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Review of childhood obesity: from epidemiology, etiology, and comoribiditis to clinical assessment and treatment

by jmiller on January 16, 2017

“Most obese children do not have an underlying endocrine or single genetic cause for their weight gain.  Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children.”  (Mayo Clin Proc, Jan)  Click here to read full text.

Providing appropriate end-of-life care to religious and ethnic minorities

by jmiller on January 16, 2017

“There is overwhelming evidence that racial and ethnic minorities face multiple health care disparities.  Recognizing and addressing cultural and religious/spiritual (RS) values is a critical aspect of providing goal-concordant care for patients facing a serious illness, especially at the end of life.  Failure to address a patient’s cultural and RS needs can lead to diminished quality of care and worse health outcomes.  Given the multitude of cultural and RS values, we believe that a framework of cultural and RS curiosity along with a willingness to engage patients in discussions about these elements of their care within an interdisciplinary team should be the goal of all providers who are discussing goals, preferences, and values with patients facing advanced terminal illness.  (Mayo Clin Proc, Jan)  Click here to read full text.

Guidelines for family-centered care in the neonatal, pediatric, and adult ICU

by jmiller on January 11, 2017

These guidelines (Crit Care Med, Jan) “identify the evidence base for best practices for family-centered care in the ICU.”  The original guidelines published in 2007 have been one of the most widely cited documents on family-centered care.  However, the prior guidelines were developed using what is now an outdated evidence analysis. The new guidelines described in this work are not an update of the prior guidelines, but instead are the result of a completely new and more rigorous analysis.  These new guidelines represent the current state of international science in family-centered care and family support for family members of critically ill patients across the lifespan. “  Click here to read full text.

Your health care in 2017: what you must know

by jmiller on December 29, 2016

Frank Lalli, once a long serving editor of Money Magazine, wrote this piece for last Sunday’s (Dec 25th) newspapers.  He gives a very analytical picture of what the future will likely be in respect to Obamacare; purchasing health insurance across state lines; drug prices; changes to Medicare and Medicaid; insurance changes through employers; etc.  It’s a fascinating read with thoughtful analysis.  To read full text, click here.

Higher mortality in weekend admissions to the hospital: true, false, or uncertain?

by jmiller on December 28, 2016

This “Viewpoint” article (JAMA, Dec 27) concludes, “recent studies suggest that patients admitted during weekends are at no greater risk of dying than those admitted during the week.  Policy makers need to avoid unjustified claims about an increased risk of death among patients admitted during weekends because doing so only serves to undermine public confidentce and trust in hospitals and damage staff morale.  Neither of these are in the interest of patients or the public.”   To read full text, click here.

Cardiovascular safety of Celecoxib, Naproxen, or Ibuprofen for arthritis

by jmiller on December 27, 2016

Both  the NEJM  (Nov 13, epub) and The Medical Letter (Dec. 19) reported on the cardiovascular safety of Celebrex.  The NEJM publication  concludes:  “At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety.  In summary, the PRECISION trial also showed that celecoxib treatment also resulted in lower rates of gastrointestinal events than did either comparator drug and in lower rates of renal adverse events than did ibuprofen.”  Click here to read full text.  The Medical Letter (Dec. 19) reported that “the average dosage of the COX-2 selective NSAID celecoxib (Celebrex) used in the PRECISION trial was too low to support the determination that celecoxib is noninferior to ibruprofen and naproxen with regard to cardiovascular safety.  Cox-2 selective NSAIDS cause less gastrointestinal toxicity and bleeding than nonselective NSAIDS, but they may have a prothromobotic effect, and all NSAIDS are nephrotoxic.  Elderly patients, who are most at risk, should exercise caution in taking any NSAID, including celecoxib.  To read Medical Letter piece, click here.

Partnering with nurses to transform primary care – JAMA forum

by jmiller on December 27, 2016

This is a very interesting piece about developing skill mix with registered nurses to transform primary care.  The author cites the many challenges to making it work, but as one physician explains t “I’m able to actually see more patients and spend more time with them on issues that matter and require my expertise.  Click here to read this forum (JAMA, Dec. 20)

Teens of the week: Where are they now? Featuring Helen Selonick, daughter of Dr. Stu Selonick and wife of AAMC’s emergency room doc, James Prevas

by jmiller on December 27, 2016

This is a beautiful piece, published December 26th in the Capital,  revisiting a 2003 Teen of the week:  Helen Selonick, daughter of Dr. Stu Selonick, who also became (and married) a physician.  This is a delightful piece to share.  To read full article, click here.

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