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Print Issue: November 06, 2007

Evidence-Based Medicine

NEW AHA GUIDELINES ON PREVENTING INFECTIVE ENDOCARDITIS

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Level 3: Lacking direct evidence Antibiotic prophylaxis is indicated in patients with certain cardiac conditions who are undergoing bacteremia-producing procedures. However, the American Heart Association (AHA) 2007 guidelines recommend antibiotics for fewer conditions and procedures than the 1997 guidelines (Circulation. 2007;116:1736-1754; full-text available online free of charge at: http://circ.ahajournals.org/, accessed October 12, 2007). Cardiac patients…

Evidence-Based Medicine

MOST SCIATICA PATIENTS RECOVER WITHOUT SURGERY…

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Level 1: Likely reliable evidence The efficacy of early microdiskectomy for severe sciatica was evaluated in a randomized trial (N Engl J Med. 2007;356:2245-2256). Participants aged 18-65 years with severe sciatica for 6-12 weeks (N=283) were randomized to early surgery vs. conservative treatment for six months. Patients in the latter group had surgery after six…

Commentary

Speak up now—2008 will be too late

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Now that the 2008 presidential race is in full swing, each of the candidates is out on the hustings promoting a variety of issues. While the wars in Afghanistan and Iraq will no doubt be the leading foreign policy issues, our work as nurse practitioners and physician assistants provides us with a unique perspective on…

Stat Consult

Avian influenza

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Dr. Seid is a physician at Messiah College, Grantham, Pa., and a reviewer for DynaMed. Dr. Alper is medical director of clinical reference products for EBSCO Publishing, in Ipswich, Mass., and editor-in-chief of DynaMed (www.dynamicmedical.com), a database of comprehensive updated summaries covering nearly 2,000 clinical topics. Description • Influenza (H5N1) infection in poultry that rarely…

Legal Advisor

Sharp pain obscures a diagnosis

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Gallbladder disease was most likely, but should a cardiologist have been consulted anyway? At age 43, Ms. F had reached a pleasant plateau in her professional life as a nurse practitioner. She had earned her master’s degree 13 years earlier and had worked at various jobs for five years before settling into the community clinic…

Features

Stents vs. medications to treat heart disease

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Once hailed as a breakthrough in the care of angina, stents are in the crosshairs of skeptics. Two cardiologists sort through the controversy. Earlier this year, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that patients with stable angina treated with medication alone did just as well long-term as those who…

Features

New strategies for diagnosing iron overload

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Recently discovered genetic mutations, modern diagnostic techniques, and fresh approaches to therapy change the outlook on hemochromatosis. Ben, age 46, visited his primary-care clinician with complaints of joint pains and impotence. He had also noticed that his skin seemed to be turning darker. Over the past three years, Ben has had several office visits at…

Features

New guidelines for diabetes types 1 and 2

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Endocrinologists offer updated recommendations to increase glycemic control and avoid complications. Here is a quick summary. The American Association of Clinical Endocrinologists (AACE) has released new guidelines to help the practitioner caring for patients with diabetes mellitus.1 Several well-designed, large-scale trials have demonstrated that tight glycemic control can yield benefits in end-organ/complication prevention. As the…

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