WIHI - A Podcast from the Institute for Healthcare Improvement

This week: Dr. Ford discusses differentiating between gastroesophageal reflux laryngopharyhngeal reflux as well as making and confirming the laryngopharyngeal reflux diagnosis. Aggressive and prolonged treatment is required to resolve laryngopharyngeal refulx findings.

The objective of this study was to examine the impact of the varicella vaccination program on medical visits and associated expenditures. The study found that since the introduction of the vaccination program, varicella hospitalizations, ambulatory visits, and their associated expenditures have declined dramatically among all age groups in the United States.

This week: The objective of this trial was to describe women's symptoms and management strategies after stopping menopausal hormone therapy, in this case, estrogen plus progestin. The study found that more than half of the women with menopausal symptoms prior to the trial also reported these symptoms after discontinuing use of the study pills. Women who had symptoms after they stopped study medication reported using a wide range of strategies to manage symptoms, many of them helpful. Investigation of alternative strategies to manage menopausal symptoms is warranted.

This week: Increasing reports of pertussis among US adolescents and adults have stimulated vaccine development for older age groups. This study assessed the efficacy of a combined tetanus-diphtheria 5-component pertussis vaccine in adolescents and adults. The vaccine elicited robust immune responses to pertussis, tetanus, and diphtheria antigens, while exhibiting an overall safety profile similar to that of a licensed tetanus vaccine.

This week: Updated recommendations on the treatment of tuberculosis (TB) and latent TB infection exist. Prescribing an appropriate treatment regimen for TB and ensuring completion of therapy is best achieved with directly observed therapy, which is essential for curing patients with the disease, minimizing the risk of drug-resistant TB, and for enhancing TB control. Thus, treatment of TB often requires close collaboration between the public and private sectors. New drugs are needed for the treatment of multidrug-resistant TB. Better diagnostic tests for latent TB infection and shorter, safer treatment regimens are needed.

This week: Dr. Kemer discusses how about half the children, age six and under with elevated blood lead levels, didn't receive follow up testing and among them, nonwhite children and those living in urban and other high-risk lead settings, were even less likely to receive follow up testing compared to their counterparts; thus proving the need for interventions to overcome disparities in care. These follow up tests for children with high blood lead levels are essential for managing lead poisoning and for maximizing cognitive development.

This week: Dr. Wright discusses why Thiazide-type diuretics are safe and effective in reducing blood pressure but the effects overwhelm the observed adverse metabolic affects of those medications. A standardized and inexpensive approach to initial blood pressure management is possible and should be adopted; Methods of monitoring and improving antihypertensive use are warranted.

This week: Susan Hendrix discusses why hormone replacement therapy (HRT) shouldn't be the treatment of choice for post-menopausal women with urinary incontinence, but if chosen as treatment, women should be warned of the risks and monitored closely for the symptoms of urinary incontinence. If symptoms appear, women should be weaned off of HRT.