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2007 ZYNX HEALTH CONFERENCE STARTS MAY 9

The third annual Zynx Health Conference will feature case studies from a wide range of Zynx clients including Alegent Health, Ascension Health, Catholic Healthcare West, Memorial Hermann Healthcare, PinnacleHealth, and Vanderbilt University Medical Center. In addition, the keynote speaker will be bestselling author and journalist Malcolm Gladwell (“The Tipping Point,” “Blink”). The conference will take place May 9-11 at the Don CeSar Resort in St. Pete Beach, Florida.

> Click here for full details on conference logistics, accommodations, and the registration process.

Keep your quality improvement initiatives up-to-date, and enhance your use of Zynx Health evidence-based tools by incorporating new findings from the latest medical literature.

SCREENING MAMMOGRAPHY MAY REDUCE BREAST CANCER MORTALITY IN WOMEN 40 TO 49 YEARS OF AGE BUT DOES NOT BENEFIT THIS PATIENT GROUP AS MUCH AS IT DOES WOMEN 50 YEARS AND OLDER
Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-515. PubMed ID: 17404353.

The American Cancer Society and the American College of Obstetricians and Gynecologists recommend that women 40 to 49 years of age have regular screening mammography, but questions have been raised about the reliability of data showing that the procedure is associated with a 15% reduction in breast cancer deaths in this age group. Consequently, Qaseem and colleagues, writing for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians, developed a clinical practice guideline. The guideline was developed for the purpose of enhancing clinicians’ understanding of the risks and benefits of screening mammography for women in this age group, and for the purpose of providing recommendations for clinicians who advise patients on whether or not to undergo this procedure.

> Click here for the full summary.

ANTICOAGULANT THERAPY RESULTS IN A REDUCTION IN RECURRENT STROKE BUT DOES NOT REDUCE THE RISK OF DEATH OR DISABILITY IN PATIENTS WITH ACUTE CARDIOEMBOLIC STROKE
Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials. Stroke. 2007;38:423-430. PubMed ID: 17204681.

According to Paciaroni and colleagues, heparinoids have received wide acceptance in clinical practice despite the controversy surrounding the role of immediate anticoagulation in the treatment of acute cardioembolic stroke. The authors note that no definitive data have been obtained regarding the impact of anticoagulants on early stroke recurrence or functional outcome. Therefore, Paciaroni et al conducted a meta-analysis to assess both the safety and efficacy of anticoagulants as initial therapy for acute cardioembolic stroke.

> Click here for the full summary.

IN PATIENTS WITH EXTENSIVE BUT STABLE CORONARY ARTERY DISEASE, ADDING PERCUTANEOUS CORONARY INTERVENTION TO OPTIMAL MEDICAL THERAPY DOES NOT REDUCE THE INCIDENCE OF MAJOR CARDIOVASCULAR EVENTS
Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al (for the COURAGE Trial Research Group). Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-1516. PubMed ID: 17387127.

Treatment guidelines for initial management of stable coronary artery disease (CAD) recommend a non-invasive approach with optimal medical therapy, which comprises intensive pharmacologic therapy, lifestyle intervention, and risk factor reduction. However, according to Boden and colleagues, approximately 85% of the percutaneous coronary interventions (PCIs) performed in the United States during 2004 were electively added to initial management of patients with stable CAD. The early use of PCI in stable CAD patients has received limited study, according to the authors, with much of the research conducted prior to current standards of medical management. Consequently, Boden et al conducted a randomized controlled trial evaluating initial management with PCI plus optimal medical therapy as compared with optimal therapy alone in patients with stable CAD.

> Click here for the full summary.

TWO HOURS OF IMMEDIATE POSTBIRTH MOTHER-INFANT SKIN-TO-SKIN CONTACT FACILITATES BREAST-FEEDING
Moore ER, Anderson GC. Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. J Midwifery Womens Health. 2007;52:116-125. PubMed ID: 17336817.

According to Moore and Anderson, the first 2 hours after delivery is the optimal time for establishing effective breast-feeding. Due to a surge in the infant of levels of circulating catecholamines that occurs immediately after birth, an infant’s olfactory bulbs become extremely sensitive. As a result, infants who experience skin-to-skin contact with the mother immediately after birth are capable of crawling unaided towards the mother’s nipple, and are able to fasten correctly within about an hour. In order to compare the breast-feeding competency of infants who received early infant-mother skin-to-skin contact with those who did not, Moore and Anderson conducted a randomized controlled trial.

> Click here for the full summary

FOR PATIENTS WITH BIPOLAR DEPRESSION, THE COMBINATION OF AN ANTIDEPRESSANT AND A MOOD STABILIZER DOES NOT LEAD TO A GREATER REDUCTION IN SYMPTOMS AS COMPARED WITH A MOOD STABILIZER ALONE
Sachs GS, Nierenberg AA, Calabrese JR, Marangell LB, Wisniewski SR, Gyulai L, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722. PubMed ID: 17392295.

According to Sachs and colleagues, clinicians commonly combine mood stabilizing agents with antidepressants when treating patients with bipolar depression despite a lack of evidence supporting the treatment of this illness with standard antidepressants. Furthermore, the authors note, pivotal studies examining the effectiveness of adjunctive antidepressant therapy were conducted under the aegis of pharmaceutical companies and involved narrow eligibility requirements as well as short-term cross-sectional outcomes. Therefore, Sachs et al undertook a randomized controlled trial in which they not only examined the efficacy of adjunctive antidepressants in patients with bipolar disorder, but also addressed the issue of antidepressant-related affective switch to mania.

> Click here for the full summary.

RECENTLY PUBLISHED GUIDELINES

Evidence Alert publishes citations for guidelines released in the previous 2 to 8 weeks from selected organizations. For more information, click on the methodology link located in the upper right panel.

1. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007;115:1481-501. Epub 2007 Feb 19. PMID: 17309915.

> Click here for a PDF version of the guideline.

2. Adams HP, Jr., Del ZG, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655-1711. PMID: 17431204.

> Click here for a PDF version of the guideline.