEMENT OF OCCULT GASTROINTESTINAL BLEEDING | 1050 | ||
| ENDOSCOPY AND OTHER DIAGNOSTIC TESTS | 1050 | ||
| Isolated Iron Deficiency Anemia | 1050 | ||
| Spiral Enteroscopy | 1053 | ||
| Intraoperative Enteroscopy | 1053 | ||
| DOUBLE BALLOON ENTEROSCOPY VERSUS VIDEO CAPSULE ENDOSCOPY: COST-EFFECTIVENESS ANALYSIS | 1054 | ||
| Positive Fecal Occult Blood Test with or Without Iron Deficiency Anemia | 1054 | ||
| SUMMARY | 1054 | ||
| ACKNOWLEDGMENTS | 1055 | ||
| REFERENCES | 1055 | ||
| The Role of Esophagogastroduodenoscopy Surveillance for Patients with Barrett Esophagus | 1057 | ||
| Key points | 1057 | ||
| INTRODUCTION | 1057 | ||
| DEVELOPMENT OF BARRETT ESOPHAGUS AND ESOPHAGEAL ADENOCARCINOMA | 1058 | ||
| MANAGEMENT OF BARRETT ESOPHAGUS | 1059 | ||
| SURVEILLANCE CHALLENGES AND STRATEGIES | 1060 | ||
| RECOMMENDATIONS | 1062 | ||
| FUTURE CONSIDERATIONS | 1062 | ||
| REFERENCES | 1062 | ||
| The Evidence-Based Evaluation of Iron Deficiency Anemia | 1065 | ||
| Key points | 1065 | ||
| INTRODUCTION | 1065 | ||
| Case 1 Presentation | 1066 | ||
| Case 2 Presentation | 1070 | ||
| Case 3 Presentation | 1071 | ||
| Case 4 Presentation | 1072 | ||
| REFERENCES | 1073 | ||
| Indications and Usefulness of Common Injections for Nontraumatic Orthopedic Complaints | 1077 | ||
| Key points | 1077 | ||
| INTRODUCTION | 1077 | ||
| OSTEOARTHRITIS OF THE KNEE | 1077 | ||
| Corticosteroid Injections for Osteoarthritis of the Knee: Efficacy | 1078 | ||
| Corticosteroid Injections for Osteoarthritis of the Knee: Safety | 1079 | ||
| Corticosteroid Injections for Osteoarthritis of the Knee: Cost | 1079 | ||
| Corticosteroid Injections for Osteoarthritis of the Knee: Conclusions | 1079 | ||
| Intra-articular Injection of Hyaluronic Acids in Knee Osteoarthritis: Efficacy | 1079 | ||
| Intra-articular Injection of Hyaluronic Acids in Knee Osteoarthritis: Safety | 1080 | ||
| Intra-articular Injection of Hyaluronic Acids in Knee Osteoarthritis: Cost | 1080 | ||
| Intra-articular Injection of Hyaluronic Acids in Knee Osteoarthritis: Conclusion | 1080 | ||
| SHOULDER PAIN (IMPINGEMENT SYNDROME) | 1080 | ||
| Corticosteroid Injection for Shoulder Impingement Syndrome: Efficacy | 1080 | ||
| Corticosteroid Injection for Shoulder Impingement Syndrome: Safety | 1081 | ||
| Corticosteroid Injection for Shoulder Impingement Syndrome: Cost | 1082 | ||
| Corticosteroid Injection for Shoulder Impingement Syndrome: Conclusions | 1082 | ||
| LATERAL EPICONDYLITIS (EPICONDYLALGIA) | 1082 | ||
| Corticosteroid Injection for Lateral Epicondylalgia Syndrome: Efficacy | 1082 | ||
| Corticosteroid Injection for Lateral Epicondylalgia Syndrome: Safety | 1082 | ||
| Corticosteroid Injection for Lateral Epicondylalgia Syndrome: Cost | 1083 | ||
| Corticosteroid Injection for Lateral Epicondylalgia Syndrome: Conclusions | 1083 | ||
| GREATER TROCHANTERIC PAIN SYNDROME | 1083 | ||
| Corticosteroid Injection for Treatment of Greater Trochanteric Pain Syndrome: Efficacy | 1083 | ||
| Corticosteroid Injection for Treatment of Greater Trochanteric Pain Syndrome: Safety | 1083 | ||
| Corticosteroid Injection for Treatment of Greater Trochanteric Pain Syndrome: Cost | 1083 | ||
| Corticosteroid Injection for Treatment of Greater Trochanteric Pain Syndrome: Conclusion | 1084 | ||
| DE QUERVAIN TENOSYNOVITIS | 1084 | ||
| Corticosteroid Injection for De Quervain Tenosynovitis: Efficacy | 1084 | ||
| De Quervain Tenosynovitis: Safety | 1084 | ||
| De Quervain Tenosynovitis: Cost | 1084 | ||
| De Quervain Tenosynovitis: Conclusion | 1084 | ||
| DISEASES OF THE LUMBAR SPINE | 1084 | ||
| Treatment of Lumbar Spine Disease with Corticosteroid Injection: Efficacy | 1085 | ||
| Treatment of Lumbar Spine Disease with Corticosteroid Injection: Safety | 1086 | ||
| Treatment of Lumbar Spine Disease with Corticosteroid Injection: Cost | 1086 | ||
| Treatment of Lumbar Spine Disease with Corticosteroid Injection: Conclusions | 1086 | ||
| REFERENCES | 1086 | ||
| Utilization and Safety of Common Over-the-Counter Dietary/Nutritional Supplements, Herbal Agents, and Homeopathic Compounds ... | 1089 | ||
| Key points | 1089 | ||
| INTRODUCTION | 1089 | ||
| DISEASES OF ALLERGY AND IMMUNOLOGY | 1090 | ||
| UROLOGICAL DISEASES: BENIGN PROSTATIC HYPERPLASIA AND URINARY TRACT INFECTION | 1091 | ||
| BONE HEALTH | 1091 | ||
| VIRAL UPPER RESPIRATORY TRACT INFECTIONS AND INFLUENZA (COLDS AND FLU) | 1092 | ||
| CARDIOVASCULAR DISEASE | 1092 | ||
| DEPRESSION | 1093 | ||
| DIABETES MELLITUS | 1094 | ||
| OBESITY | 1095 | ||
| INTERACTION OF NUTRITIONAL SUPPLEMENTS WITH PRESCRIPTION MEDICATIONS | 1095 | ||
| HOMEOPATHIC COMPOUNDS | 1096 | ||
| SUMMARY | 1096 | ||
| REFERENCES | 1097 | ||
| Cancer Screening in Older Adults | 1101 | ||
| Key points | 1101 | ||
| INTRODUCTION | 1101 | ||
| CANCERS COMMONLY AFFECTING THE ELDERLY | 1102 | ||
| COSTS OF COMMON CANCER SCREENING TESTS | 1103 | ||
| USING LIFE EXPECTANCY TO DETERMINE BENEFIT IN CANCER SCREENING | 1103 | ||
| REVIEWING CURRENT SCREENING GUIDELINES | 1104 | ||
| Breast Cancer Screening | 1104 | ||
| Colorectal Cancer Screening | 1105 | ||
| Prostate Cancer Screening | 1105 | ||
| Lung Cancer Screening | 1106 | ||
| HAVING THE DISCUSSION | 1106 | ||
| MAKING AN EVIDENCED-BASED, HIGH-VALUE CANCER SCREENING DECISION: AN EXAMPLE | 1107 | ||
| SUMMARY | 1108 | ||
| HELPFUL LINKS FOR CLINICIANS | 1108 | ||
| REFERENCES | 1108 | ||
| Symptom Control at the End of Life | 1111 | ||
| Key points | 1111 | ||
| INTRODUCTION | 1111 | ||
| PATIENT-CENTERED END-OF-LIFE CARE | 1112 | ||
| COMMUNICATION IN SERIOUS ILLNESS | 1112 | ||
| SYMPTOM ASSESSMENT, MANAGEMENT, AND BURDENS OF TREATMENT | 1113 | ||
| Pain | 1113 | ||
| Dyspnea | 1115 | ||
| SPIRITUAL DISTRESS | 1116 | ||
| Depression | 1116 | ||
| ANXIETY | 1117 | ||
| Fatigue | 1117 | ||
| Anorexia/Cachexia | 1117 | ||
| Delirium | 1118 | ||
| Nausea/Vomiting | 1118 | ||
| BURDENS OF END-OF-LIFE TREATMENT | 1119 | ||
| SUMMARY AND FUTURE DIRECTION | 1119 | ||
| REFERENCES | 1120 | ||
| Treating Dyspnea | 1123 | ||
| Key points | 1123 | ||
| INTRODUCTION | 1123 | ||
| PATHOPHYSIOLOGY OF DYSPNEA | 1124 | ||
| Mechanism of Dyspnea | 1124 | ||
| Symptoms of Dyspnea | 1124 | ||
| MANAGEMENT GOALS AND TREATMENT OPTIONS: REDUCING DYSPNEA AND IMPROVING QUALITY OF LIFE | 1125 | ||
| Dyspnea Secondary to Hypoxemia | 1126 | ||
| Dyspnea in the Patient with no Hypoxemia | 1127 | ||
| Negative Effects of Oxygen Therapy | 1128 | ||
| EVALUATION | 1128 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 1128 | ||
| REFERENCES | 1129 | ||
| The Role of Intravenous Fluids and Enteral or Parenteral Nutrition in Patients with Life-limiting Illness | 1131 | ||
| Key points | 1131 | ||
| INTRODUCTION | 1131 | ||
| EVALUATION OF PATIENTS FOR USE OF ARTIFICIAL NUTRITION OR HYDRATION | 1132 | ||
| SETTING THE STAGE FOR THE DISCUSSION: 2 CASES | 1132 | ||
| Case 1: A Case of Advanced Dementia | 1132 | ||
| Case 2: A Case of Malignancy | 1133 | ||
| OPTIONS FOR ARTIFICIAL NUTRITION OR HYDRATION | 1133 | ||
| Total Enteral Nutrition | 1133 | ||
| Parenteral Nutrition | 1135 | ||
| BRINGING IT ALL TOGETHER: REVISITING THE CASES | 1135 | ||
| Case 1: A Case of Advanced Dementia | 1135 | ||
| Case 2: A Case of Malignancy | 1136 | ||
| BARRIERS TO NOT PROVIDING ARTIFICIAL NUTRITION OR HYDRATION | 1137 | ||
| The Do-something Mindset | 1137 | ||
| Regulatory Considerations | 1137 | ||
| Financial Considerations | 1138 | ||
| Lack of Health Care Provider Education | 1138 | ||
| METHODS FOR ENCOURAGING ORAL FEEDING | 1138 | ||
| Oral Assisted Comfort Feeding | 1138 | ||
| Discontinuation of Nonessential Medications | 1139 | ||
| Therapeutic Management of Swallowing Disorders | 1139 | ||
| Dental and Oral Care | 1139 | ||
| A SPECIAL CASE: WHEN A PATIENT IS ACTIVELY DYING | 1139 | ||
| SUMMARY | 1140 | ||
| REFERENCES | 1140 | ||
| Index | 1143 |