This issue of Medical Clinics, guest edited by Drs. Marc Shalaby and Edward Bollard, is devoted to Quality Patient Care: Making Evidence-Based, High Value Choices. Articles in this issue include: Cardiovascular testing in asymptomatic patients: carotid duplex, cardiac stress testing, screen for PVD; Utility of echocardiogram in the evaluation of heart murmurs; Evidenced-based recommendations for the evaluation of palpitations in the primary care setting; Radiologic evaluation of common orthopedic complaints: low back pain, non-traumatic knee/shoulder/hip pain, and ankle injuries; Indications and usefulness of common injections for non-traumatic orthopedic complaints – shoulder, trochanteric bursa, epidural injections, tennis elbow, and knee; The evidence-based evaluation of chronic cough; Evaluation of uncomplicated headache; Evaluation of syncope; Pre-operative assessment: Cataract surgery, pre-operative EKG testing, screening for cardiopulmonary disease, urinalysis, coagulation studies, other lab assessments; The approach to occult GI bleed; The role of EGD surveillance for patients with Barrett’s esophagus; The evidence-based evaluation of iron deficiency anemia; Cancer screening in the elderly; Utilization and safety of common over the counter dietary/nutritional supplements, herbal agents and homeopathic compounds for disease prevention; Utilization of oxygen for the patient with dyspnea; IV fluids, enteral or parenteral nutrition; and Symptom control at the end of life.

Over the past decade health care systems around the world have placed increasing importance on the relationship between patient choice and clinical decision-making. In the years since the publication of the second edition of Shared Decision Making in Health Care, there have been significant new developments in the field, most notably in the US where 'Obamacare' puts shared decision making (SDM) at the centre of the 2009 Affordable Care Act. This new edition explores shared decision making by examining, from practical and theoretical perspectives, what should comprise an effective decision-making process. It also looks at the benefits and potential difficulties that arise when patients and clinicians share health care decisions. Written by leading experts from around the world and utilizing high quality evidence, the book provides an up-to-date reference with real-word context to the topics discussed, and in-depth coverage of the practicalities of implementing and teaching SDM. The breadth of information in Shared Decision Making in Health Care makes it the definitive source of expert knowledge for healthcare policy makers. As health care systems adapt to increasingly collaborative patient-clinician care frameworks, this will also prove a useful guide to SDM for clinicians of all disciplines.

This issue of Medical Clinics, guest edited by Dr. Danelle Cayea, is devoted to Geriatrics. Articles in this important issue include: Thoughtful prescribing and deprescribing, Identifying goals of care, Overview of brief, high yield geriatrics assessment for clinic and hospital, Fall prevention, evaluation, and treatment, Cognitive impairment evaluation and management, Urinary and bowel symptoms, Sadness and worry in older adults, Chronic pain syndromes in older adults, Osteoporosis, Evaluation and management of difficult symptoms of older adults primary care, Perioperative assessment and management, Challenges related to safety and independence, and much more.

Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.

Practical guide for health practitioners and policy-makers, demystifying evidence-informed decision-making from the individual clinical level to global policy.

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/