November 2009 Issue of Clinical Advisor

November 2009 Issue of Clinical Advisor

Newsline

Metabolic syndrome increases PAD risk

Findings of a recent large, long-term study demonstrate that metabolic syndrome greatly raises a woman's chance of developing symptomatic peripheral arterial disease (PAD).
 

Dementia related to recurrent stroke

New-onset dementia among stroke patients appears to be most prevalent after two or more strokes, indicating that providing the best possible stroke care and secondary ...
 

Waist-to-hip ratio better predicts mortality in older adults

A long-term study indicates that the measure of waist-to-hip ratio (WHR) is much stronger than BMI as a predictor of all-cause mortality in high-functioning older ...
 

Online network helps NPs and PAs manage patients with asthma

The Web site provides users with treatment information, professional training opportunities, and downloadable practice and patient-education tools.
 

Most diabetes patients are not eating right

Your patients who have diabetes may need more nutritional eduction and counseling, according to a recent report.
 

Keep pushing flu shots for heart patients

Influenza vaccination should be encouraged whenever it is indicated, particularly in people with cardiovascular disease — a group in which the shots appear to be ...
 

Gout drug prevents BP jump in men

Allopurinol, which is used to lower uric acid levels to counteract gout, may also reduce BP that has been raised by a diet high in ...
 

Weight loss helps ailing kidneys

Additional evidence has emerged to support the benefits of weight loss in individuals with kidney disease.
 

Death rates surge with inadequate vitamin D

Insufficient levels of serum 25-hydroxyvitamin D (25[OH]D) appear to be a major contributor to deaths in older adults.
 

Drug Updates from MPR

Embeda is a long-acting opioid for continuous pain relief

Embeda is designed to reduce the drug's appeal in the event of tampering.
 

Advisor Forum

Fungal sinus infections

How prevalent are fungal infections in the differential diagnosis of chronic sinusitis?
 

Elevated PSA with a negative biopsy

Elevated PSA with a negative biopsy What is the next step in the treatment of a patient who has a prostate-specific antigen (PSA) level between ...
 

The effects of coenzyme Q10 on myopathy

Patients who experience muscle soreness and fatigue while taking the statins seem to get relief by simultaneously ingesting coenzyme Q10 30 mg. Do any clinical ...
 

Postsplenectomy follow-up

What advice should be given to a patient who has undergone splenectomy because of trauma? What guidelines do you recommend for both medical and dental ...
 

Treatment options for bacterial vaginosis

In the treatment of bacterial vaginosis (BV), what is the effectiveness of metronidazole (Flagyl) 2 g in a single dose as opposed to the seven-day ...
 

Recurrent periorbital dermatitis

A 48-year-old white man routinely develops a reddish, bilateral, slightly papular rash on his lower eyelids. The rash resolves with OTC hydrocortisone but reappears. This ...
 

Gender-related cravings

Are there any studies which show that men and women have different approaches to food?
 

Anticholinergics in older men with urinary symptoms

What is the recommendation for the use of anticholinergics to treat lower urinary tract symptoms (LUTS) in patients aged 70-90 years?
 

When to stop taking birth control pills

At what age should a patient being treated for perimenopausal bleeding and other symptoms discontinue birth control pills? What tests do you recommend to confirm ...
 

Ovarian cancer protection through contraception

Does the contraceptive patch or vaginal ring provide protection from ovarian cancer as oral contraceptives (OCs) do?
 

Inhaled steroids for pregnant patients

Is there any difference in inhaled steroids when it comes to using them in pregnant patients?
 

Side effects of autism diet?

Are there any side effects or deficiencies when eliminating casein and gluten from the diet of an autistic patient? How long should a diet trial ...
 

Is group B streptococcal infection an STD?

Should infection with group B streptococcus (GBS) be considered a sexually transmitted disease (STD) the way methicillin-resistant Staphylococcus aureus (MRSA) is?
 

Nasal foreign body removal is a breeze

I see many children in the emergency department with a foreign body lodged in one nare.
 

Turn low back pain upside down

An inversion table may help in the treatment of low back pain, which is usually caused by pressure between two vertebral bodies.
 

Cover Feature

Factors influencing immunization rates

To reach the goal of providing herd immunity in communities, clinicians must use every patient encounter to determine vaccination status.
 

Clinical Feature

Hormone therapy following menopause

The revised position statement issued by the North American Menopause Society evaluates the latest evidence and offers recommendations on who should pursue hormone therapy.
 

Dermatologic Look-Alikes

A pair of generalized red rashes

Two men present with red rashes—one started on the back and spread to the upper arms, and the other was limited to the chest.
 

Clinical Challenge

Recurrent cellulitis following buttock augmentation

The patient's pain and swelling failed to resolve despite previous hospitalization and IV cephalosporin therapy.
 

Commentary

Dealing with the difficult patient

Do you have a patient who is impossible to communicate with? Our expert has some advice.
 

Alternative Meds Update

Colloidal silver—science or fraud?

While topical and implanted silver products are safe, there is no clinical indication for oral colloidal silver use.
 

Dermatology Clinic

Target lesions in a patient with acne

Numerous red target lesions develop on the extremities of a young woman being treated for acne.
 

Irregular purplish blue markings on the limbs of a newborn

Blue markings on the arm and leg of a newborn were first thought to be bruises from a traumatic delivery.
 

Stat Consult

Carpal tunnel syndrome

A review of the diagnosis, treatment, and testing of carpal tunnel syndrome.
 

Legal Advisor

Errors lead to undiagnosed melanoma

After referring his patient to a dermatologist to have a mole looked at, the clinician considered the case resolved. Not so fast.
 

Documentation and charting: Protect the patient, protect yourself

It may seem like drudgery at times, but insufficient or erroneous documentation can have dire legal consequences.
 

Washington State Supreme Court overturns certificate of merit requirement

Some states require a qualified medical expert to sign off on a document attesting that there is merit to the plaintiff's claim.
 

Courts to decide legitimacy of malpractice award caps

State supreme courts in Georgia, Illinois, Oklahoma, and Maryland will determine whether to do away with caps on non-economic damages.
 

Fatigue, emotional distress linked to medical errors

Internal medicine residents who report higher levels of fatigue and emotional distress also report higher levels of major medical errors.
 

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