WIHI - A Podcast from the Institute for Healthcare Improvement

The effectiveness of screening depends on the underlying biology of cancer. Depending on the growth rates and metastatic potential of the tumor, screening may or may not be effective. Screening is much less effective than we had hoped for aggressive tumors as they can metastasize even when small or grow rapidly and present as interval tumors. For slow growing tumors with very low metastatic potential, early identification will not improve outcome and screening can lead to the identification of additional lesions not destined to become a clinical problem (both invasive and preinvasive lesions), and may be responsible for 20-30% of cancers detected by screening. There are ways that we can improve screening today 1-limit it to the populations who are most likely to have the tumors where early detection makes a difference (The USPSTF guidelines are a good start) 2- work to improve the diagnostic accuracy, especially with mammography (using trained mammographers to interpret images), and minimize biopsy recommendations for very low risk lesion; Use shared decision making to discuss screening, prepare patients for results, and consider prevention interventions as part of the risk assessment process when high risk individuals are identified. 3- use available tools to predict tumor behavior of screen detected tumors, and consider less aggressive interventions as appropriate. We can and must do better- we need to work to identify populations at risk for the most aggressive tumors where screening is less effective, and find better treatment and prevention strategies. It is very important to invest in large scale demonstration projects to better determine risk factors for specific biologic types of cancer, and test less aggressive interventions both for screening and treatment- of low risk tumors.

Open Notes and the Electronic Medical Record

All Hospitals in Favor of Saving Money: 'Say Patient Flow!'

Errors and adverse events are common, and disclosure of these events to patients is recommended but often does not take place. Physician fear of litigation inhibits disclosure, but so does physicians' lack of confidence in their communication skills and concern that disclosure might be harmful to the patient. Important future developments in the field include linking disclosure with offers of compensation, and using performance improvement tools to enhance the disclosure process.

Getting Down to Business...and Health Care Reform

New Ways to Reduce Diagnosis Errors

Errors and adverse events are common, and disclosure of these events to patients is recommended but often does not take place. Physician fear of litigation inhibits disclosure, but so does physicians' lack of confidence in their communication skills and concern that disclosure might be harmful to the patient. Important future developments in the field include linking disclosure with offers of compensation, and using performance improvement tools to enhance the disclosure process.

Quality Care During Advanced Illness

Run, Don't Walk! The Urgent Need for Patient Safety

Reducing Avoidable Visits to the Emergency Department

Errors and adverse events are common, and disclosure of these events to patients is recommended but often does not take place. Physician fear of litigation inhibits disclosure, but so does physicians' lack of confidence in their communication skills and concern that disclosure might be harmful to the patient. Important future developments in the field include linking disclosure with offers of compensation, and using performance improvement tools to enhance the disclosure process.

At an individual level, combining healthy lifestyle factors may substantially reduce the risk of developing hypertension; according to the findings of the study, women who followed 6 healthy factors had nearly an 80% reduction in risk. At a population level, a large fraction of all new cases of hypertension could hypothetically be prevented if all individuals in the population followed combinations of healthy lifestyle factors; according to the findings of the study, this fraction may is 78%. Given that hypertension is a leading cause of preventable death in the population, and given that the majority of hypertension may be preventable through lifestyle modification, efforts should be intensified to improve lifestyle as a means of improving public health.

The Medical Home

The Blogosphere's Hospital CEO

Cognitive Behavioral Therapy (CBT) is an effective treatment for chronic insomnia and can help reduce medication treatment for this condition Clinicians can be successfully trained in CBT. CBT works well alone for insomnia and while medication treatment may help early in the course of this condition, it has not advantages for long term use.