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ABIM’s Choosing Wisely campaign advises against overprescribing antipsychotics
The American Psychiatric Association has released a set of recommendations for the use of antipsychotic medications, the latest in the "Choosing Wisely" series from medical organizations working in collaboration with the American Board of Internal Medicine Foundation.
The list, designed with input from the ABIM and several workgroups within the APA, is not intended to revise clinical procedures on treating patients with psychotic disorders but instead to educate patients and physicians about unnecessary treatment and spark conversations "between patients and physicians about what care is really necessary."
"We think patients really need to be part of the partnership with the physician about their own treatments. It’s a true partnership when it works well," Dr. James H. Scully Jr., medical director and CEO of the APA, said in a video released with the guidelines.
The recommendations include:
• Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and ongoing monitoring, as metabolic, neuromuscular, and cardiovascular side effects are relatively common with antipsychotics.
• Avoid prescribing two or more antipsychotic medications at the same time, since there is little evidence to show the efficacy of such treatments in most patients. Only in cases of three separate failed monotherapies should psychiatrists look to multiple concurrent medications.
• Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia, as the risks tend to outweigh the benefits and could cause troubling side effects, such as cerebrovascular problems, increased mortality rates, parkinsonism, or extrapyramidal signs. Practitioners should only look into antipsychotics when other therapies are ineffective or the patient’s dementia is a risk to themselves or others.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults; there is "inadequate evidence" to prove the efficacy of such therapies.
• Avoid the routine prescribing of antipsychotics as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.
The American Psychiatric Association has released a set of recommendations for the use of antipsychotic medications, the latest in the "Choosing Wisely" series from medical organizations working in collaboration with the American Board of Internal Medicine Foundation.
The list, designed with input from the ABIM and several workgroups within the APA, is not intended to revise clinical procedures on treating patients with psychotic disorders but instead to educate patients and physicians about unnecessary treatment and spark conversations "between patients and physicians about what care is really necessary."
"We think patients really need to be part of the partnership with the physician about their own treatments. It’s a true partnership when it works well," Dr. James H. Scully Jr., medical director and CEO of the APA, said in a video released with the guidelines.
The recommendations include:
• Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and ongoing monitoring, as metabolic, neuromuscular, and cardiovascular side effects are relatively common with antipsychotics.
• Avoid prescribing two or more antipsychotic medications at the same time, since there is little evidence to show the efficacy of such treatments in most patients. Only in cases of three separate failed monotherapies should psychiatrists look to multiple concurrent medications.
• Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia, as the risks tend to outweigh the benefits and could cause troubling side effects, such as cerebrovascular problems, increased mortality rates, parkinsonism, or extrapyramidal signs. Practitioners should only look into antipsychotics when other therapies are ineffective or the patient’s dementia is a risk to themselves or others.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults; there is "inadequate evidence" to prove the efficacy of such therapies.
• Avoid the routine prescribing of antipsychotics as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.
The American Psychiatric Association has released a set of recommendations for the use of antipsychotic medications, the latest in the "Choosing Wisely" series from medical organizations working in collaboration with the American Board of Internal Medicine Foundation.
The list, designed with input from the ABIM and several workgroups within the APA, is not intended to revise clinical procedures on treating patients with psychotic disorders but instead to educate patients and physicians about unnecessary treatment and spark conversations "between patients and physicians about what care is really necessary."
"We think patients really need to be part of the partnership with the physician about their own treatments. It’s a true partnership when it works well," Dr. James H. Scully Jr., medical director and CEO of the APA, said in a video released with the guidelines.
The recommendations include:
• Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and ongoing monitoring, as metabolic, neuromuscular, and cardiovascular side effects are relatively common with antipsychotics.
• Avoid prescribing two or more antipsychotic medications at the same time, since there is little evidence to show the efficacy of such treatments in most patients. Only in cases of three separate failed monotherapies should psychiatrists look to multiple concurrent medications.
• Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia, as the risks tend to outweigh the benefits and could cause troubling side effects, such as cerebrovascular problems, increased mortality rates, parkinsonism, or extrapyramidal signs. Practitioners should only look into antipsychotics when other therapies are ineffective or the patient’s dementia is a risk to themselves or others.
• Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults; there is "inadequate evidence" to prove the efficacy of such therapies.
• Avoid the routine prescribing of antipsychotics as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.
Orthopaedic surgeons’ ‘Choosing Wisely’ list centers on osteoarthritis treatments
Three of the five recommendations in the first-ever list developed by the American Academy of Orthopaedic Surgeons for the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign focus primarily on treatments for symptomatic osteoarthritis.
The campaign is meant to educate patients and physicians about unnecessary and potentially harmful testing and treatment.
According to the Choosing Wisely website, the AAOS’s list was formed based on a review of the most recent approved clinical practice guidelines previously developed by AAOS physician volunteer work groups and a selection of a variety of topics frequently used in orthopaedic surgical practice with input from specialty society leaders and the Academy’s presidential leadership and board of directors. The list was created with the intent to "serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment."
However, some specialists find fault with the recommendations. For example, Dr. Roy Altman, a professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles, said the methodology used to create the guidelines overlooks a number of treatments, including multimodal therapy, and could have the unintended consequence of allowing specialists to deny effective care to patients.
"These guidelines are not consistent with my clinical experience," Dr. Altman said. In particular, he noted that many of his patients react positively to injection treatments for osteoarthritis (OA), which the Choosing Wisely recommendations specifically discourage.
AAOS’s recommendations are as follows:
• Avoid using postoperative ultrasonography screening for deep vein thrombosis on patients receiving hip or knee arthroplasty because it is not effective at diagnosing unsuspected cases.
• Don’t use needle lavage for long-term relief in symptomatic OA treatment, as the procedure "does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness, or swelling."
• Do not use glucosamine and chondroitin sulfate to treat patients with symptomatic knee OA.
• Lateral wedge or neutral insoles do not improve pain or functional outcomes in patients; on the contrary, patients with OA of the knee may experience fewer symptoms without insoles.
• Routine postoperative splinting of the wrist after the carpal tunnel release procedure does not improve subjective outcomes, and may lead to detrimental effects, including adhesion formation, stiffness, and prevention of nerve and tendon movement.
Three of the five recommendations in the first-ever list developed by the American Academy of Orthopaedic Surgeons for the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign focus primarily on treatments for symptomatic osteoarthritis.
The campaign is meant to educate patients and physicians about unnecessary and potentially harmful testing and treatment.
According to the Choosing Wisely website, the AAOS’s list was formed based on a review of the most recent approved clinical practice guidelines previously developed by AAOS physician volunteer work groups and a selection of a variety of topics frequently used in orthopaedic surgical practice with input from specialty society leaders and the Academy’s presidential leadership and board of directors. The list was created with the intent to "serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment."
However, some specialists find fault with the recommendations. For example, Dr. Roy Altman, a professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles, said the methodology used to create the guidelines overlooks a number of treatments, including multimodal therapy, and could have the unintended consequence of allowing specialists to deny effective care to patients.
"These guidelines are not consistent with my clinical experience," Dr. Altman said. In particular, he noted that many of his patients react positively to injection treatments for osteoarthritis (OA), which the Choosing Wisely recommendations specifically discourage.
AAOS’s recommendations are as follows:
• Avoid using postoperative ultrasonography screening for deep vein thrombosis on patients receiving hip or knee arthroplasty because it is not effective at diagnosing unsuspected cases.
• Don’t use needle lavage for long-term relief in symptomatic OA treatment, as the procedure "does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness, or swelling."
• Do not use glucosamine and chondroitin sulfate to treat patients with symptomatic knee OA.
• Lateral wedge or neutral insoles do not improve pain or functional outcomes in patients; on the contrary, patients with OA of the knee may experience fewer symptoms without insoles.
• Routine postoperative splinting of the wrist after the carpal tunnel release procedure does not improve subjective outcomes, and may lead to detrimental effects, including adhesion formation, stiffness, and prevention of nerve and tendon movement.
Three of the five recommendations in the first-ever list developed by the American Academy of Orthopaedic Surgeons for the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign focus primarily on treatments for symptomatic osteoarthritis.
The campaign is meant to educate patients and physicians about unnecessary and potentially harmful testing and treatment.
According to the Choosing Wisely website, the AAOS’s list was formed based on a review of the most recent approved clinical practice guidelines previously developed by AAOS physician volunteer work groups and a selection of a variety of topics frequently used in orthopaedic surgical practice with input from specialty society leaders and the Academy’s presidential leadership and board of directors. The list was created with the intent to "serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment."
However, some specialists find fault with the recommendations. For example, Dr. Roy Altman, a professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles, said the methodology used to create the guidelines overlooks a number of treatments, including multimodal therapy, and could have the unintended consequence of allowing specialists to deny effective care to patients.
"These guidelines are not consistent with my clinical experience," Dr. Altman said. In particular, he noted that many of his patients react positively to injection treatments for osteoarthritis (OA), which the Choosing Wisely recommendations specifically discourage.
AAOS’s recommendations are as follows:
• Avoid using postoperative ultrasonography screening for deep vein thrombosis on patients receiving hip or knee arthroplasty because it is not effective at diagnosing unsuspected cases.
• Don’t use needle lavage for long-term relief in symptomatic OA treatment, as the procedure "does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness, or swelling."
• Do not use glucosamine and chondroitin sulfate to treat patients with symptomatic knee OA.
• Lateral wedge or neutral insoles do not improve pain or functional outcomes in patients; on the contrary, patients with OA of the knee may experience fewer symptoms without insoles.
• Routine postoperative splinting of the wrist after the carpal tunnel release procedure does not improve subjective outcomes, and may lead to detrimental effects, including adhesion formation, stiffness, and prevention of nerve and tendon movement.
FDA approves another quadrivalent influenza vaccine
The Food and Drug Administration announced on Aug. 16 the approval of another new vaccine that protects against four strains of seasonal influenza in people aged 3 years and older.
The new vaccine, Flulaval Quadrivalent, is an intramuscular quadrivalent vaccine, named for its ability to protect against two A virus strains and two B virus strains of the influenza virus and is manufactured by GlaxoSmithKline. Until 2012, influenza vaccines protected against only one B virus strain, Dr. Leonard Friedland, vice president and director of scientific affairs and public health for GSK Vaccines North America, noted in a written statement.
"Trivalent vaccines do reduce influenza risk, even in years when a vaccine strain-mismatch occurs, though quadrivalent influenza vaccines are the important next step in broadening strain coverage," said Dr. Friedland.
GlaxoSmithKline will begin distributing the drug in time for the 2013-2014 flu season.
The Food and Drug Administration announced on Aug. 16 the approval of another new vaccine that protects against four strains of seasonal influenza in people aged 3 years and older.
The new vaccine, Flulaval Quadrivalent, is an intramuscular quadrivalent vaccine, named for its ability to protect against two A virus strains and two B virus strains of the influenza virus and is manufactured by GlaxoSmithKline. Until 2012, influenza vaccines protected against only one B virus strain, Dr. Leonard Friedland, vice president and director of scientific affairs and public health for GSK Vaccines North America, noted in a written statement.
"Trivalent vaccines do reduce influenza risk, even in years when a vaccine strain-mismatch occurs, though quadrivalent influenza vaccines are the important next step in broadening strain coverage," said Dr. Friedland.
GlaxoSmithKline will begin distributing the drug in time for the 2013-2014 flu season.
The Food and Drug Administration announced on Aug. 16 the approval of another new vaccine that protects against four strains of seasonal influenza in people aged 3 years and older.
The new vaccine, Flulaval Quadrivalent, is an intramuscular quadrivalent vaccine, named for its ability to protect against two A virus strains and two B virus strains of the influenza virus and is manufactured by GlaxoSmithKline. Until 2012, influenza vaccines protected against only one B virus strain, Dr. Leonard Friedland, vice president and director of scientific affairs and public health for GSK Vaccines North America, noted in a written statement.
"Trivalent vaccines do reduce influenza risk, even in years when a vaccine strain-mismatch occurs, though quadrivalent influenza vaccines are the important next step in broadening strain coverage," said Dr. Friedland.
GlaxoSmithKline will begin distributing the drug in time for the 2013-2014 flu season.
FDA approves rapid diagnostic test for HIV-1, HIV-2
The first rapid diagnostic test to simultaneously detect the HIV-1 p24 antigen and antibodies to both HIV-1 and HIV-2 earned Food and Drug Administration approval August 8.
Like other HIV tests, the Alere Determine HIV-1/2 Ag/Ab Combo test can detect antibodies to HIV-1, the most common type of HIV, and HIV-2 in human serum, plasma, or venous and fingerstick blood specimens.
But the new test also can distinguish acute HIV-1 infection from established HIV-1 infection, if the blood specimen is positive for HIV-1 p24 antigen but negative for HIV-1 and HIV-2 antibodies.
The new test could be a crucial tool for identifying HIV-infected individuals who might not be able to be tested in traditional health care settings, said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in a statement.
"This test helps diagnose HIV infection at an earlier time in outreach settings, allowing individuals to seek medical care sooner," Dr. Midthun explained.
Orgenics makes the Alere Determine HIV-1/2 Ag/Ab Combo test.
The first rapid diagnostic test to simultaneously detect the HIV-1 p24 antigen and antibodies to both HIV-1 and HIV-2 earned Food and Drug Administration approval August 8.
Like other HIV tests, the Alere Determine HIV-1/2 Ag/Ab Combo test can detect antibodies to HIV-1, the most common type of HIV, and HIV-2 in human serum, plasma, or venous and fingerstick blood specimens.
But the new test also can distinguish acute HIV-1 infection from established HIV-1 infection, if the blood specimen is positive for HIV-1 p24 antigen but negative for HIV-1 and HIV-2 antibodies.
The new test could be a crucial tool for identifying HIV-infected individuals who might not be able to be tested in traditional health care settings, said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in a statement.
"This test helps diagnose HIV infection at an earlier time in outreach settings, allowing individuals to seek medical care sooner," Dr. Midthun explained.
Orgenics makes the Alere Determine HIV-1/2 Ag/Ab Combo test.
The first rapid diagnostic test to simultaneously detect the HIV-1 p24 antigen and antibodies to both HIV-1 and HIV-2 earned Food and Drug Administration approval August 8.
Like other HIV tests, the Alere Determine HIV-1/2 Ag/Ab Combo test can detect antibodies to HIV-1, the most common type of HIV, and HIV-2 in human serum, plasma, or venous and fingerstick blood specimens.
But the new test also can distinguish acute HIV-1 infection from established HIV-1 infection, if the blood specimen is positive for HIV-1 p24 antigen but negative for HIV-1 and HIV-2 antibodies.
The new test could be a crucial tool for identifying HIV-infected individuals who might not be able to be tested in traditional health care settings, said Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, in a statement.
"This test helps diagnose HIV infection at an earlier time in outreach settings, allowing individuals to seek medical care sooner," Dr. Midthun explained.
Orgenics makes the Alere Determine HIV-1/2 Ag/Ab Combo test.
