Feature Archive

Evidence-Based Medicine Adjuvant Chemo With Endocrine Therapy for HR+/HER2- Breast Cancer

Adjuvant Chemo With Endocrine Therapy for HR+/HER2- Breast Cancer

Although endocrine therapy following surgery is recommended for HR-positive/HER2-negative, axillary node-negative breast cancers, the value of adjuvant chemotherapy in the setting of moderate risk is unclear.

Evidence-Based Medicine Limited Formula Supplementation May Not Adversely Affect Breastfeeding

Limited Formula Supplementation May Not Adversely Affect Breastfeeding

Although exclusive breastfeeding for the first 6 months of life is recommended by several health organizations, there may be a delay before abundant maternal milk production is established.

Evidence-Based Medicine Budesonide/Formoterol for the Prevention of Serious Asthma Exacerbations

Budesonide/Formoterol for the Prevention of Serious Asthma Exacerbations

The SYGMA trials assessed the use of an as-needed combined corticosteroid/beta-agonist inhaler in patients with mild asthma.

Clinical Challenge Case Study: Elbow and Biceps Pain After a Fall

Case Study: Elbow and Biceps Pain After a Fall

An elderly man presents to the emergency department with elbow and biceps pain after falling on the stairs.

Neurology Information Center Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying

Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying

Pseudobulbar affect is a significant national health issue in the United States, with approximately 2 million individuals affected.

Diabetes Resource Center Fasting Insulin vs Hemoglobin A1c: Are We Getting It Right?

Fasting Insulin vs Hemoglobin A1c: Are We Getting It Right?

The early diagnosis and management of prediabetes will have a significant impact on patient outcomes and healthcare spending.

Legal Advisor HIPAA Violation Derails NP's Career

HIPAA Violation Derails NP's Career

A HIPAA violation harms the successful career of a healthcare provider and causes problems for her former and current employers.

Clinical Advisor 20th Anniversary 20 Years: The Evolution of the Physician Assistant Profession

20 Years: The Evolution of the Physician Assistant Profession

The demand for PAs, along with the escalating number of PA applicants, has helped fuel the growth.

Stat Consult Stat Consult: Cleft Lip and Palate

Stat Consult: Cleft Lip and Palate

Cleft lip and palate is defined as congenital malformation of the upper lip and/or oral cavity disrupting normal facial structure and oromotor function.

Clinical Challenge Case Study: Purple Fingertips in an Elderly Woman

Case Study: Purple Fingertips in an Elderly Woman

An elderly woman with a history of hypertension and metastatic bladder cancer presents to the ED with bilateral finger pain and cyanosis associated with a 15-lb weight loss.

Clinical Advisor 20th Anniversary Nurse Practitioner Profession: 20 Years of Change

Nurse Practitioner Profession: 20 Years of Change

Changes in the NP profession over the past 20 years include the growth of the profession, methods of practice, and the types of patients and conditions treated.

Legal Advisor A Case of Wrongful Termination?

A Case of Wrongful Termination?

A clinician quits her job but afterward sues for wrongful termination.

Endocrinology Information Center Subclinical Hypothyroidism: Controversies in Testing and Treatment

Subclinical Hypothyroidism: Controversies in Testing and Treatment

Divergent recommendations in guidelines from the USPSTF and the ATA/AACE contribute to the controversy surrounding whether to test and treat for subclinical hypothyroidism.

Infectious Diseases Information Center Chagas Disease in the United States: A Growing Public Health Concern

Chagas Disease in the United States: A Growing Public Health Concern

The United States has the seventh highest prevalence of Chagas infection in the Western hemisphere, with most cases seen among immigrants from Latin America.

Neurology Information Center Weighing the Risks of Deep Brain Stimulation

Weighing the Risks of Deep Brain Stimulation

DBS has been known to generate other movement-related disorders such as dyskinesias, blepharospasm, and hypokinesia.

20th Anniversary Clinical Pearl Giveaway Internet "Challenges" and Teenagers: a Guide for Primary Care Providers

Internet "Challenges" and Teenagers: a Guide for Primary Care Providers

Discussions involving Internet challenges with children and adolescents should be as sensitive as those about sexuality and drug or alcohol use.

Stat Consult Stat Consult: Chronic Low Back Pain

Stat Consult: Chronic Low Back Pain

Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.

Neurology Information Center Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.

Vaccine Information Center Platform Manufacturing May Speed Pandemic Vaccine Development

Platform Manufacturing May Speed Pandemic Vaccine Development

With the advent of platform manufacturing technology, vaccines can be developed quickly to stop the spread of outbreaks.

Asthma Information Center Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Poor control of asthma and obstructive sleep apnea can feed off one another, according to Michelle Zeidler, MD, pulmonologist at the University of California, Los Angeles, and director of the UCLA Sleep Fellowship Program.

Practice Management Information Center Should Clinicians Treat Family and Friends? Three Experts Weigh In

Should Clinicians Treat Family and Friends? Three Experts Weigh In

Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.

Legal Advisor Patient Test Results Never Received

Patient Test Results Never Received

A clinician fails to follow up after ordering diagnostic tests for a patient.

Clinical Challenge Case Study: Sudden Abdominal Pain

Case Study: Sudden Abdominal Pain

A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior.

Practice Management Information Center Does Political Affiliation Influence Patient Care? An Interview With Anupam B. Jena, MD

Does Political Affiliation Influence Patient Care? An Interview With Anupam B. Jena, MD

To shed further light on the study's implications, MPR interviewed lead author Anupam B. Jena, MD, PhD, Ruth L. Newhouse Associate Professor, Harvard Medical School, Boston, MA.

Features Social Media and Adolescents: What Are the Health Risks?

Social Media and Adolescents: What Are the Health Risks?

Primary care providers should screen for depression and other health-related risks associated with the use of social media by adolescents.

Features A History of Race and the Emerging Role of Genetics in Primary Care

A History of Race and the Emerging Role of Genetics in Primary Care

In 2003, the Human Genome Project became the culmination of the history of genetics research, allowing us to understand the role of genetics in human health and disease. As part of The Clinical Advisor's 20th Anniversary, this article explores the influence of race and genetics in clinical practice.

Pediatrics Information Center Managing Pediatric Migraine: Current Therapies and Future Directions

Managing Pediatric Migraine: Current Therapies and Future Directions

Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.

Legal Advisor Liability After a Missed Diagnosis

Liability After a Missed Diagnosis

A patient dies after a clinician fails to act on signs of a potential case of deep vein thrombosis.

Features Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Patients with ALS require multidisciplinary care and rehabilitative interventions; maximizing independent function and quality of life are the goals.

Clinical Challenge Case Study: Cardiovascular Complications of Chronic Obstructive Pulmonary Disease

Case Study: Cardiovascular Complications of Chronic Obstructive Pulmonary Disease

A 55-year-old man with chronic obstructive pulmonary disease reports having some mild chest pain.

Stat Consult Stat Consult: Parenteral Nutrition Issues

Stat Consult: Parenteral Nutrition Issues

Some include mechanical complications, central vascular access complications, and compatibility issues.

Features Oral Anticoagulation: Reversing the Current View in Bleeding Events

Oral Anticoagulation: Reversing the Current View in Bleeding Events

Advances in new reversal agents will be key for managing patients treated with DOACs to prevent major bleeding events.

Neurology Information Center Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Medical records of 48 children examined by Asperger show that he specifically called for 12 of the children to be transferred to the Am Spiegelgrund facility, the 'euthanasia' institution founded in 1940.

Endocrinology Information Center Updated Clinical Practice Guidelines on Testosterone Therapy in Men With Hypogonadism

Updated Clinical Practice Guidelines on Testosterone Therapy in Men With Hypogonadism

Testosterone therapy is recommended in men with hypogonadism to correct symptoms of testosterone deficiency. Men who are otherwise healthy do not need to be screened for hypogonadism.

Clinical Challenge Case Study: Mottling and Infection in an Adult

Case Study: Mottling and Infection in an Adult

A 44-year-old woman presents to her local emergency department after 5 days of persistent fever, productive cough, and worsening dyspnea on exertion.

Legal Advisor Voiding a Noncompete Clause

Voiding a Noncompete Clause

A clinician attempts to void a restrictive noncompete clause that she had signed before beginning her current job as an NP.

Clinical Challenge Case Study in Diabetes: Fungal Infections

Case Study in Diabetes: Fungal Infections

A 68-year-old patient with type 2 diabetes presents to a urologist to evaluate funguria, and a CT scan showed right hydroureteronephrosis.

Features Deep Vein Thrombosis: History and Evolution of Treatment

Deep Vein Thrombosis: History and Evolution of Treatment

Deep vein thrombosis is a significant source of morbidity and mortality, so it is imperative that clinicians understand how to recognize and treat patients with the disorder.

Clinical Challenge Case Study: Headache, Back Pain, and Fever

Case Study: Headache, Back Pain, and Fever

A 25-year-old woman presents to the emergency department with a chief complaint of headache, back pain, and fever, while also experiencing some vaginal itching and discharge.

Stat Consult Stat consult: Sudden cardiac death

Stat consult: Sudden cardiac death

Described as death within an hour of onset of any symptom

Clinical Challenge Case Study: Worsening Dyspnea in a Pregnant Woman

Case Study: Worsening Dyspnea in a Pregnant Woman

A 32-year-old woman, diagnosed several months earlier with pulmonary arterial hypertension, presented to the emergency department with dyspnea and near syncopal episodes.

Legal Advisor A Patient Is Mistakenly Told He Is Dying

A Patient Is Mistakenly Told He Is Dying

A clinician shares a patient's incorrect diagnosis with another government agency.

Clinical Challenge Case Study: Chest Pain and Shortness of Breath in a Patient with Colorectal Cancer

Case Study: Chest Pain and Shortness of Breath in a Patient with Colorectal Cancer

A 64-year-old woman who was recently diagnosed with colorectal cancer is brought to the emergency department with substernal chest pain and shortness of breath.

Features Acute infectious diarrhea: a clinical approach

Acute infectious diarrhea: a clinical approach

The first step for managing a patient with diarrhea is to determine the severity of dehydration according to the estimated volume loss and the symptoms and signs noted on physical examination.

Stat Consult Stat consult: Intimate partner violence

Stat consult: Intimate partner violence

Intimate partner violence was reported in over 30% of female psychiatric patients.

Clinical Challenge Case Study: Syncope, Dizziness, and Fatigue on a Camping Trip

Case Study: Syncope, Dizziness, and Fatigue on a Camping Trip

A 52-year-old man presents to the emergency department with dizziness and fatigue after a syncopal episode on a camping trip.

Pain Information Center Assessing lidocaine efficacy for chronic pain management

Assessing lidocaine efficacy for chronic pain management

Intravenous, patch lidocaine might be effective in treating, preventing chronic pain.

Clinical Challenge Case Study: A gradually progressive rash after a URI

Case Study: A gradually progressive rash after a URI

A 33-year-old man presents to the emergency department for 6 small spots on his chest, arms, and legs that gradually grew in diameter after using a topical cream and cephalexin.

Practice Management Information Center Sex and drugs: An interview about discussing sensitive patient topics

Sex and drugs: An interview about discussing sensitive patient topics

Dr Windel Stracener, a family practitioner for 22 years, discusses substance abuse, sexual activity, and other sensitive topics many clinicians do not ask their patients.

Legal Advisor Sexual Harassment at Work

Sexual Harassment at Work

A nurse in a VA facility files a complaint against a clinician, which ends with a criminal conviction.

Features Coronary artery disease: primary prevention measures

Coronary artery disease: primary prevention measures

Primary prevention efforts such as exercise, weight control, cessation of smoking, and alcohol intake can greatly affect the development of CAD.

Features Managing acute UTIs in postmenopausal women

Managing acute UTIs in postmenopausal women

UTIs present clinically as dysuria, with symptoms of frequent and urgent urination secondary to irritation of the urethral and bladder mucosa.

Clinical Challenge Case Study: Dizziness in a 42-year-old man

Case Study: Dizziness in a 42-year-old man

A 42-year-old man presents to the emergency department with vertigo that is worse with head motion as well as vomiting, but has no headache or abdominal pain.

Influenza Information Center The race to develop a universal influenza vaccine

The race to develop a universal influenza vaccine

NIH's National Institute of Allergy and Infectious Diseases is researching ways to develop a universal influenza vaccine against multiple strains.

Influenza Information Center The flu pandemic of 1918: 100 years later

The flu pandemic of 1918: 100 years later

In 1918, between 50 and 100 million people are thought to have died from the great influenza pandemic, representing as much as 5% of the world's population.

Clinical Challenge Case Study: Lower extremity edema and heart failure in a middle-aged woman

Case Study: Lower extremity edema and heart failure in a middle-aged woman

A 55-year-old obese woman with hypertension, diabetes, and scleroderma is referred for follow-up after a recent admission for new-onset heart failure.

Legal Advisor A dosage change over the phone

A dosage change over the phone

A clinician makes a dosage change for a patient during a telephone call, which leads to a lawsuit.

Features Long-acting reversible contraceptives: a review

Long-acting reversible contraceptives: a review

Because of the high number of unintended pregnancies and the effectiveness of LARCs, they should be a first-line contraceptive option for most women.

Obesity Resource Center Case Study: Shortness of breath in a COPD patient with obesity

Case Study: Shortness of breath in a COPD patient with obesity

A middle-aged patient with morbid obesesity and COPD complains about having shortness of breath at rest and dyspnea on exertion.

Features Noninvasive colorectal cancer screening

Noninvasive colorectal cancer screening

The FIT and the MT-sDNA are evidence-based tests that should be considered for CRC screening when a colonoscopy cannot be performed.

Mood Disorder Information Center Analyzing differences in illness and outcomes for anxious depression

Analyzing differences in illness and outcomes for anxious depression

Ranging definitions of anxiety associated with depression have caused variations in findings.

Clinical Challenge Case Study: Foot pain after jogging

Case Study: Foot pain after jogging

A 64-year-old woman presents to an urgent care clinic with 24 hours of left foot pain. She states that she tweaked it while jogging. The pain is localized to the lateral portion of her foot.

Legal Advisor Clinicians in a contract dispute

Clinicians in a contract dispute

Two NPs in practice together end up in court after one loses her license.

Mood Disorder Information Center Modest changes in level of exercise may prevent new cases of depression

Modest changes in level of exercise may prevent new cases of depression

Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.

Features Human papillomavirus in males

Human papillomavirus in males

The importance of male vaccination cannot be overemphasized, because the risk of male-to-female HPV transmission is significant.

Clinical Challenge Case Study: Diarrhea and rash

Case Study: Diarrhea and rash

A 60-year-old man with a history of gastroesophageal reflux disease presents to the emergency department with 2 to 3 days of fever, non-bloody diarrhea, and a worsening non-pruritic rash.

Clinical Challenge Case Study: Sore throat and bruises

Case Study: Sore throat and bruises

A 32-year-old woman presents to an urgent care clinic with a sore throat, subjective fever, and abnormal bruising.

Legal Advisor A patient commits murder

A patient commits murder

A nurse practitioner is sued by her patient's children after their mother is murdered.

Features Assessing and treating disorders of primary hemostasis

Assessing and treating disorders of primary hemostasis

An evaluation begins with a focused history and physical examination, CBC count with platelet trend, and examination of the peripheral smear.

Mood Disorder Information Center Patients with various dermatologic disorders have greater depression risk

Patients with various dermatologic disorders have greater depression risk

Common psychiatric comorbidities such as depression, suicidal ideation, and body dysmorphic disorder are found in up to 30% of dermatologic patients.

Alternative Meds Update Copper: A metal for osteoarthritic pain management

Copper: A metal for osteoarthritic pain management

Oral copper supplements are not recommended unless extensive metabolic testing shows a true copper deficiency.

Features Preventing suicide in US veterans

Preventing suicide in US veterans

Greater awareness and enhancing communication between patients and primary care providers can help lower the risk of suicide among US veterans.

Clinical Challenge Case Study: Cardiac conditions of rheumatoid arthritis

Case Study: Cardiac conditions of rheumatoid arthritis

A 69-year-old man with no prior medical history presents over the course of several months with new-onset nonspecific joint pain and swelling without evidence of erosions.

Legal Advisor Fired after violating a patient's privacy

Fired after violating a patient's privacy

A nurse notifies other clinicians that a patient is positive for hepatitis C.

Stat Consult Stat consult: Head lice

Stat consult: Head lice

Approximately 6 to 12 million head lice cases are diagnosed in the United States per year, primarily affecting elementary school children.

Features Breast cancer screening: a review of current mammography guidelines

Breast cancer screening: a review of current mammography guidelines

Consensus regarding mammography screening varies, and conflicting guidelines from medical organizations can cause confusion for patients and providers.

Practice Management Information Center Divergent views on the ACP position statement on physician-assisted suicide

Divergent views on the ACP position statement on physician-assisted suicide

The ACP proposes that efforts should focus on improving end-of-life care, as through palliative and hospice care.

Features Preventing sudden death in young athletes

Preventing sudden death in young athletes

Hypertrophic cardiomyopathy, myocarditis, valvular heart disease, and dilated cardiomyopathy are among the most common causes.

Mood Disorder Information Center Limited evidence available for augmentation therapy in treatment-resistant depression

Limited evidence available for augmentation therapy in treatment-resistant depression

Clinicians prescribing antidepressants may need to consider augmenting monotherapy with another agent.

Alternative Meds Update Kefir: A natural probiotic with vitamins, minerals, and proteins

Kefir: A natural probiotic with vitamins, minerals, and proteins

Commercially prepared kefir is considered to be safe, mainly as a result of the pasteurization process that is required for dairy products.

Clinical Challenge Case Study: Headache, neck stiffness, and fever

Case Study: Headache, neck stiffness, and fever

A 55-year-old man with a history of hypertension and migraines is sent by his primary care provider to the emergency department for a spinal tap to rule out meningitis.

Clinical Challenge Case Study: A subdural hematoma after a fall

Case Study: A subdural hematoma after a fall

A 65-year-old Hispanic man presents to the emergency department via EMS after an unwitnessed fall from a presumed standing height.

Legal Advisor The importance of good notetaking

The importance of good notetaking

Taking good notes is one of the most important steps a clinician can take to reduce the risk of a lawsuit.

Clinical Challenge Case Study: Abdominal pain, distention, and constipation

Case Study: Abdominal pain, distention, and constipation

A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days' duration.

Features Opioids and naloxone for pain management

Opioids and naloxone for pain management

Co-prescribing naloxone and opioids in primary care is recommended for patients who have a high risk for opioid overdose.

Alternative Meds Update Cod liver oil: An antibacterial, antifungal agent

Cod liver oil: An antibacterial, antifungal agent

Cod liver oil is rich in omega-3 fatty acids as well as eicosapentaenoic acid and docosahexaenoic acid and has high concentrations of vitamins A and D.

Infectious Diseases Information Center Diagnosis of hospital-acquired pneumonia still a challenge

Diagnosis of hospital-acquired pneumonia still a challenge

Clinicians must rely on the combination of clinical examination, signs and symptoms, microbiologic testing, and radiographic findings to diagnose hospital-acquired pneumonia.

Legal Advisor Birth control leads to a blood clot

Birth control leads to a blood clot

A patient presents with chest pain 6 weeks after beginning use of a contraceptive device.

Clinical Challenge Case Study: Leg pain, nausea, and malaise

Case Study: Leg pain, nausea, and malaise

A 39-year-old man presents to the emergency department with 3 days of progressive bilateral leg pain, nausea, and malaise.

Features Hand-foot-and-mouth disease in adults

Hand-foot-and-mouth disease in adults

The disease may often go undiagnosed in adults because clinicians may be relatively inexperienced in identifying childhood illnesses in adults.

Clinical Challenge A faster heart rate and numbness: Is the patient having a heart attack?

A faster heart rate and numbness: Is the patient having a heart attack?

A 30-year-old woman presents with an increased heart rate, shortness of breath, and tingling in her right arm.

Alternative Meds Update Boron: a water-soluble element found in the earth's surface

Boron: a water-soluble element found in the earth's surface

Boron is found in small amounts in the earth's surface and is thought to be produced by the collection of particulate matter of meteorites.

Practice Management Information Center Accountable Care Organizations: Do they save money?

Accountable Care Organizations: Do they save money?

ACOs have potential for success in improving the quality of and access to care, and these models promise to provide sustainable reform of healthcare costs for the future.

Clinical Challenge Shaky, jerky eyes in an 8-week-old infant

Shaky, jerky eyes in an 8-week-old infant

An 8-week-old infant, presents to primary care with bilateral "shaky, jerky eyes."

Legal Advisor Fired for refusing vaccination

Fired for refusing vaccination

A clinician files a lawsuit against her employer after being fired for refusing Tdap immunization.

Features Managing systolic heart failure

Managing systolic heart failure

Primary care providers can help significantly reduce heart failure exacerbations and improve their patients' overall quality of life.

Stat Consult Stat consult: Minor burns

Stat consult: Minor burns

The most common causes of minor superficial burns are sunburns and minor thermal injuries.

Features Necrotizing myopathy: muscle weakness

Necrotizing myopathy: muscle weakness

Clinicians in all settings are in a position to identify patients with potential myopathic processes and complete an initial diagnostic work-up.

Legal Advisor A nurse fired for falling asleep on the job

A nurse fired for falling asleep on the job

After a nurse is fired for falling asleep at her job at a hospital, she claims that it was in retaliation for taking time off under the FMLA.

Clinical Challenge Case Study: Fever and low platelets

Case Study: Fever and low platelets

A 66-year-old woman with a history of sarcoidosis and hypertension presents to the emergency department for 4 days with right-sided abdominal pain, vomiting, fever, and mild diarrhea without blood.

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