Patient-Centered Care, Shared Decision Making and Patient Decision Aids

Today we had a great talk by our very own Dr. Emily Bowen, PGY2. She talked about Patient Decision Aids.

Wanting LESS of this:
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And MORE of this:

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Some points from her talk today!

UTSWIM: What are patient decision aids?
Dr. Bowen: As the focus on shared decision making began to increase after the IOM report, the number of patient decision aids available was rapidly expanding. . It was hard to know which ones were based on accurate information and which were actually effective. This led to the foundation of IPDAS in 2003.
UTSWIM: and what did the IPDAS do?
Dr. Bowen: It provided Qualifying Criteria to be a patient decision aid: 1.Identify a specific decision to be made, 2.Helps patients choose deliberately among options, 3.Positive and negative features of the options are presented, 4.Outcomes provided are relevant to health status, 5.Does not recommend one option over others, 6.Helps patients clarify their values.
UTSWIM: so what does the literature show?
Dr. Bowen: A 2014 cochrane review of 115 randomized trials involving >34,000 patients showed that decision aids increase knowledge, increase risk perception by patients, higher proportion of patients choosing an option congruent with their values, lowered decisional conflict but the effects of decision aids on adherence, cost, and resource use were inconclusive
UTSWIM: can you share some examples of decision aids that you liked?
Dr. Bowen:  Of course! Below are some examples that we also put onto our Residency website.
Statins
https://statindecisionaid.mayoclinic.org/

Diabetes: 
https://diabetesdecisionaid.mayoclinic.org/

AHRQ’s decision aids:
http://effectivehealthcare.ahrq.gov/index.cfm/tools-and-resources/patient-decision-aids/ Please note, I have NOT reviewed the evidence for each of these individually so cannot advocate for their efficacy or the evidence behind them specifically.
Prostate Cancer:

http://onlinelibrary.wiley.com/store/10.1002/cncr.30367/asset/supinfo/cncr30367-sup-0003-suppinfo.pdf?v=1&s=6b8485e1b7989a7b99397e3f9a56e051fb64779b (This is the prostate cancer screening decision aid currently available from ACS: slightly different than the one I will show in the talk but similar)
http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-024618.pdf

Thank you so much taking time Dr. Emily Bowen for your Resident Update Talk!
UTSWIM

#fridayimagechallenge(with answers)

From the (excellent) August Parkland MICU team and Tri we have a CXR for today’s image challenge.

We had one correct answer which I think came from Arjun… Nitin’s answer of ‘get this man some steroids!’ will also be accepted.

Hit “read more” for the case and answer.

 

photonegative-pulm-edema-1

Continue reading #fridayimagechallenge(with answers)

#ResidentRecognition

Thank you Dr. Ben Galloway, one of our 3rd year residents! This comes from the Renal Department by way of one of ours nephrology attendings Dr. Jiten Patel:

Ben was scheduled to another clinic that was cancelled  last minute that afternoon. He checked in with the Renal clinic which was next door if they needed anything and found out one of the providers was out. He immediately offered to help see patients and allowed for the clinic to finish on time. The clinic and patients greatly appreciated his assistance.

 

Keep up the great team work Ben!

Aortic stiffness and ethnic differences

The Journal of the American College of Cardiology: Cardiovascular Imaging recently published an observational article from the Dallas Heart Study, based out of UTSW, which found ethnic differences in Aortic stiffness. Aortic compliance has previously been shown to be associated with higher rates of hypertension, myocardial infarction, stroke, and death. This study, using cardiac magnetic resonance parameters, was the first to show that African-Americans have the highest prevalence of Aortic stiffness, followed by Hispanics. The differences in Aortic compliance between ethnicities may in part explain the correlated differences in hypertension. The authors state that they do not know why different ethnic groups would have varying average Aortic compliance, but postulate that it may be related to differences in average dietary sodium intake or vascular collagen content.
stiff-aorta
Interview with the authors
Link to article
================================
– Rick Mills, MD
PGY2, Internal Medicine

Your patient has sickle cell and a Hg of 4!

A very serious case was presented at Morning Report last week: a patient with sickle cell disease (SCD), very low hemoglobin and acute on chronic respiratory distress. What would you do?

With early screening and better treatment of patients with SCD, long term complications of the disease are becoming more prevalent. Pulmonary Hypertension  (PH) -group 1, 2 and 5- and renal failure are late manifestations of SCD, often seen beyond the 2nd decade of life.  It is strongly recommended to refer patients with SCD and proteinuria >300mg/24h to a nephrologist and initiate early RRT in the setting of acute kidney failure. Lack of RCTs limits the strength of screening recommendations for PH; however, based on observational studies, tricuspid regurgitant velocity of >2.5m/s on trans-thoracic echocardiography can be used to identify at risk patients. Both conditions have an independent effect on morbidity and premature mortality in patients with SCD. In the acute clinical setting, early recognition, aggressive blood pressure control, early RRT and transfusion are critical aspects of management.

Cardiovascular complications and risk of death in sickle-cell disease
Cardiovascular complications and risk of death in sickle-cell disease

https://www.ncbi.nlm.nih.gov/pubmed/21131035

  • Sarah Kiani

 

 

#fridayimagechallenge (with answer)

Great imaging this week coming from Potpourr (we) case two weeks ago at the VA, click “see more” below for great discussion of case by Joey Harrington. Check back Friday for a challenging CXR.

A 38 year-old female presents with 1 month of cough, chest pain, and one episode hemoptysis (she says about 2 cups). She has a PMH significant for TB 6 years ago, but cannot convincingly describe her treatment course to you. She does say that the diagnosis was made after a cavitary lesion was incidentally noted in her LUL field on a CXR.

Her CT is shown below:

tb

Remember to include your name/level of training in the answer for some chocolate, best differential wins this week

send interesting images/ECGs to utswecg@gmail.com

 

Continue reading #fridayimagechallenge (with answer)

Vicky’s Surprise Party – 40 year VA Anniversary

Today, November 9th our very own Vicky Robertson marked 40 years working at the VA. Vicky has impacted so many lives everyday through her tireless work to care for her house staff, friends, family and our veterans. She is such an integral part of our program and the VA  – we thank her from every house staff that she has helped, taken care and made feel like a family. Thank you Vicky Robertson.

Please share your own Vicky Robertson stories in the comments.

Pictures from her surprise party for her anniversary party – thank you Priyanka for organizing this!
file-nov-09-1-14-21-pmVicky opening her card from Dr. Kazi

img_3025 Celebrating Vicky!

img_3027 Vicky with Dr. Mulligan and Dr. Miller
img_3030 Congrats Vicky!

img_3032Thank you for wonderful 40 years! To many more to come!

 

UTSW Internal Medicine

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