July 2011 Issue of Clinical Advisor

July 2011 Issue of Clinical Advisor

Newsline

Skin cancer over- and under-recognized

Many of the skin lesions for which primary-care providers refer patients to a dermatologist are noncancerous, but specialists often notice other lesions that are malignant.

Tips for improving quality of primary care

To improve the quality and cost-effectiveness of health care, the National Physicians Alliance compiled the top five practices in primary care that could be changed ...

Headaches resolve at similar rates with and without drugs

Prescription medications for headaches should be evaluated carefully on an individual patient basis due to the potential for adverse events.

Co-vaccination OK after all

Administering the herpes zoster and pneumococcal vaccines to patients during the same visit does not appear to compromise the effectiveness of the zoster vaccine.

Hot flushes that start earlier, last longer

Median duration of moderate-to-severe hot flushes is 10.2 years — and even longer if they begin near a woman's entry into the menopause transition, data ...

Food allergy guidelines released

Recommendations from the National Institute of Allergy and Infectious Diseases sets forth 43 clinical recommendations on the diagnosis and management of food allergy.

Sunlight can help kids avoid asthma

Summertime may become even more youth-friendly with the recent discovery that the vitamin D produced from sun exposure plays a role in protecting against childhood ...

Keep swimmer's ear at bay

Most cases of acute otitis externa — swimmer's ear — can be easily treated with prescription antimicrobial ear drops, but with cases peaking during the ...

Extra calcium won't reduce fracture risk

Clinicians should focus on increasing calcium intake among women who are not consuming enough of this mineral rather than increasing the calcium intake of those ...

Preventing and treating viral hepatitis

Department of Health and Human Services (HHS) has issued an action plan for the prevention, care, and treatment of viral hepatitis.

Drug Updates from MPR

Tradjenta to reduce hemoglobin A1c levels

Linagliptin increases the concentrations of active incretin hormones, stimulating the release of insulin in a glucose-dependent manner and decreasing the levels of glucagon in the ...

Advisor Forum

Latent tuberculosis in a patient vaccinated with BCG?

Are health care providers performing proper follow-up for patients who where previously diagnosed with BCG vaccine who have positive skin tests for tuberculosis?

Tips for tracking Tdap vaccination status

Current FDA indications for tetanus, diptheria and pertussis vaccine call for only one dose between ages 11 and 64 years. What strategies or processes have ...

Are ACE inhibitors and ARBs recommended for renal disease?

Tight glycemic, BP and cholesterol control, as well as weight reduction, exercise and smoking cessation can help prevent renal nephropathy.

Are certain antidiabetes drugs better than others after gastric bypass?

Following gastric bypass surgery, many patients will still need metformin or glipizide (Glucotrol). Is there any evidence that one class of hypoglycemic agents is better ...

Consider many factors when assessing GI bleed risk

The risk for experiencing a serious GI event rises exponentially with increasing numbers of risk factors.

Advice for managing insomnia in patients with dementia

Experts are not certain why reversed sleep-wake cycles occur in patients with dementia, but it may be related to late-day confusion, end-of-day exhaustion and reduced ...

Is IBS more common in vitamin B12-deficient patients?

A clinician notices that many of her patients with low vitamin B12 levels also have irritable bowel syndrome.

Are iodine preparations safe for treating pressure sore eschar formations?

The use of povidine-iodine in wound care is controversial. Several experimental studies have demonstrated concerns regarding its safety and effect on wound healing.

Evidence-based vs. the "gold standard": Which is better in medical malpractice lawsuits?

Only 30% of standardized care has solid research driving practice guidelines.

Clinical Feature

When to treat or refer a burn-injured patient

Guidelines from the American Burn Association provide a reliable road map for the assessment and treatment of these challenging injuries

How to implement home BP monitoring

Measuring BP at home can provide invaluable data to ensure accurate diagnosis and treatment. Make sure patients follow the proper protocol.

Therapy for major depressive disorder

Depression can be dealt with in the clinical setting if the practitioner is familiar with the latest drug treatments and psychotherapeutic options.

Taking back control: the fight against obesity

As obesity rates continue to rise, primary-care clinicians remain integral in assessing, diagnosing, and treating this worldwide epidemic.

Dermatologic Look-Alikes

Vascular nodules and papules

Two patients present with red lesions. A white infant aged 4 months presented with a three-month history of a red, verrucous nodule on his scalp, ...

Clinical Challenge

Acute onset of recent memory loss

Suddenly unable to remember the year or the president's name, an otherwise healthy man is admitted for observation.

Neck rash coupled with refractory neuropathic pain

After initial treatment, the rash left a hypopigmented patch.

Commentary

Professionalism doesn't wear sweats

Is professionalism in medicine on the decline? A few months ago I saw a new patient who had transferred from another practice because the physician ...

Alternative Meds Update

Salvia: A treatment option for depression and mental illness?

Despite salvia's growing notoriety as a hallucinogenic drug abused by teenagers, the herb has medicinal properties and has been used to treat various ailments including ...

Evidence-Based Medicine

Evidence-based treatments for ST-elevation MI associated with reduced mortality

Use of evidence-based procedures such as primary percutaneous coronary intervention, reperfusion and revascularization is on the rise.

Accelerated diagnostics help predict risk in patients with chest pain

Patients who visit the ED with acute coronary syndrome symptoms often have less serious conditions, but current diagnostic protocols are costly, lengthy and tend to ...

NSAIDS increase risk for recurrences, death in patients with prior MI

For patients with cardiovascular disease, current guidelines recommend NSAIDs for pain relief only in patients for whom there are no alternatives and only at the ...

Mediastinal lymph node dissection does not increase stage I or II NSCLC survival

Treatment for early-stage non-small cell lung cancer is primarily surgical, but the optimal extent of mediastinal lymph node resection is unclear.

Progesteron gel reduces preterm birth risk, neonatal respiratory distress

Intramuscular or vaginal progesterone appears effective for reducing premature delivery, but data on neonatal outcomes have been limited until recently.

Stat Consult

Stat Consult: Polycystic ovary syndrome

A quick review of polycystic ovary syndrome, a heterogeneous androgen excess syndrome that can cause hirsutism, secondary amenorrhea, obesity, hyperinsulinemia and infertility, providing the latest ...

Legal Advisor

Is colon cleansing safe?

Many patients seek clinician approval before undertaking various fasting and detoxification regimens.

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