PRACTICE-CHANGING PUBLICATIONS: TOP ARTICLES FROM THE GLMS
BOARD OF GOVERNORS
A
t the September 2019 GLMS Board of Governors meeting,
I pitched a novel concept to the physician members. I
proposed they select a publication from the past one to
two years, within their specialty, which they found to be
critical to their field; something that changed the way
they practice.
Me asking them to provide content for this “From the
President” article might appear to be a bit self-serving. However,
my goal was two-fold. First, I wished to feature the Board
members, highlighting their service as leaders within our medical
community and within their respective specialties. Secondly, I
hoped this might remind us all of the vast amount of research
which shapes our world of medicine each day. By stepping outside
of our own field, even for a few minutes, we can expand our
personal knowledge, appreciate our colleagues and collaborate in
patient care.
To this end, find below a sampling of the GLMS Board’s
“Practice-Changing Publications.”
DR. VALERIE BRIONES-PRYOR, INTERNAL MEDICINE:
Clinical Practice Guidelines for Clostridium difficile Infection in
Adults and Children: 2017 Update by the Infectious Diseases Soci-
ety of America (IDSA) and Society for Healthcare Epidemiology of
America (SHEA). McDonald LC, et al. Clin Infect Dis. 2018; 66(7):
e1-e48.
Dr. Briones-Pryor heard this guideline presented at the Society of
Hospital Medicine meeting, Spring 2019, as part of the Updates
in Hospital Medicine. This article presented the recommendation
to change first-line treatment from Metronidazole to oral Van-
comycin or Fidaxomicin. It outlined guidelines for stool testing.
This has required hospitals and primary care doctors to change
their formularies, learn something new and develop protocols for
testing. This again emphasizes the importance of antibiotic stew-
ardship.
DR. LEWIS HARGETT, PHYSICAL MEDICINE & REHABILITATION:
Concomitant Use of Opioids and Benzodiazepines in the Outpatient
Setting. Simon J, et al. PMRJ 2019; 11(4): 337-343.
Dr. Hargett stated that physical medicine and rehabilitation phy-
sicians are well trained in managing pain. This article specifically
addressed the negative role benzodiazepines may play when used
4
LOUISVILLE MEDICINE
with opioids. Physicians and other prescribers should be aware
that most patients who present for pain management also have
anxiety and, as noted in this publication, 49.4% of patients who
were prescribed opioids were also taking benzodiazepines. The
combination of both of these medications can result in extreme
sedation, respiratory depression and even death. According to the
CDC and the NIH, 30% of opioid deaths involve benzodiazepines.
DR. SARAH MOYER, PUBLIC HEALTH:
The Importance of Policy Change for Addressing Public Health Prob-
lems. Pollack Porter KM, et al. Public Health Reports 2018; 133(1_
suppl): 9S-14S.
Most of the gains in life expectancy over the past 100 years have
been due to policy change. Dr. Moyer’s featured publication
speaks to how policy changes, including motor vehicle safety, to-
bacco control and maternal and infant health, led to the average
life expectancy in the US increasing from 47.3 years in 1900 to
76.8 years in 2000. However, it decreased from 78.8 years in 2014
to 78.7 years in 2015 and 78.6 years in 2016. In fact, life expec-
tancy decreased over this time period for the first time since the
1918 influenza pandemic. This emerging trend is the result of nu-
merous public health challenges, especially the opioid and obesity
epidemics, which continue to burden society.
DR. BRIAN SOSNIN, FAMILY MEDICINE:
American Association of Family Practice Congress adopts resolu-
tions on physician privileges, medical education, employee benefits.
Family Practice News 2019; 49(10).
Dr. Sosnin chose an article from Family Practice News which
highlighted resolutions addressing practice enhancement, educa-
tion and advocacy during the three-day meeting of the American
Academy of Family Physicians (AAFP) Congress of Delegates.
Hospital privileges were a hot topic for the reference committee on
practice enhancement. Resolutions which were adopted included
one which calls on the AAFP to oppose health insurance com-
panies “privileging physicians solely on their hospital privileges
and hospital credentials.” Another adopted resolution calls on the
AAFP to collaborate with the Joint Commission to create policy
stating hospitals remove barriers and restriction of privileges to
hospitals and intensive care units for qualified family physicians
who practice hospital medicine. Dr. Sosnin’s article highlighted
the need for physicians to participate in policy and advocacy.