Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril. On physical examination, temperature is 37.5 °C (99.5 °F), ...

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shutterstock_91422131 A thought provoking article in the November, 2014 edition of Pediatrics highlights a growing problem with modern medicine: Just because we can make a diagnosis doesn’t mean we should. The article, titled “Overdiagnosis: How our compulsion for diagnosis may be harming our children,” has been made available for free to everyone. It’s fairly dense and technical, but if you’ve been following this blog ...

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McKinsey & Company recently issued a report on effective means of fighting hyper-endemic obesity in the modern world. Among other things, they concluded that "implementing an obesity-abatement program on the required scale will not be easy." I presume that is intended to be somber, but the magnitude of understatement makes it almost funny. And sad. No, it will not be easy -- not in the world as it is. In the ...

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One of my residents presented some research that she had completed under my supervision. Since I left the staff of the U.S. Preventive Services Task Force four years ago, it has been my sense that the Task Force has substantially lowered its evidence "bar" for recommending a preventive service, an impression confirmed in private discussions with colleagues who closely follow the group's activities. In a JAMA editorial published last year, Drs. Steven Woolf ...

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shutterstock_115054471 Lately, I’ve been hearing an awful lot about millennials, and how they’re the up-and-coming sector of our economy. So I did some research: I discovered that they’re nearly 80 million strong, and aged between 17 and 34 years. Far too young to be able to impact their heart health, right? New data from the NIH’s ongoing Coronary Artery Risk Development in Young Adults ...

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Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are ...

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Every fall I write about bronchiolitis because it is one of the most common respiratory ailments affecting infants and children under about two years of age. It is the most common reason infants end up in the hospital during the winter and early spring months. Every year we get severe cases in the PICU. Pediatricians have struggled for decades to figure out how to treat bronchiolitis but we don’t have ...

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Postpartum depression may be a misnomer. A more accurate term might be postpartum neglect -- not by mothers, but of mothers. The human infant is uniquely helpless in the early weeks and months of life. His arms fly up over his head at random moments in a primitive “startle reflex.” His sleep patterns have no rhyme or reason. He eats and poops round the clock. Serving an evolutionary purpose, in part to achieve an upright ...

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The cherry trees are still there, blossoming every spring, on a patch of land near Stanley Park in Vancouver. They were planted in 1985 by a group of volunteers from AIDS Vancouver, to honor the memory of three Canadian sons who were among the early victims of AIDS. One of these men was Gaetan Dugas, who died in 1984. During this same period in San Francisco, Randy Shilts, a reporter ...

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As the PBS Newshour recently reported, Westminster, Massachusetts could be the first town in the United States to ban the sale of tobacco. As I watched the debate unfold among neighbors, I was shocked at the level of intensity with which citizens stepped up to defend the sale of tobacco in their town. At one point an elderly gentleman dependent on nasal oxygen due to years of smoking-related pulmonary disease states ...

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