March 2010 Issue of Clinical Advisor

March 2010 Issue of Clinical Advisor

Newsline

Blood calcium highs, lows can be lethal in kidney disease

Mortality risk for patients who had abnormally high calcium levels for a prolonged period was 31% greater than that of the individuals with normal blood ...
 

Sleepiness may point to Alzheimer's risk

Cognitive fluctuations significantly affect dementia severity and neuropsychological performance.
 

Be sure a spoonful of medicine is just that

Make sure your patients administer liquid medicine in accurate measures when they are at home.
 

Self-monitoring for people not on insulin?

There is no proof to support self-monitoring in patients with type 2 diabetes.
 

Concussions: Don't let the name fool you

In children, the concussion label is strongly predictive of earlier discharge from the hospital and return to school.
 

New guidelines nix TENS for chronic back pain

However, TENS should be considered for the treatment of painful diabetic neuropathy.
 

Treat complete heart risk

Tailoring treatment to individual heart attack risk was more effective in preventing heart attack, stroke, and cardiovascular death than strategies to lower cholesterol.
 

Regimen improves knee osteoarthritis

Strength-training regimens, self-management programs, or a combination of the two are equally beneficial for physically inactive, middle-aged people with symptomatic osteoarthritis of the knee.
 

Urological association at odds with new prostate recommendations

The American Urological Association and the American Cancer Society disagree over when baseline screening should begin.
 

No connection between NSAIDs and skin-cancer risk

Regular use of NSAIDs resulted in no significant reduction in squamous cell carcinoma risk
 

Psychological issues plague patients with asthma

Psychological disorders are more than twice as prevalent in adults with asthma as in the general population.
 

Drug Updates from MPR

Delayed-release caps for pancreatic disorder

Zenpep is used to treat exocrine pancreatic insufficiency.
 

Antipsychotic with improved tolerability

Fanapt is for acute treatment of schizophrenia.
 

Once-monthly treatment 
for arthritis

The FDA has approved Actemra only for relatively severe disease.
 

Advisor Forum

Improved pre-injection skin prep

Is one pre-injection skin prep better than others?
 

Screening for endometrial cancer

Which is preferred - transvaginal ultrasound or endometrial biopsy?
 

Gene therapy for ichthyosis or pityriasis rubra pilaris?

Ichthyosis and pityriasis rubra pilaris are very difficult conditions for a child to deal with emotionally and physically.
 

No shirt, no service

No more photos of clinicians listening to heart and chest sounds through clothing, please.
 

Role of high-sensitivity CRP in cardiovascular disease

Should an elevated hs-CRP be treated with statins in a patient with normal lipids?
 

Treating Bell's palsy in pregnancy

Are steroids or acyclovir safe in the first trimester?
 

Diagnosing bipolar disorder in an alcoholic

What can be done for a mood disorder secondary to alcohol abuse when the patient has failed all treatments?
 
 

Shingles vaccine after lymphoma treatment

Is it safe for a patient who underwent chemotherapy to receive the herpes zoster vaccine?
 

Pediatric diabetes treatment

What treatment is recommended for obese children with elevated insulin levels and normal fasting blood sugar?
 

Low libido in women

What diagnostic options and treatments are available for women in their late 20s and early 30s who complain of loss of libido?
 

Does fibromyalgia require sleep testing?

Should all patients with fibromyalgia undergo sleep studies?
 

Chronic suppressive antiviral therapy for herpes labialis

What information do you have on resistance rates among antivirals for herpes simplex virus?
 

Are LDL goals permanent?

Does a single Framingham Risk score >20% permanently establish the LDL goal at 100?
 

Emergency department triage protocol

Our hospital begins workups in the lobby waiting area and orders with limited patient history and evaluation.
 

More on triglycerides, the forgotten lipid

Investigators find that triglyceride levels are an independent risk factor for heart disease.
 

A warning about statins during pregnancy

Be extremely cautious prescribing any statin for a young woman during childbearing years.
 

Nonpharmacologic approach to depression

Exercise and psychotherapy are effective in preventing relapse and recurrence of depression.
 

When SSRIs are not enough for depression

Consider buspirone or mirtazapine as an additive agent.
 

Another look at GERD treatment

Tolerability is often confused with long-term safety.
 

Cover Feature

What to look for with 
drug-induced urticaria

An accurate diagnosis is crucial. It is necessary to know which related drugs need to be avoided, as well as alternative drugs to recommend for ...
 

Clinical Feature

What lies behind the 
vitamin D revolution?

Once known primarily for maintaining bone strength, vitamin D is now thought to contribute to prevention of colon, prostate, and breast cancers.
 

Mixing NSAIDs with antiplatelet therapy

Combining these agents may compound GI complications. New guidelines help primary-care clinicians identify and protect patients most at risk.
 

Links between obesity and mental health

When treating obesity, psychological issues must not be overlooked. Learning why patients eat can help clinicians improve what patients eat.
 

Dermatologic Look-Alikes

Purple eruptions

Two patients with purple lesions and no other abnormal skin findings.
 

Clinical Challenge

New onset of lower extremity weakness 
after a viral illness

Upper respiratory infection triggers complications in a healthy college student.
 

Commentary

When a delusion is not a delusion

There has been a recent explosion in the diagnosis if delusions of parasitosis, in which patients mistakenly believe they have a skin infestation.
 

Alternative Meds Update

Pomegranate packs a powerful punch

The juice of the pomegranate provides abundant antioxidants and has potential as an anticarcinogenic and anti-inflammatory.
 

Dermatology Clinic

Painful tightening 
of the skin on the legs

A 62-year-old man with a painful erythematous rash on the shins
 

Atrophic rash in a 
patient with hepatitis C

Plaques develop on the face, trunk, and hands of a man with hepatitis C.
 

Evidence-Based Medicine

Nitrates or ACE inhibitors within 24 hours of acute MI reduce 10-Day mortality 


Neither beta blockers nor calcium channel blockers given during the first 24 hours were found to reduce all-cause mortality.
 

Radiation from CT scans might increase lifetime risk of cancer

CT scans expose patients to much higher doses of radiation than plain x-rays
 

Chlorhexidine-alcohol scrub may prevent surgical site infections better than povidone-iodine

Surgeries included colorectal, small intestinal, gastroesophageal, biliary, thoracic, gynecologic, or urologic procedures.
 

Lithium appears more effective than valproate for relapse prevention in bipolar disorder

The primary outcome was a change in management due to a new mood episode.
 

Atropine drops appear to be at least as effective as patching for amblyopia in children

In children with amblyopia, compliance with patch wearing can be a problem.
 

Evidence for oseltamivir reducing influenza duration still intact but evidence about reducing complications questioned

No statistically significant benefit for oseltamivir for reducing complications was found based on a meta-analysis of three trials.
 

Legal Advisor

Are you being paid what you're worth?

Could you make more money simply by restructuring the way your salary is calculated? Here are three of the most common compensation structures available.
 

Child causes inadvertent needle stick

A woman is accidentally injured when her autistic foster son flinches before an injection.
 

Illinois Supreme Court overturns damage caps

According to the Court, the statutory cap "unduly encroaches upon the fundamentally judicial prerogative of determining whether a jury's assessment of damages is excessive within ...
 

Medical malpractice payments declining

Data show declining legal costs, declining payments to injured parties, and a low rate of compensation, even for cases resulting in death.
 

Utah mulling bill to protect clinician apologies

It has been shown that apologies can prevent lawsuits from being filed because the injured party feels that his or her grievances are being addressed ...
 

Malpractice insurance nightmare

When it comes to keeping your malpractice policy up to date, never assume anything.
 
Popular Topics
Allergy & Immunology Alzheimer’s Disease And Dementias Arthritis Cancer Cardiology Cardiovascular Disease Cholesterol Contraception Dermatology Diabetes Ethics Gastrointestinal Disorders Geriatrics Hepatitis HIV/AIDS Hyperlipidemia Hypertension Influenza Malpractice Medicolegal Nutrition Obesity Pain Substance Abuse Women’s Health

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