7535. A commitment to high-value care education from the internal medicine community.
The Alliance for Academic Internal Medicine, American Board of Internal Medicine (ABIM), ABIM Foundation, and American College of Physicians are collaborating to enhance the education of physicians in high-value care (HVC) and make its practice an essential competency in undergraduate and postgraduate education by 2017. This article serves as the organizations' formal commitment to providing a foundation of HVC education on which others may build. The 5 key targets for HVC education are experiential learning and curriculum, environment and culture, clinical support, regulatory requirements, and sustainability. The goal is to train future health care professionals for whom HVC is part of normal practice, thus providing patients with improved clinical outcomes at a lower cost.
7536. Fecal Microbiota Transplantation for Clostridium difficile Infection: A Systematic Review.
作者: Dimitri Drekonja.;Jon Reich.;Selome Gezahegn.;Nancy Greer.;Aasma Shaukat.;Roderick MacDonald.;Indy Rutks.;Timothy J Wilt.
来源: Ann Intern Med. 2015年162卷9期630-8页
The role of fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) is not well-known.
7537. The obesity paradox in type 2 diabetes mellitus: relationship of body mass index to prognosis: a cohort study.
作者: Pierluigi Costanzo.;John G F Cleland.;Pierpaolo Pellicori.;Andrew L Clark.;David Hepburn.;Eric S Kilpatrick.;Pasquale Perrone-Filardi.;Jufen Zhang.;Stephen L Atkin.
来源: Ann Intern Med. 2015年162卷9期610-8页
Whether obesity is associated with a better prognosis in patients with type 2 diabetes mellitus is controversial.
7538. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme.
作者: Ekkehard Schleussner.;Gabriele Kamin.;Gregor Seliger.;Nina Rogenhofer.;Susanne Ebner.;Bettina Toth.;Michael Schenk.;Melanie Henes.;Michael K Bohlmann.;Thorsten Fischer.;Oana Brosteanu.;Rupert Bauersachs.;David Petroff.; .
来源: Ann Intern Med. 2015年162卷9期601-9页
A daily injection of low-molecular-weight heparin (LMWH) is often prescribed to women with unexplained recurrent pregnancy loss (RPL), although evidence suggesting a benefit is questionable.
7540. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method.
作者: Jennifer Meddings.;Sanjay Saint.;Karen E Fowler.;Elissa Gaies.;Andrew Hickner.;Sarah L Krein.;Steven J Bernstein.
来源: Ann Intern Med. 2015年162卷9 Suppl期S1-34页
Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA Appropriateness Method was applied. After reviewing the literature, a 15-member multidisciplinary panel of physicians, nurses, and specialists in infection prevention rated scenarios for catheter use as appropriate, inappropriate, or of uncertain appropriateness by using a standardized, multiround rating process. The appropriateness of Foley catheters, intermittent straight catheters (ISCs), and external condom catheters for hospitalized adults on medical services was assessed in 299 scenarios, including urinary retention, incontinence, wounds, urine volume measurement, urine sample collection, and comfort. The scenarios included patient-specific issues, such as difficulty turning and catheter placement challenges. The panel rated 105 Foley scenarios (43 appropriate, 48 inappropriate, 14 uncertain), 97 ISC scenarios (15 appropriate, 66 inappropriate, 16 uncertain), and 97 external catheter scenarios (30 appropriate, 51 inappropriate, 16 uncertain). The refined criteria clarify that Foley catheters are appropriate for measuring and collecting urine only when fluid status or urine cannot be assessed by other means; specify that patients in the intensive care unit (ICU) need specific medical indications for catheters because ICU location alone is not an appropriate indication; and recognize that Foley and external catheters may be pragmatically appropriate to manage urinary incontinence in select patients. These new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
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