A new study detects 396 clinical practices that should be reversed

A medical reversal is the need to stop a clinical activity because a well-done study shows that in the real world the desired results are not being met, or that the adverse effects don’t outweigh the benefits. In a previous review (2013) of over 2,000 NEJM articles, Vinay Prasad and his team already discovered 146 clinical practices that should be reversed and, given the significance of the finding, the Catalan Society of Healthcare Management (SCGS) invited Vinay Prasad to explain it to us live, which he did on March 18, 2018 (you can see the video of the conference at the link).

Exercise as a clinical management tool

Paco Miralles
 

In the consultation of any internist...

• Mr Sebastián (68 years old), your glycated haemoglobin is in adequate parameters. Your diabetes doesn’t appear to have affected your kidney because you are not losing albumin. The tension controls are correct and I do not notice hypoglycaemia in the provided tests. Your diabetes is under controll.
• Do I continue with the same treatment?
• Yes, let's review the treatment. With insulin, we will maintain the same scheme that has worked so well. I remind you: from the basal, the long-lasting, you put 24 units, with a fixed guideline in meals of 8 units and correct it with the scheme written in the report (I don’t reproduce it so as not to bore you more). The rest of the treatment will stay the same.
• And I continue with the exercise?
• Sure! Keep walking for at least 45 minutes along the promenade (those of us who are lucky to live in a coastal city, especially Malaga).

High blood pressure: please don’t lose your head

Xavier Bayona
 

Although I am sure that we well know the difference between a risk factor and a disease, I allow myself the license to start this post by defining them. Risk factor (hypertension, hypercholesterolemia...) is that situation that has been related to the development of a disease (maybe the disease never develops despite having one or more risk factors), while the disease is the alteration in the organism's state or of any organ that interrupts or disrupts vital functions, affecting the state of health (ischemic heart disease, embolism...).

Since Julian Tudor Hart, in an article published in the British Medical Journal in 1993 after following a cohort of hypertensive patients for 21 years, concluded that the basis of treatment is the detection of hypertension and that the most important measures are hygienic-dietary and working from the community, countless articles have been written. But the essence of management remains: detect it, decrease sodium intake, increase physical exercise, abandon toxic habits and if they do not achieve the desired objectives, start pharmacological treatment.

Integrated care, the pragmatic roadmap of Ontario

Marco Inzitari

I had an exceptional opportunity to be a visiting professor at the Institute of Health Policy, Evaluation and Management at the University of the Toronto School of Public Health, Canada. Before going on vacation, I would like to share some main lessons learned about integratedcare in Ontario, which is the most populous region in the country.

Upon arrival, I was invited to share the Catalan experience on integrated care in a very well-structured symposium, Essential Ingredients of Integrated Care (# IHPMEIC19, for those who want to rescue tweets), organized by prof. Walter Woodchips. The symposium ranged from "macro" aspects of public policy to teamwork; through interprofessional relationships, active patient participation, and cross-cutting facilitating aspects such as technology and recruitment tools. Besides these interesting contents, the symposium made it easier for me to land in reality and gave me a global vision of "who is who".