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Delirium in hospitalized older adults

by jmiller on October 25, 2017

Clinical Practice article (NEJM, Oct 12) focuses on delirium presenting the clinical problem; strategies and evidence; management; prevention; guidelines; and conclusions and recommendations.  “Agitation should be managed with non-pharmacologic strategies first.  Physical restraints should be avoided.  Antipsychotic agents should be reserved for unremitting symptoms that threaten patient safety; if required, haloperidol (initial dose, 0.25 mg), olanzapine (2.5 mg), or quetiapine (12.5 mg) would be reasonable first choices depending on the amount of sedation desired.”     To read full text, click here.

“Global Surgery” by Dr. Adrian Park is now in our electronic medical libary.

by jmiller on September 20, 2017

“Our intent in creating this book is to tell the story of global surgery, including its brief history and exciting future, and to provide important practical information for those who wish to engage in this most worthy of pursuits. Our hope is that this book will prove to be a trusted and well-thumbed resource for you at whatever stage of your global surgical journey you find yourself.”  With so many of our physicians providing international charitable surgical services, this book will provide a wealth of information to enrich this experience.  To access the book, click on the  “Medical Staff” icon  at the top toolbar; locate and click on “Medical Library” on the left sided toolbar.  The “Medical Library” is located on the right hand column, where the first entry is “AAMC Electronic Journal and Book List A to Z”.  If you click on and type “Global Surgery” in the search box, you will have access to Dr. Park’s new book.  If you have any questions, please call Joyce Miller, ext. 4877 or send an email to

AudioDigest Platinum – NEW to our electronic Medical Library – Earn CME and MOC credits in your car on the way to work or from your laptop at home!

by jmiller on September 13, 2017

AudioDigest Platinum allows for unlimited CME with institutional access to 16 medical specialties.  Listen to lectures on the go with the Audio Digest Mobile app available on Apple iTunes or Google Play.  Customize auto-loading playlists tailored to an individual user’s areas of interest.  Current clinical updates, best practice, and MOC activities.  Obtain your username and password through the Medical Library on the Intranet. Please register ensuring the previous user is logged out if you are on a shared computer.   Questions:  Call Joyce Miller, 443.481.4877.  Click here to view flyer.

JAMA Clinical Guideline Symposia: Routine preoperative laboratory tests for elective surgery

by jmiller on August 8, 2017

Major recommendations: For ASA grade 1 or 2 patients undergoing minor surgery, do not routinely offer preop tlab tests.  For ASA grade 3 or 4, consider renal function testing in patients at risk of acute kidney injury.  For ASA grade 1 patients undergoing intermediate surgery do not routinely offer any preop lab tests.  For all patients undergoing major or complex surgery, offer preop lab testing with CBC counts and renal function.  Consider coagulation testing in ASA grade 3 or 4 patients with chronic liver disease or taking anticoagulants.  Click here to read full text.

Amyotrophic lateral sclerosis

by jmiller on August 8, 2017

This review article (NEJM, July 13) covers epidemiological features; pathological characteristics; genetic features; concepts in pathogenesis; and therapeutics and beyond. Click here to read full-text.

Subarachnoid hemorrhage

by jmiller on August 8, 2017

This clinical practice article (NEJM, July 20) reviews the signs and symptoms; strategies and evidence; medical interventions to reduce the risk of re-rupture; treatment of ruptured cerebral aneurysms; treatment of complications arising from subarachnoid hemorrhage and aneurysm treatment; areas of uncertainty; guidelines; and conclusions and recommendations.  To read full text, click here.

In the news: Longer sleep is associated with lower BMI and favorable metabolic profiles

by jmiller on August 2, 2017

“After adjustment for age, ethnicity, sex, smoking, and socioeconomic status, sleep duration was negatively associated with body mass index, waist circumference, and positively associated with body mass index, waist circumference, and positively associated with high-density lipoprotein cholesterol.  Sleep duration tended to be positively associated with free thyroxine levels and negatively associated with HbA1c and CRP.  Findings show that short-sleeping adults are more likely to have obesity, a disease with many comorbidities.  (PLOS, July 27) Click here for full text.

In the news: Coffee drinking and mortality in 10 European countries; Association of coffee consumption with total and cause-specific mortality among Nonwhite populations; and Association of coffee drinking with total and cause-specific mortality

by jmiller on July 12, 2017

“Coffee consumption was inversely associated with total and cause-specific mortality.  Higher consumption of coffee was associated with lower risk for death in African Americans, Japanese Americans, Latinos and whites.  Bottom line:  “Although drinking coffee cannot be recommended as being good for your health on the basis of these kinds of studies, the studies do suggest that for many people, no long-term harm will result from drinking coffee.”  Two of these studies are from the most recent posting in Ann Intern Med, and one from NEJM.  Click here to read full-text.

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