2015 Clinical Guideline Resources

Resources updated to support the 2015 Guidelines discussion for new Family Medicine Residents:

Hypertension: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Additional Resources: 
American Family Physician: POEMs: JNC 8 Report on Prevention, Evaluation and Treatment of Hypertension
AAFP: 2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert

Hyperlipidemia: 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
American Heart Association: CV Risk Calculator
AAFP: New Guidelines Propose Significant Shift in Cholesterol Management

Diabetes: American Diabetes Association: Standards of Medical Care in Diabetes—2015
(including the new Abridged Standards for Primary Care Providers)
American Association of Clinical Endocrinologists: AACE Comprehensive Diabetes Management Algorithm 2015
Additional Resources: 
National Diabetes Education Program: 2012 Diabetes Numbers at a Glance
CDC Diabetes Data & Trends

In addition, there are a number of "apps" that I think can be of use in clinic:

1) Agency for Healthcare Research & Quality: electronic Preventive Service Selector (ePSS)
2) Shots by STFM (Society or Teachers of Family Medicine)
3) American Heart Association/American College of Cardiology  ASCVD Risk Calculators (online)

Links for Computer Applications: AAFP Scientific Assembly 2014

Meaningful Use

http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

How to Implement EHRs
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-1-assess-your-practice-readiness

Stages of Meaningful Use

•         Stage 1

–      13 required core objectives

–      5 menu objectives (from list of 9)

–     Total of 18 objectives

–     http://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-1  

•         Stage 2

–      17 core objectives

–      3 menu objectives (from list of 6)

–      total of 20 objectives

–     http://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-2  

 

EHR Selection & Implementation

•        AAFP Center for Health Information Technology

•        AAFP Health-IT Guides

–    Selecting & Implementing an HER

•     http://www.aafp.org/practice-management/health-it/product.html  

CDS Implementation Guides

•        HealthIT.gov

–    http://www.healthit.gov/policy-researchers-implementers/cds-implementation   

–    How-to guides:

•     Start with a Strong Foundation for CDS

•     Assemble a CDS Implementation Team

•     Plan for Successful CDS Development, Design, and Deployment 

•     Roll Out Effective CDS Interventions

•     Measure Effects and Refine CDS Interventions

Old Fashioned CDS System

•        DiagnosisPro: http://en.diagnosispro.com/

Smartphone Apps

Reference

•        All-in-one

–    UpToDate: www.uptodate.com  

–    ePocrates: www.epocrates.com  

–    Medscape Mobile App: http://www.medscape.com/public/mobileapp  

Reference

•        Leverage content

–    Elsevier: ClinicalKey: www.clinicalkey.com  

–    Skyscape: Omnio: www.omnio.com  

Drug Reference

•        Lexicomp: www.lexi.com

•        Micromedex: http://micromedex.com/mobile  

•        Monthly Prescribing Reference:

–    www.empr.com/app  

•        Physician’s Drug Reference:

–    Standalone or Omnio

–    http://www.pdr.net/resources/mobilepdr/  

Tools

•        PatientKeeper

–    Patient lists

–    Aggregate patient data

–    Order entry

–    Charge capture

–    http://www.patientkeeper.com/mobile-platform/index.html  

Tools

•        ePSS: electronic Preventative Services Selector

–    AHRQ: http://epss.ahrq.gov/PDA/index.jsp  

•        Shots by STFM:

–    http://www.immunizationed.org/Shots-Mobile-App  

•        ASCVD Risk Estimator: ACC/AHA

–    http://www.cardiosource.org/Science-And-Quality/Practice-Guidelines-and-Quality-Standards/2013-Prevention-Guideline-Tools.aspx  

Tools

•        VisualDx:

–     Diagnosis search/differential builder

–    http://www.visualdx.com/features/mobile-access

•        MedCalc:

–    http://medcalc.medserver.be/  

•        Pregnancy wheel

–     Huge range

Patient Health Apps

•         Calorie counters

•         Activity trackers

•         Smoking Cessation:

–     Smokefree.gov/apps-quitguide

•         Patient Social Media:

–     CaringBridge: www.caringbridge.org/  

•         Exercise monitors

–     Fitbit: www.fitbit.com

–     Jawbone: www.jambone.com/up  

–     Apple Watch: coming

•         Sleep monitors

–     Sleepbot: www.mysleepbot.com  

–     Sleep Cycle: www.sleepcycle.com  

•  

2014 Guidelines Resources

Resources to support the 2014 Guidelines discussion for new Family Medicine Residents:

Hypertension: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Additional Resources: 
American Family Physician: POEMs: JNC 8 Report on Prevention, Evaluation and Treatment of Hypertension
AAFP: 2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert

Hyperlipidemia: 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
American Heart Association: CV Risk Calculator
AAFP: New Guidelines Propose Significant Shift in Cholesterol Management

Diabetes: American Diabetes Association: Standards of Medical Care in Diabetes—2014
American Association of Clinical Endocrinologists: AACE Comprehensive Diabetes Management Algorithm 2013
Additional Resources: 
National Diabetes Education Program: 2012 Diabetes Numbers at a Glance
CDC Diabetes Data & Trends

Journal Club Resources

A good place to find Journal Club resources is the Centre for Evidence Based Medicine at Oxford: http://www.cebm.net/

There you can find a step-by-step introduction to the process of EBM, including tools such as the worksheets to appropriately evaluated each type of article.

If you have any trouble using this site, or finding the correct worksheet, please contact me by email.

Thanks,

Dr. Z

A Funny Thing Happened on the Way to ATP 4 - New Cholesterol Guidelines 2013

In somewhat of a surprise move, the National Hearth, Lung and Blood Institute (NHLBI) has partnered with the American Heart Association and American College of Cardiology (AHA/ACC) in order to get new Guidelines out the door.  One set, focused on Cholesterol, is essentially ATP 4 (Adult Treatment Panel 4) replacing the 12 year old ATP 3.  The links for this guideline can be found below.

Summary of all 4 Guidelines

2013 AHA/ACC Cholesterol Guideline

Risk Calculator (Excel)

A good commentary on this subject can be found at Dr. Bilizarian's blog on Medscape.

A note, this risk calculator appears to overestimate individual risk between 75% and 150%, leading to suggest greatly increased statin use.  More to follow...

Resources for Toxic Exposures from Environmental Hazards

Excellent case studies in Environmental Medicine can be found at the CDC Agency for Toxic Substances and Disease Registry (ATSDR):
http://www.atsdr.cdc.gov/csem/csem.html

Abstracts for articles on BPA and Phthalates in Adolescents, along with opposing editorial in August 19, 2013 Pediatrics:
BPA article abstract: Bisphenol A and Chronic Disease Risk Factors in US Children
http://pediatrics.aappublications.org/content/132/3/e637.abstract?sid=7355a77d-5ccc-49d1-a93a-deb9047b002b

Phthalate article abstract: Urinary Phthalates and Increased Insulin Resistance in Adolescents
http://pediatrics.aappublications.org/content/132/3/e646.full

Editorial: Urine Chemical Content May Be a False Measure of Environmental Exposure
http://pediatrics.aappublications.org/content/132/3/e747.full

NIH Consensus Development Conference on Diagnosing Gestational DiabetesMellitus

While the 2013 ADA recommendations support the 1 step approach to screening for Gestational Diabetes Mellitus, a subsequent NIH Consensus Conference in March 2013 supports the previous 2 step method.  You can find the statement from this conference at :

http://prevention.nih.gov/cdp/conferences/2013/gdm/files/Gestational_Diabetes_Mellitus508.pdf