I was engaged in one of my pleasures, sitting in a coffee shop leafing through medical journals. Usually, I am perusing newspapers. I spend many hours each week combing through various newspapers and routinely forward items of interest to folks of interest. No newspapers today. I have a few gastroenterology journals to look through. My professional reading habits have evolved over my career. I am more interested in reading about ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide ...

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I have a confession to make.  I don’t think what I do each day makes any sense. Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus. Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated ...

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Doctors at Memorial Sloan-Kettering Cancer Center recently declared they would not use Zaltrap (Sanofi), for advanced colorectal cancer. In a New York Times editorial, they suggested the extraordinary cost for incremental benefit could not justify its use. Sanofi appeared to cave to the pressure and announced a 50% discount - which only made things worse. This August, Zaltrap received FDA approval for the treatment of advanced colorectal cancer. In ...

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Flu season has begun in the U.S., and in addition to familiarizing themselves with the Advisory Committee on Immunization Practice's vaccination guidelines for the 2012-13 season (offer influenza vaccine to everyone 6 months of age or older), physicians should consider how they plan to diagnose patients with suspected influenza. Despite the availability of multiple antiviral medications for influenza, whom to treat remains a ...

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I learned of a disturbing decision from the Court of Appeals for the Second Circuit. In an insane ruling, two of judges determined that a drug rep promoting “off-label” uses for a drug was exercising his freedom of speech. Let’s stroll to the back of a typical doctor’s office to see how this plays out. Of all the ways pharmaceutical companies ...

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The long-acting beta agonist (LABA) paradox strikes again. A new article in a Milwaukee newspaper sounds an old theme. Advair, the most widely used asthma medicine, contains a long-acting beta agonist—salmeterol. “[L]ong-acting beta-agonists have been linked to 1,900 asthma deaths from 2004 through 2011, according to an estimate provided by AdverseEvents Inc., a private firm that analyzes drug side effect data reported to ...

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Today I experienced another example of the growing efficiency of the healthcare world: The Steward of Scripts. First, a little background information is necessary. After I perform surgery it is necessary to perform a number of immediate post operative duties. The operative note must be dictated, a brief note is written in the chart, post operative orders are written and, for patients that are going home the same day, prescriptions must ...

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Doctor: What medicines do you take at home? Patient: Something for the diabetes. Doctor: Do you know the name of it? Patient: "Starts with an M.  Or a P.  Honey, what's the name of that pill? Wife: Well dear, I don't know but it's a little blue one.  You know doc, the little blue one? Nothing will drive your health care provider more crazy than conversations ...

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