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). Read…Details
Improving outcomes after hospitalization: A prospective observational multicenter evaluation of care coordination strategies for reducing 30-day readmissions to Maryland hospitals
“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…Details
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…Details
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,…Details
“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 80; Stage 1: Systolic between 130-139 or diastolic between 80-89; stage 2: Systolic at least 140 or…Details
“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"
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…Details
Ten steps the federal government should take now to reverse the opioid addiction epidemic; Reframing the opioid epidemic as a national emergency
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…Details
This Clinical Review (JAMA, Oct24/31) concludes: “Urinary incontinence is common in women, although few seek care despite many effective treatment options. Clinicians should priotitize urinary incontinence detection, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate conservative and medical therapy, and refer to specialists when underlying pathology is identified or conservative…Details
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),…Details