October 2011 Issue of Clinical Advisor

October 2011 Issue of Clinical Advisor

Newsline

CDC: Spread the word on flu vaccination

Health-care workers who were required by their employers to be vaccinated against influenza and who had the service offered onsite, had near universal coverage levels.

Infant rotavirus vaccine shields others, too

Vaccination of U.S. infants against rotavirus appears to provide indirect protection to older children and adults, too.

Pain relievers may increase bleeding

A combination of ibuprofen and acetaminophen can relieve chronic knee pain — including that caused by osteoarthritis — but at the cost of increased side ...

Untreated celiac disease may cause infertility

Women with unexplained infertility are at heightened risk for having undiagnosed celiac disease (CD), which may be a modifiable and treatable risk factor

Abnormal liver tests pose death risk for elderly

One in six people aged 75 years and older is likely to have at least one abnormal liver test, and those who have two or ...

Cervical cancer screening over-recommended

Primary-care providers continue to recommend annual cervical cancer screening, despite recommendations that suggest three-year intervals for such testing.

Risk calculator computes blood-clot odds

A new risk-prediction model designed for primary-care use can help identify asymptomatic patients at high risk of venous thromboembolism.

GERD not helpful in esophageal cancer screening

Medically treated patients with mild or absent GERD symptoms were shown to have significantly higher odds of developing Barret's esophagus and esophageal adenocarcinoma.

Primary care may offer suicide intervention opportunities

Primary-care clinicians write more prescriptions for antidepressants and see suicidal patients more frequently in the month prior to suicide than do mental health clinicians.

CDC warns of emerging infections

Fungal infections, invasive Haemophilus influenza and legionellosis are on the rise in the United States.

Women are overscreened, undertreated for osteoporosis

Inappropriate screening could lead to improper osteoporosis management.

Drug Updates from MPR

New option for those starting HIV therapy

Rilpivirine, a diarylpyrimidine non-nucleoside reverse transcriptase inhibitor of HIV-1, approved for use in combination with other antiretroviral agents for the treatment of HIV-1 infection in ...

Blood thinner for treatment of ACS

Ticagrelor significantly reduced the rate of cardiovascular death, MI or stroke compared with clopidogrel in a clinical trial.

Advisor Forum

Treating atrial fibrillation during pregnancy

How often should follow-up ECG be performed on a pregnant patient with atrial fibrillation (AF) that resolves with medication that is then discontinued?

Depression treatment in an overweight recent ex-smoker

Which antidepressant would you recommend for a woman aged 47 years who presents with depressed mood, low energy, decreased motivation and hypersomnia?

Reflux rebound after stopping PPI therapy

What is the likelihood of acid-reflux rebound in a patient stopping a proton-pump inhibitor (PPI) (pantoprazole [Protonix]) after taking the medication for one month or ...

Recurrent bouts of biliary colic

A gastroenterologist and surgeon have recommended cholecystectomy for a patient with recurrent biliary colic and a 3% biliary ejection fraction on CCK-HIDA scan. Is this ...

Treating chronic esophageal reflux

What treatment options are available for chronic esophageal reflux? Is surgery ever preferable to long-term treatment with a proton-pump inhibitor?

Are high-dose beta blockers safe for patients with pulmonary disease

Is it safe for a patient with chronic obstructive pulmonary disease to be on high doses (e.g., 100 mg b.i.d.) of metoprolol?

Cardioprotection in a complex patient

What is the best choice for cardioprotection in a woman aged 75 years with episodic symptomatic angina, MI one year earlier and a sensitivity to ...

Is this rash related to terbinafine?

A patient taking terbinafine for onychogryphosis developed a fine pruritic rash over sun exposed body areas while on vacation. Could the drug be to blame?

Simple pounds-to-kilograms conversion

A nurse shares a simple tip for converting pounds to kilograms when calculating pediatric doses.

Dietary-restriction tool is money in the bank

Advise patients with dietary restrictions to manage their daily allowance like a checkbook.

Making contraceptive vaginal-ring insertion easy

A nurse offers advice for patients that are unsure how to properly place the contraceptive vaginal ring.

Preventing drug confusion

Many providers confuse metoprolol tartrate and metoprolol succinate. Learn an easy way to keep them straight.

Maintain precision when apply medications to the scalp

A simple tip to help you keep scalp medications where they belong, instead of saturating the hair.

Clinical Feature

When to screen for prostate cancer

In an update of its 2001 guidelines, the American Cancer Society stresses the importance of sharing the screening decision with the patient.

Diagnosing new-onset diabetes in children and teens

Type 2 diabetes in this population is increasing, but type1 diabetes is more prevalent. The ability to differentiate between these conditions is crucial.

Evaluating salivary gland tumors and diseases

When diagnosing, consider the location and duration of the lesion, patient age, underlying systemic disorders and clinical appearance.

Dyspnea with comorbid heart failure and COPD

There are guidelines for the management of each as a separate condition, but how do you evaluate and treat them when they appear together?

Dermatologic Look-Alikes

Newly developed brown papules

Two patients present with newly developed brown papules. The first patient, a 45-year-old man, presented with a new mole that continues to grow and is ...

Clinical Challenge

A running accident leads to the discovery of a humeral lesion

A woman fractured her upper arm in a fall while exercising. A large osteolytic growth was discovered on x-ray.

Severe headache, fever and arm rash after vaccination

The patient's symptoms indicated that lumbar puncture was required to rule out a meningitis diagnosis.

Commentary

Step up, speak out — for your own sake

Politics, laws, rules and regulations are the very core of what drives what clinicians can and can't do; it determines reimbursement and therefore your salary. ...

Alternative Meds Update

Royal jelly beneficial for hypertension and cholesterol

Royal jelly contains a complex mixture of proteins, vitamins, minerals and carbohydrates that offer health benefits to patients with medical conditions, including hypertension, hyperlipidemia and ...

Puzzling GI upset in a teenager

Esophagogastroduodenoscopy, colonoscopy, complement fixation, celiac, sonogram, gynecologic workup and routine labs have all been negative in a teen with a three-year history of recurrent chronic ...

Evidence-Based Medicine

Corticosteroid benefit uncertain in hospitalized pneumonia patients

A review of recent clinical trials reveals the benefits of corticosteroids in adults hospitalized with community-acquired pneumonia remain uncertain.

Isoniazid TB prohpylaxis: 36 months more effective than six months

For HIV-infected adults with a positive tuberculin skin test, TB Prophylaxis with isoniazid for 36 months appears more effective than for six months.

Exemestane may reduce breast-cancer risk without adverse effects

The aromatase inhibitor exemestane (Aromasin) may reduce the risk of invasive breast cancer in at-risk postmenopausal women.

Vitamin D decreases all-cause mortality in elderly women with insufficiency

Studies have suggested that vitamin D supplementation may reduce cancer and cardiovascular disease, but evidence for the effects of supplementation on mortality has been inconsistent.

Androgen-deprivation plus radiation may improve prostate cancer survival

Research suggests that androgen-deprivation therapy improves survival when added to radiotherapy in men with locally advanced, stage T3 or T4 prostate cancer or with prostate ...

Stat Consult

Stat Consult: Influenza in 
children

A quick review of influenza A and influenza B viruses in children, providing information on the infections' epidemiology and associated complciations, as well as tips ...

Legal Advisor

Painful BP cuff leads to arm injury

Can a clinician be sued for battery if a patient objects to a medical treatment, even after giving consent?

Malpractice caps fail to reduce health costs, report indicates

Exorbitant pain and suffering awards have been blamed for high clinician insurance premiums and increases in overall health insurance costs, but a new report shows ...

Settlement reached in malpractice case involving physician's death

A doctor with Lambert Eaton Myasthenic Syndrome was mistakenly administered insulin by a nurse who neglected to read a note in his medical history specifying ...

Malpractice firm loses hard drive with patient medical records

An employee at the medical malpractice firm representing cardiologist, Mark Midei, MD, who has been accused of performing unnecessary stent procedures, misplaced a hard drive ...

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