Louisville Medicine Volume 67, Issue 9 - Page 6

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.