WIHI - A Podcast from the Institute for Healthcare Improvement

The HPV vaccine has been shown to work very well in preventing new (incident) infection and disease caused by the HPV types targeted in the vaccine. JAMA study shows that HPV vaccination does not hasten clearance of existing (prevalent) infection with the HPV types targeted by the vaccine (HPV16 and 18). It is most cost-effective to administer the vaccine before patients are exposed to HPV, because the vaccine is effective in preventing new infection but does not appear to be effective in treating established infection.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Episodes of emotional stress, especially when sudden, severe and unexpected, may have significant adverse effects on the heart. Acute emotional stress can increase sympathetic stimulation of the heart and can alter brain activity in a way that makes the heart more susceptible to rhythm disturbances. Since episodes of emotional stress are almost inevitable in life, part of a healthy lifestyle is learning how to deal effectively with stress to make them less likely to lead to adverse effects; relaxation therapy, yoga, meditation, and other ways of responding to stress may be important for individuals to become familiar with to accomplish this.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Folic acid supplementation is not useful for preventing colorectal adenomas. Folic acid supplementation may be harmful through increasing colorectal adenomas. Practitioners and patients should wait for strong evidence before initiating therapies given the potential for waste and unintended adverse consequences

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

While aspirin is generally a safe drug, and extremely effective, with over 50 million US adults taking it everyday for cardiovascular disease prevention, even a very small incidence of side-effects can have major implications. In terms of preventing heart attacks, strokes or cardiovascular deaths no clinical trial has identified an aspirin dose more efficacious than 75 to 81mg daily. Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk.

Evidence from two replicate RDBPC trials showed sumatriptan-naproxen as a fixed dose combination was superior in treating an attack of migraine when compared to sumatriptan alone, naproxen alone, or placebo. Most importantly, given that migraine attacks in adults are 4 to 72 hours in duration, the fixed dose combination of suma-naproxen was significantly more effective that sumatriptan monotherapy or naproxen monotherapy in providing a 24 hour sustained pain free response. Patients using the fixed dose combination therapy were less likely to use rescue medication or to have headache recurrence, and did not experience any penalty in side effects using the combination.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Screening and other prevention approaches involve subjecting very large numbers of people to an intervention, with the expectation that a few will benefit, but most will not (as they would have never developed the condition anyway). In general screening for diseases such as cancer will uncover some reservoir of abnormalities that appear to be precursors to clinical disease but are not yet causing disease. We really have no evidence to support screening for lung cancer right now with any technology. We really should be advocating for our patients to help them understand why they shouldn't have this test until we know that it is more likely to hurt them or help them.