Conditions

Pediatricians have a role in reporting domestic violence

Conditions
May 16, 2010

by Crystal Phend

One of the most effective ways to prevent child abuse may be for pediatricians to identify domestic violence against a child’s caregiver, according to a report from the American Academy of Pediatrics.

Intimate partner violence in the home has a profound effect on kids, Jonathan D. Thackeray, MD, of Columbus Children’s Hospital in Columbus, Ohio, and colleagues wrote in the May issue of Pediatrics.

They pointed to elevated risk of …

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Pediatricians need to wonder when dealing with behavior problems

Conditions
May 15, 2010

Last week, I again had the privilege of teaching pediatricians in training. These students were very bright, challenging and asked excellent questions. They all agreed about the limit of the pediatric model of “giving advice.” One resident, who had young children of her own, spoke of new mothers using blogs for emotional support. Many of these mothers speak less than kindly about their pediatricians, who they perceive as “not getting …

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Declining autopsy rate, and how that impacts doctors

Conditions
May 12, 2010

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.

Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death …

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Activities for family members with dementia

Conditions
May 12, 2010

There is a lot of focus on what elders with dementia can’t do. But what about more discussion of what they can do?

When you see a patient with dementia, how do you help family members maintain meaningful interactions with their loved ones? I am sad to admit that I don’t do this nearly as well as I should. After all, this is not the type of thing we are taught …

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C-section rates as a marker for obstetric care quality

Conditions
May 12, 2010

by Michael Smith

When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.

But the converse isn’t true — higher-than-expected C-section rates aren’t associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.

The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas …

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Causes of Beau Biden’s stroke

Conditions
May 11, 2010

Beau Biden, son of Vice President Joe Biden, suffered a stroke today.

beau bidenHe is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:

Biden has what the doctors “believe to be a mild stroke,” according to Gardner. “[He is] “fully alert, …

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Treating cancer needs to be an individual patient decision

Conditions
May 11, 2010

The heresy of one age becomes the orthodoxy of the next.
-Helen Keller

The patient returned to my clinic several years after her original thyroid cancer surgery. “The cancer blood test never went completely back to zero,” she told me. “We knew there was cancer in there somewhere. Finally, the new ultrasound machine found it! I guess it is time for more surgery!”

I guess. In my patient’s situation, the latest high resolution diagnostic …

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How PCOS can be diagnosed and treated in primary care

Conditions
May 9, 2010

Hypothetical case scenario

27-year old female presents to the office with a complaint of irregular periods. Menarche was at age 15, and periods occur about 1-2 times a year. Breast development began at age 9, followed shortly by axillary & pubic hair. Growth spurt was at age 13. She’s been trying to get pregnant for the last one year now, and has never been seen before for her irregular periods.

On physical …

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MKSAP: A 21-year-old man is evaluated for painful mouth sores

Conditions
May 8, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 21-year-old man is evaluated for painful sores in his mouth. Episodes of these sores have occurred two to three times yearly since he was 16 years old, and he believes they are associated with stress. They usually appear on the inside of his mouth as a single, round, painful lesion, lasting for 5 …

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Hiatal hernia in women can present with heartburn

Conditions
May 8, 2010

by David Edelman, MD

Heartburn and acid reflux disease are common problems affecting women of all ages. The problem develops when acid in the stomach backs up into the esophagus. There is a muscle known as the diaphragm that separates the chest from the abdominal cavity. When you eat or drink, the food goes from the mouth down the esophagus, through the diaphragm and into the stomach. …

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Indoor tanning can be an addictive behavior

Conditions
May 8, 2010

by John Gever

“Jersey Shore” wannabes beware: some people crave the indoor tanning experience so much that it qualifies as an addiction, researchers said.

Among 229 college students completing a survey, 39.3% met DSM-IV criteria for addiction, reported Catherine E. Mosher, PhD, of Memorial Sloan-Kettering Cancer Center in New York City, and Sharon Danoff-Burg, PhD, of the State University of New York at Albany, in the April issue of Archives of Dermatology.

Participants …

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Dying of old age in the era of modern medicine

Conditions
May 8, 2010

He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late.

Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke …

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Explaining chronic medical treatment to patients

Conditions
May 7, 2010

Although some psychiatric conditions are acute and transient, most are chronic. They may wax and wane, but most of them do not go away. Likewise, psychiatric medications can significantly improve people’s functioning and quality of life, but they manage, not cure, mental illness.

It’s therefore not surprising that a common conversation that patients and psychiatrists have revolves around the question, “Do I have to be on this medication ‘forever’?”

I’ve previously written …

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Autistic enterocolitis may not be real

Conditions
May 7, 2010

by Todd Neale

The status of a new inflammatory bowel condition identified in the retracted Lancet paper that linked the MMR vaccine and autism — autistic enterocolitis — appears to be in limbo.

The 1998 paper by Andrew Wakefield, MBBS, and colleagues was fully retracted by The Lancet in February, although the alleged and repeatedly disproven vaccine link was dropped in 2004 …

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Inhalant abuse remains prevalent in teens

Conditions
May 6, 2010

by Todd Neale

Although inhalant abuse has become less prevalent since the early 1990s in all age groups, it remains a source of injury and death, particularly among teenagers, researchers have found.

From 1993 to 2008, intentional exposure to 3,410 different inhalants was reported to U.S. poison control centers, Toby Litovitz, MD, of the National Capital Poison Center in Washington, and colleagues reported in the May issue of Pediatrics.

The highest rate of …

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Medical device security may be vulnerable to hackers

Conditions
May 2, 2010

by Kristina Fiore

Although no such attacks have yet been reported, medical devices could be susceptible to hackers, and a thorough security analysis should be done as part of FDA approval, researchers argue.

Premarket regulatory evaluation should include a risk-based security assessment depending on the nature of the device and the perceived threat of a security compromise, said William H. Maisel, MD, MPH, of Beth Israel Deaconess Medical Center, in Boston, and …

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CT scans for lung cancer screening may not save lives

Conditions
April 30, 2010

Should smokers receive screening CT scans?

As it stands, there’s no evidence that screening patients with either chest x-rays or CT scans save lives, but a large, federally-funded study should yield some answers in the next year or so.

Recently, however, there’s data suggesting that screening chest CT scans for lung cancer gives a lot of false positives. Needless to say, these false positives are magnified with CT scans versus …

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Treating critically ill patients on Mount Everest

Conditions
April 27, 2010

Ken Kamler tells an incredible story of collective resilience in the face of one of the most dangerous mountaineering expeditions ever attempted: “I was faced with treating a lot of critically ill patients at 24,000 feet, which was an impossibility.”

Incredible lecture from TEDMED 2009.

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Speep apnea increases stroke risk in men

Conditions
April 27, 2010

by Charles Bankhead

Severe obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.

Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

“This study provides compelling …

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