Consultant Connect’s Post

🎉 Excited to share our recent *Annals of Internal Medicine* editorial, co-authored with Dr. Jake Lebin, a skilled medical toxicologist and emergency physician University of Colorado Department of Emergency Medicine! Together, we examined two recent RCTs testing team-based deprescribing interventions aimed at reducing polypharmacy and fall risk in older adults. Polypharmacy is a common issue among older adults, often leading to medically treated falls, emergency visits, hospitalizations, and adverse drug events. While deprescribing interventions hold promise to reduce these risks, evidence remains mixed. The trials by Ie and Phelan assessed innovative approaches, combining medication optimization, clinical decision support, and patient education. Yet, neither study found significant reductions in primary outcomes like falls, hospitalizations, or mortality. That said, these trials did show some valuable secondary benefits: one intervention led to 0.62 fewer medications per patient and fewer inappropriate prescriptions at 12 months, and another increased the discontinuation of tricyclic antidepressants. These results, while modest, remind us not to be overly skeptical of deprescribing’s potential in older adults and underscore the importance of tackling polypharmacy holistically. Working with Jake has been incredibly rewarding, and I’m inspired by his dedication to advancing safer, evidence-based care for our patients. Here’s to more scientific advancement in this essential area! 🌟 #GeriatricMedicine #Polypharmacy #Deprescribing #FallsPrevention #Collaboration https://lnkd.in/gX9DfpbE American College of Physicians https://lnkd.in/gPkShEE8

Nabla will be deployed to all medical teams at Denver Health 🎉 Incredible news - and so proud to partner with Denver Health, a true model for the future of safety-net health systems, which provided over $140 million in uncompensated care to more than 85,000 patients last year. After an 8-week pilot across 12 specialties, including family medicine, behavioral health, neurology, and infectious disease, Denver Health has decided to fully deploy Nabla. Seamlessly integrated into Epic, Nabla was quickly adopted by 400+ clinicians within the first week (short-term goal: 3,000) and used for over 16,000 encounters in the first month. 3 key highlights: 1. KPIs that speak for themselves 📈: Clinicians using Nabla reported a 40% reduction in note-typing per patient encounter, with 82% feeling less time pressure per visit. 2. Expanding our product capabilities 🚀: Nabla is now working to on coding optimisation (esp. Clinical Documentation Improvement and Hierarchical Condition Category), as well as nursing and center support. 3. The one and only message to remember 💌 : "I still receive spontaneous hugs from our doctors expressing their gratitude for the way Nabla has improved their working lives.”, sent to us by Dr Daniel Kortsch, Ass. CMIO and AI Officer at Denver Health.

All PD modalities should be presented as part of modality choice decisions - and clinical factors considered carefully. Follow the link to download pdf

𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐈𝐑 𝐓𝐮𝐞𝐬𝐝𝐚𝐲𝐬: 𝐇𝐨𝐰 𝐝𝐨 𝐲𝐨𝐮 𝐚𝐬𝐬𝐞𝐬𝐬 𝐲𝐨𝐮𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬? Dr. Orsi Franco gave a very insightful presentation on this topic during the recent CIRSE webinar on #ClinicalPractice. ➡️ Watch it here: https://t.ly/y_XMD 3 questions you should always ask your patient during the assessment: 1) Do you know why you are here today? This question will allow you to understand how much the patient knows about his/her condition, assess the patient’s knowledge of IR and expectations, evaluate the patient’s communication abilities, and identify key elements to include in the conversation. 2) Can you describe a typical day for you? This question will help you to understand the patient’s activity level, learn more about his/her living environment, identify potential limitations that might affect adherence to a treatment plan, and determine how to best help the patient overcome some of these limitations. 3) Can you summarize what we discussed? This last question will allow you to understand if the patient has comprehended the discussion, evaluate the need to involve a caregiver, clarify any unclear points, and assess the level of detail needed for the final report. And here are some general conclusions from Dr. Orsi’s talk: ▪️ Patient assessment is crucial for successful IR interventions ▪️ There is a need for a dedicated, peaceful, and well-equipped space ▪️ Clear and empathetic communication builds trust and ensures patient understanding ▪️ Holistic patient view: patient’s overall health, comorbidities, and social environment ▪️ Active patient involvement in the care plan will improve adherence and outcomes ▪️ Need for continuous learning and adaptation in clinical practice and to enhance patient care quality 𝐖𝐡𝐚𝐭 𝐢𝐬 𝐤𝐞𝐲 𝐟𝐨𝐫 𝐲𝐨𝐮 𝐰𝐡𝐞𝐧 𝐚𝐬𝐬𝐞𝐬𝐬𝐢𝐧𝐠 𝐲𝐨𝐮𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬? 𝐒𝐡𝐚𝐫𝐞 𝐲𝐨𝐮𝐫 𝐭𝐡𝐨𝐮𝐠𝐡𝐭𝐬! #IRgoingClinical #interventionalradiology #IRad #ClinicalIR

This tracks. My career in this field has been 18 years long and we are just now beginning to see the uptake of standardized EEG Source Imaging methods applied regularly to the epilepsy presurgical evaluations - as an example of the 17-year evidence to practice gap. Meanwhile this paper emphasizes that Status Epilepticus (SE) is a neuro-emergency, and just like stroke, “time is brain”. And it should be treated with the same urgency as a stroke. Evidence shows that immediate care minimizes adverse outcomes for patients. How can we decrease this evidence to practice gap? 17 years is a long time.

🗂️Understanding Medical Cases: Simple-to-Deep vs. Deep-to-Simple Approaches As clinicians, we encounter a wide spectrum of cases, from straightforward diagnoses to highly complex ones. To approach them efficiently, I’ve found that adapting your study strategy—Simple-to-Deep or Deep-to-Simple—can make a significant difference. ✅For Simple Cases: Go Simple-to-Deep Start with quick references to establish the basics, then expand your understanding as needed. Example: Iron Deficiency Anemia 1. Begin with concise resources like the Merck Manual for differential diagnoses and practical management. 2. Use Davidson’s to reinforce foundational knowledge. 3. Explore Kumar and Clark for practical diagnostic and treatment workflows. 4. Delve into deeper resources like Harrison’s or Oxford Textbook only if you encounter atypical findings. This saves time while ensuring a solid understanding. ✅For Complex Cases: Go Deep-to-Simple Start with in-depth resources to grasp the nuances, then simplify for actionable insights. Example: Systemic Lupus Erythematosus (SLE) with Renal Involvement 1. Begin with advanced texts like Harrison’s to explore pathophysiology and immunological mechanisms. 2. Use the Oxford Textbook of Medicine to understand global guidelines and advanced management strategies. 3. Turn to Kumar and Clark for practical workflows and clinical management. 4. Summarize key points with concise texts like Davidson’s for patient education and follow-up plans. This ensures a comprehensive yet practical approach for challenging cases. 🩺Key Takeaway: For simple cases, work Simple-to-Deep: Quick foundation first, detailed insights later. For complex cases, work Deep-to-Simple: Understand the depth, then simplify for practical use. 🌐This approach has been invaluable for clinical practice and retrospective studies. How do you approach simple vs. complex cases? #Medicine #ClinicalPractice #MedicalEducation #DoctorsLife #LifelongLearning #PatientCare #MedicalResearch #Harrison #MerckManual #KumarAndClark #Davidson #HealthcareProfessionals #MedicalKnowledge

It takes an average of 17 years for 14% of clinical innovations to be adopted into practice, even after which they don't reach many patients who would benefit. How do we tackle this problem for status epilepticus so that we too, can "Get With The Guidelines"? With thanks to the organizers of the #StatusEpilepticusColloquium and the editors of Epilepsy & Behavior for the invitation to speak and contribute on this topic. #StatusEpilepticus #ImplementationScience #QualityImprovement #Innovation #UChicagoMedicine https://lnkd.in/gGm_qqv2

Is Ego Disruption Good? Exploring the Depths of Therapeutic Transformation with Dr. Carl J. Bonnett, MD 🌟 Advancing Understanding in Infusion Therapy In the realm of infusion therapy, the nuances are as profound as the potential for healing. As the founder and medical director, I continually emphasize the therapeutic significance of responsibly navigating the self's transformation. This is not just about adhering to protocols—it's about pioneering them. 🔍 What You Need to Know: • Therapeutic Potential: The patient's experience needs to be carefully monitored, highlighting our commitment to safe and transformative care. • Redefining Recovery: Emotional and psychological recover after a therapy experience is important for the long-term mental renewal of our patients. • Educational Imperative: It's our responsibility to educate both patients and the broader medical community about the nuanced benefits of infusion therapies within supervised, clinical environments. Tune into the full episode of our podcast for deeper insights: https://bit.ly/4elX2j7 If you're new to my page, I'm Sam Ko, founder and medical director of Reset Ketamine. Since 2018, I've provided ketamine infusion therapy. I'm also the co-creator of Ketamine StartUp, assisting in the launch of more than 16 ketamine clinics nationwide. I trained as an emergency physician at Loma Linda University, where the landmark study on ketamine use in the ER was conducted. Additionally, I serve as expert faculty for the American Society of Ketamine Physicians, Psychotherapists, and Practitioners. #KetamineTherapy #MedicalEthics #InfusionTherapy #KetamineStartUpPodcast

What really distinguishes a geriatrician from other medical disciplines? To better understand the role of a geriatrician, we can refer to the "5 M's": Mind: Assessment of cognitive status and cognitive performance. Mobility: Evaluation of the patient's functional status and mobility. Medications: Review and management of medications. Multicomplexity: Consideration of the patient's overall complexity, rather than focusing on individual diseases. What Matters Most (matters most to me): This aspect involves communication with the person and their families to identify values, preferences, and care goals. It emphasizes shared decision-making and aligning medical care with what is most important to the individual, including end-of-life care planning. To integrate all this information, the geriatrician uses the Comprehensive Geriatric Assessment (CGA). This methodology identifies and explains the multiple issues of the older or geriatric person, assesses their limitations and resources, defines their care needs, and develops an individualized care plan tailored to those needs.

Jordyn T. Kettner and Tera L. Raymond highlight a missed opportunity to enhance medication management for patients with traumatic brain injury (TBI) through the involvement of clinical pharmacists. Their study, conducted at the Kansas City Veterans Affairs Medical Center, underscores the prevalence of polypharmacy, medication adherence issues and treatments lacking clear indications among veteran patients. Despite efforts to integrate pharmacist-led services through targeted consultations, no referrals were received, revealing organizational challenges and gaps in awareness. The findings show that 30.8% of patients exhibited medication-related issues requiring targeted interventions. These results not only demonstrate the potential for pharmacists to play a critical role in this area but also reveal the current gaps in care practices. The study emphasizes the urgent need to incorporate pharmacists into interdisciplinary teams to optimize clinical outcomes, reduce medication-related risks and improve patient adherence. This work calls for greater awareness among healthcare teams and the development of proactive processes to identify and manage patients in need of medication management. The implications extend beyond veterans, potentially benefiting all TBI patients dealing with cognitive challenges and complex treatment regimens. #PharmacyPractice #TBIManagement #ClinicalPharmacists #HealthcareInnovation #VeteranCare #MedicationManagement