WIHI - A Podcast from the Institute for Healthcare Improvement

The Leaders Needed for the Changes Health Care Needs

1.) When evaluating adolescents and adults with persistent cough illness, the presence of classic symptoms of pertussis (paroxysmal cough, whooping cough, post-tussive emesis) modestly increase the likelihood of pertussis, and their absence modestly decreases the likelihood of pertussis; but they are not strong enough to rule-in or rule-out disease. 2.) Most patients in whom pertussis is suspected will not derive symptomatic benefit from antibiotic treatment because their illness duration is usually > 10 days. 3.) Vigilant testing and treatment should be provided to adolescents and adults who have been exposed to a known case of pertussis, or have contact with individuals at high risk for serious complications of pertussis, ie, child care providers and teachers, health care workers, and patients who live or work with infants under 6 months of age; unvaccinated children; or immunosuppressed individuals.

The Power to Detect and Reduce Harm: IHIs Global Trigger Tool and Adverse Events in the US

Reducing Readmissions, Restoring Revenues: Making Good Care Count

The Buzz about Medical Training: Its Slowly Changing

1) Describe the frequency with which physicians report encountering other physician who may be impaired or incompetent; 2) Explain the 3 basic options available to policy-makers for regulating and ensuring the quality of medical practitioners; 3) Name at least 3 newer mechanisms by which the profession of medicine is enhancing its ability to self-regulate and detect physicians who are not providing high quality care.

Leaders Never Stop Learning: A Conversation with IHIs New President and CEO, Maureen Bisognano

1. UI is very common in older women and should be in Review of System for ALL older women. 2. Initial behavioral therapy (pelvic floor muscle exercises, urge and stress strategies, caffeine avoidance) is easy to do and should be FIRST line treatment for older women with urge and stress urinary incontinence. 3. Modifiable Contributing Factors for urinary incontinence should be addressed before prescribing antimuscarinic medications and include: urinary tract infection, constipation, diabetes control, mobility impairment, sleep apnea, caffeine, timing of diuretics, over-sedation.

1. Careful alcohol histories are needed for all patients, particularly to identify binge drinking, which is frequent among moderate and especially younger drinkers. 2. Even moderate alcohol consumption has important and plausible health effects based on short-term trials and observational studies, including lower risk of heart disease presumably via higher HDL-cholesterol and higher risk of breast cancer (presumably via higher levels of estrone and DHEA sulfates). 3. Given these points, even controlled alcohol consumption is unlikely to benefit younger drinkers, but is a reasonable point of discussion for middle-aged and older adults, especially as a launching point for education about problem drinking and the potential risks and benefits of including alcohol as part of a healthy diet in older age.

Against All Odds: Maternal Survival in Ghana and the US

Unprofessional Behavior Not Permitted Here

1. Know how to assess a cognitively impaired older driver in the office setting. 2. Know how and where to refer at-risk cognitively impaired older drivers. 3. Know how to counsel cognitively impaired older drivers in regards to driving retirement.

The Image of Better Radiation Imaging Practices

Learning by Data and by Doing

1. Falls are common health events that cause discomfort and disability for older adults and stress for caregivers. Previous falls; strength, gait and balance impairments; and medications are the strongest risk factors for falling. 2. The most effective strategy for reducing the rate of falling in community-living older adults may be intervening on multiple risk factors including strengthening and balance exercises through physical therapy, medication reduction, environmental modifications to reduce fall hazards, cataract surgery. Vitamin D has strong evidence of benefit for preventing fractures among older men at risk and probably of preventing falls in all at risk older adults. 3. While challenges and barriers exist, fall prevention strategies can be incorporated into clinical practice.