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Vitamin and mineral supplements: what clinicians need to know

by jmiller on March 7, 2018

Recommendations:  most vitamins and supplements have not demonstrated a clear benefit; most vitamins and minerals should be obtained through food.  Exceptions are Vitamin D and calcium; people who have undergone bariatric surgery; people with pernicious anemia; age related macula degeneration; and in pregnancy, where folic acid and prenatal vitamins are recommended.  (JAMA, Mar 6).  Click here to read full text.

Improving outcomes after hospitalization: A prospective observational multicenter evaluation of care coordination strategies for reducing 30-day readmissions to Maryland hospitals

by jmiller on January 3, 2018

“Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG for 30 days post-discharge.  All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse.  PAL and TG care coordination interventions were associated with lower rates of 30-day readmission.  Our findings underscore the importance of determining the appropriate intervention for the hardest to reach patients, who are also at the highest risk of being readmitted.  (J Gen Intern Med, Nov)  Click here to read full text.

Patient-Clinician Communication: ASCO Clinical Oncology Consensus Guideline

by jmiller on December 12, 2017

This practice guideline (Journal of Clinical Oncology, Nov 1) recommends “that in addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills.  Recommendations are accompanied by suggested strategies for implementation.”  Click here to read full text.

“‘Physician Heal Thyself’ Isn’t Working” – Editorial by Dr. Adrian Park in Annals of Surgery

by jmiller on November 16, 2017

Congratulations to Dr. Adrian Park for having his second publication in one year in the top prestigious surgery journal, Annals of Surgery.  Dr. Park’s editorial is a commentary on the work of Dr. Chantal Alleblas, appearing in the same issue, which focuses on worker injury related to minimally invasive surgery in the abdominal cavity, including, general, gynecological, and urological surgery.  These surgeon related worker injuries are mainly the result of  ergonomic issues causing musculoskeletal disorder injuries, a topic that may be equally important as “physician burnout”, but with far less media attention.  Click here to read Dr. Park’s editorial and Dr. Alleblas’s  article “Prevalence of musculoskeletal disorders among physicians performing minimally invasive surgery: a systematic review”.

In the news: New ACC/AHA High blood pressure guidelines lower definitiion of hypertension

by jmiller on November 14, 2017

“High blood pressure should be treated earlier with lifestyle changes and in some patients with medication.  Blood pressure categories in the new guideline are:  Normal:  Less than 120/80 mm Hg; Elevated:  Systolic between 120-120 and diastolic less than 80Stage 1:  Systolic between 130-139 or diastolic between 80-89; stage 2:  Systolic at least 140 or diastolic at least 90 mm HG;  Hypertensive crisis:  Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage”.  Full guidelines are in Nov. JACC.  Click here for news summary.

In the news: Alcohol and cancer: a statement of the American Society of Clinical Oncology

by jmiller on November 14, 2017

“Alcohol is causally associated with oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer.  Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use.”  (Journal of Clinical Oncology, November)  Click here to read full text.

“Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department” and editorial “Opioid vs nonopioid acute pain management in the emergency department”

by jmiller on November 14, 2017

Article concludes:  “For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics.”  The editorial suggests that “evidence that nonopioid medications may provide similar pain reduction as opioid medications in selected ED patients.”  (JAMA, Nov 7)  Click here to read full text.

Ten steps the federal government should take now to reverse the opioid addiction epidemic; Reframing the opioid epidemic as a national emergency

by jmiller on October 25, 2017

Two “Viewpoint” papers (NEJM, Oct 24/31) on the opioid epidemic:  briefly, the ten steps are:  improving surveillance of possible opioid addiction; improving reporting of and response to opioid-related overdoses and fatalities; promoting more cautious prescribing for acute pain; changing labeling for chronic pain and greatly restricting or eliminating marketing of opioids for this indication; increasing insurance coverage of and access to non-opioid and non-pharmacological management of pain; interrupting the supply of heroin and illicitly produced synthetic opioids and improving coordination between legal and public authorities; identifying possible opioid addiction early and linking individuals to treatment; expanding low-threshold access to opioid agonist treatment,particularly with methadone and buprenorphine; implementing harm reduction measures for current users, including access to clean syringes and naloxone.; considering removing ultra-high-dosage-unit opioid analgesics from the market.  Click here to read both “Viewpoints”.

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