November 06, 2007 Archives - Clinical Advisor

Print Issue: November 06, 2007

RETIRED CLINICIANS WILLING TO SERVE

Why can’t retired but fit clinicians be part of a national health corporation that would allow those with an active state license the opportunity to provide health care in areas of need without having to apply for a license from another state? A pool of retired clinicians is an asset that could be available to…

…WHEREAS SPONDYLOLISTHESIS PATIENTS MAY BENEFIT FROM SURGERY

Level 3: Lacking direct evidence The Spine Patient Outcomes Research Trial (SPORT) enrolled 607 patients with degenerative spondylolisthesis in either a randomized group (if consenting to randomization) or an observational group (if consenting to follow-up but selecting a treatment course without randomization) (N Engl J Med. 2007;356:2257-2270). Participants were at least 18 years of age…

MEDICATION UPDATES

Having an assistant update the patient’s list of medications on every visit will keep you from overlooking them.—Jamshid S. Miah, MD, Baltimore (109-27) Contact Us at: Letters@ClinicalAdvisor.com

REUSABLE ICE-PACK RECIPE

Here is a simple recipe for an effective and inexpensive ice pack. Mix three parts water with one part rubbing alcohol. Put the solution in a plastic bag and double it after squeezing all the air out. After several hours in the freezer, you will have a reusable and pliable cold pack that can be…

MORE ON REACTIONS TO TETANUS

Recently, I experienced a severe local reaction to tetanus (Item 107-4), and subsequent immunization resulted in a systemic reaction that included swelling, pain, fever, and malaise for three days. Further testing revealed allergy to both tetanus toxoid and antitoxin as well as immunity to the toxin. Two of my patients who had similar reactions were…

DIFFERENTIATING TACHYCARDIAS

Is there a simple way to differentiate a supraventricular tachycardia from a ventricular, wide QRS tachycardia on a rhythm strip?—Jorge Lizquiano, MD, Milwaukee The simplest initial approach is to look at the lead with the most discernible P waves, then try to identify atrioventricular dissociation and screen for fusion beats seen with ventricular tachycardia (VT)…

INFREQUENT TB TESTING

As a family practitioner in a solo practice, I am occasionally asked to do TB screening tests. The requests are so infrequent that it is difficult to rationalize intradermal purified protein derivative (PPD) testing because the multidose vial expires within 30 days of using the first dose. I’d like to use tine testing as a…

INACCURATE BMIs

Several of my patients are very muscular because they exercise at the gym regularly. When I calculate a BMI using their height and weight, they fall within the overweight or obese category. But their weight is due to their muscle, not fat. Is there a more precise way to measure BMI in such patients?—Elizabeth George,…

TREAT AN ELEVATED HDL?

A 22-year-old woman has a higher-than-normal HDL level, which raises her total cholesterol despite a normal LDL. Would you treat the elevated HDL? Her life insurance premium was raised because she has an abnormal lipid panel.—Gita Dalal, MD, Edison, N.J. The higher HDL is thought to be cardioprotective. Assuming the LDL is truly “normal,” the…

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