photo by Jennie Faber on flickr

This week, the news that drinking coffee may be associated with a lower overall risk of death has been making many merry; it seems that the potential benefit comes with both caffeinated and decaffeinated coffee. The paper, published in The New England Journal of Medicine and summarized on MD Consult, noted that the amount of coffee required is not insignificant, though – six or more cups a day– which implies many trips to Starbucks, your preferred indie coffee house or to the office kitchen. The actual mechanism involved is still unclear, however, and readers were reminded that correlation is not causation. Also making the news, albeit in a more worrying way, is the antibiotic azithromycin. It was associated with an increased risk of cardiovascular death, and more caution was urged for those who prescribe the popular drug regularly. Patients who ask for antibiotics in situations that do not really warrant them may want to consider a cup of coffee instead.

The May issue of Chest features an interesting commentary on lung cancer screening, in which the authors note that while it has been demonstrated that CT scans for smokers clearly reduces mortality, it is very expensive; a lower-cost, but still-effective, approach is proposed as an alternative. An article with a critical care focus explores the use of macrolide antibiotics for patients with acute lung injury, and the results are encouraging. Also of note is a piece of original research describing a novel drug delivery system for pleural cavity chest infections – biodegradable beads that gradually release antibiotics. While the findings are at a preliminary stage, it certainly offers an interesting direction for future research. Other new research in this issue looks at sleep-disordered breathing and community-acquired alveolar pneumonia in children and an examination of COPD patients using a ‘new’ walking aid – and of course there are many other topics covered in this issue as well. Another new journal this week is the May 15 American Family Physician. A practical guide to the ‘well male’ examination is offered, together with a handout for patients, and there is also an article on the importance of preventing malaria in travelers – a handout is available for that subject as well.

There are a number of new Articles in Press in the Clinics, notably in Endocrinology and Metabolism Clinics. Soon to be appearing in an issue (but available online now) are articles on insulin-like growth factor 1 physiology, the insulin-like growth factor system in bone and insulin-like growth factors in the gastrointestinal tract and liver. Also new is the June issue of Gastroenterology Clinics, which focuses on inflammatory bowel disease. One article looks at caring for the general health of IBD patients, with an emphasis on routine vaccinations – including when not to give them, depending on ongoing treatment. Another describes ways to optimize immunomodulators and anti-TNF agents for those suffering from Crohn’s disease, while yet another takes on diagnosis and management of IBD from a non-invasive perspective. Instead, the authors describe genetic approaches that are currently available, and they offer suggestions of future treatments that may not be too far down the line.

Check back next week for more of what’s new on MD Consult.

Regular readers may have also noticed a number of changes to the Recommended Resources pages: they have a cleaner, more modern look and feel, and (in some cases) their content is expanding. Icons now indicate whether links are from a book or journal article, or if they include an image or table. The pages load more quickly, and are easier to view on a tablet or mobile device. In addition, depending on your subscription type, you may begin seeing a wider array of book-related links; this feature is being rolled out slowly across the section, but it can be viewed now on a number of pages, including breast cancer, cholelithiasis, hepatocellular carcinoma, pulmonary embolism and ulcerative colitis, to name just a few – see if you can spot the others! Keep an eye out for more additions to this section over the coming weeks and months.

As always, there have been new additions to the Journals and Clinics sections of the site as well; the May issue of Annals of Emergency Medicine examines a number of topics, including whether Medicare and minority patients are at higher risk of losing their emergency departments to closure; it would seem this is a distinct possibility. Also of interest is a paper on medication error interceptions, which concluded that pharmacist review caught nearly a third of these errors, while others were discovered elsewhere in the patient care process. Another article described the educational and institutional changes aimed at ending the routine administration of multivitamin infusions for patients with alcohol-related conditions, and their successful move to evidence-based alternative therapy models. Switching over to the May Radiologic Clinics of North America, we find an issue focused on imaging of the pancreas. MDCT and MRI approaches are detailed, and there are closer looks at both congenital abnormalities and imaging after pancreatic surgery.

Check back next week for more of what’s new on MD Consult.

May journals are arriving in good numbers, and among them is the American Journal of Obstetrics and Gynecology. One paper looks at the growing trend of elective early term deliveries. The authors emphasize that they are only addressing truly elective deliveries in this article, but they do point out the need for solid policies to frame the issue. Also of interest is a look at how labor patterns have changed over the past 50 years; another change in the field is the huge rise in the number of superobese women requiring obstetrical care. A study on the subject found a significant increase in risk for perinatal complications for such patients and their infants, even when compared to other overweight women. Also new for May is General Hospital Psychiatry. One study examines how frequently general practitioners recognize anxiety disorders, while another looks at the prevalence of depression in diabetic patients. A case report looks at a man with severe, frequent yawning that was treated with propranolol, while another covers the use of pregabalin for Tourette’s syndrome patients who have not responded well to other therapies.

Some recent additions in the Clinics can be found in the Articles in Press section of Infectious Disease Clinics of North America. An overview of tropical diseases is offered, and there is also an article on venomous bites and stings, covering snakes, lizards, spiders, jellyfish, insects and other animals. A clinical review of visceral leishmaniasis will also be appearing in an upcoming issue. Endocrinology and Metabolism Clinics is another title with recent Articles in Press; one paper looks at milestones in insulin discovery and future developments, while another looks specifically at intensive insulin therapy for patients with type 1 diabetes. A slightly earlier article proposes new goals and tactics for optimizing insulin therapy in type 2 diabetes, and all should soon be finding ‘permanent’ homes in an upcoming issue.

Check back next week for more of what’s new on MD Consult.

Photo by elleinad on flickr

MD Consult’s News section featured a dispatch from the complementary and alternative medicine realm; the results of a trial presented at the annual meeting of the Society of Behavioral Medicine suggested that hypnosis may be an effective treatment for severe postmenopausal hot flashes. It was noted that the reduction in symptoms was stronger than that seen in many pharmacological approaches, and the lack of side effects was another positive. However, there are challenges involved in making the strategy widely-available, so further steps would be needed in that regard. Reports also issue from the Society of Hospital Medicine’s meeting, with talks on hospital readmissions, recertification issues and an exploration of the possible effects of statins on pneumonia mortality.

This week also saw a new issue of Chest appear in the Journals, and it covers a wide array of pulmonology-related topics. The impact of ischemic heart disease on COPD was analyzed; patients with both conditions frequently exhibited worse health status, lower exercise capacity, and more dyspnea compared to other COPD patients. And while the many risks of smoking during pregnancy are well-known, another paper looked at the relationship between maternal smoking and subsequent wheezing among preschool children; unsurprisingly, the association was not a positive one. Another study examining children’s health looked at pediatric obesity-associated asthma and noted that it was significantly different from atopic asthma, and considerably less well-understood. Another article looked at chronic mountain sickness – a public health issue for communities at altitude, and not simply a disease of mountaineers – and role of exercise in rapid interstitial lung fluid accumulation in CMS sufferers. The authors suggests that it is a contributing factor for exercise intolerance in these populations. Also new in the Journals is the May 1 issue of The American Journal of Cardiology. It features a twin study comparing obese and non-obese siblings and their rates of cardiovascular disease – the extra epicardial fat seemed to make quite a difference. Another article looked at an unusual group of hypertrophic cardiomyopathy patients – those over 90 years of age. While still noting its well-known dangers in younger patients, the authors found that it was quite different in this elderly population. Of course, there is much more to discover beyond these articles.

New in the Clinics is Clinics in Geriatric Medicine, which focuses on polypharmacy. Factors leading to this often excessive use of drugs are examined in one article, while another looks at the role of chronic diseases and the variety of medications that are often employed as a result. One paper describes issues associated with polypharmacy in nursing home residents, and another looks at their outcomes. Techniques and tools to reduce polypharmacy are also discussed. The May issue of Clinics in Liver Disease has also arrived. Topics include drug-induced liver disease, hepatic encephalopathy and nonalcoholic fatty liver disease, among others.

Check back next week for more of what’s new on MD Consult.

Joplin's St. John's Hospital, post-tornado

It’s tornado season in the Midwest, and it is just a month shy of the 1-year anniversary of Joplin, MO’s massive tornado strike. The town’s St. John’s Hospital was rendered unusable in the disaster, but it is being reborn as Mercy-Joplin – this time with an even stronger disaster plan (and windows that can withstand winds of up to 200 mph). Elsewhere it was noticed that an Institute of Medicine report found most hospitals unprepared to handle major catastrophic events, even among those that have a response plan. The report included a guide for better disaster planning in the future.

The April issue of Neurology appeared recently and it covers a range of topics. One article suggests that a high intake of some flavonoids (obtained from tea, berries, apples, red wine, and oranges) may reduce the risk of developing Parkinson’s disease (particularly for men), although the exact mechanism was unclear. For those who have the condition, activity was shown to improve the response to levadopa, although the authors recommended further studies to explore the notion. Also examined in this issue is whether children who experience febrile seizures are at a higher risk of developing epilepsy later; the results of this long-term follow-up seem to show that risk decreasing over time, but again, the authors recommend further research to confirm their findings. Pediatric Neurology is new this week as well; the May issue is quite global in its approach. One study looked at American children with epileptic spasms, while another explored the use of antiepileptic drugs in Hong Kong. Optic neuritis in Malaysian children was examined, and, heading to Turkey, we find an article on head circumference growth reference charts.

New Clinics this week include April’s Orthopedic Clinics of North America. Among the articles in this edition is one looking at articular cartilage development from a molecular perspective, while another offers advice on diagnosing and treating juvenile idiopathic arthritis. Another paper dealing with pediatric orthopaedic issues reviews approaches to trauma and sports-related injuries of the knee, and current and future uses for bio-scaffolds to help repair impaired knees is also discussed. Revisiting our earlier neurology theme  is May’s Neurologic Clinics, which focuses on electrodiagnostic techniques for neuromuscular disorders. Carpal tunnel syndrome is one such problem whose diagnostic potential is reviewed; another is peripheral neuropathy. Of course, any study or technique may occasionally run into difficulties, and avoiding such complications in nerve conduction studies and needle electromyography is addressed in one article. The very practical issue of how to ensure reimbursement for electrodiagnostic studies is covered as well.

Check back next week for more of what’s new on MD Consult.

Photo by Writing On The Mall on flickr

Welcome back to the MD Consult blog! What’s New was on hiatus last week while I was out of town, but now we are back in business.

The News this week has featured a number of early-release articles from journals like The Lancet; one story reports that artemisinin-resistant malaria has ‘increased substantially’ along Thailand’s western border, while another from the British Medical Journal compares antibiotics and surgery for uncomplicated appendicitis. It was also suggested in another news item that low vitamin D may be a trigger for inflammatory arthritis (it is worth noting that our statistics tell us that stories about vitamin D are always among the most read on MD Consult).

In the Journals, the April issue of Best Practice & Research Clinical Endocrinology & Metabolism looks at the role of genetic testing in obesity and related conditions. While acknowledging that food intake and lack of exercise are not to be disregarded, extreme insulin resistance syndromes often have a genetic basis, and the author of one article recommends further investigation into candidate genes to identify new therapies. Another papers asks whether genetic testing is useful in the prediction of type 2 diabetes, while the potential value of genome-wide association studies to identify obesity-related genes is also explored. Also new for April is The Lancet Infectious Diseases. Topics briefly covered include tuberculosis control in India, the many problems with antibiotics in livestock production in the US, and how Russia’s drug policies have led to unintended consequences when it comes to infectious disease epidemics. Among the more in-depth research articles in this issue is a comparison of fidaxomicin and vancomycin for the treatment of C. difficile, as well as a look at antiretroviral drugs in sub-Saharan Africa’s HIV fight.

The latest in the Clinics is the May Urologic Clinics of North America, which focuses on renal cancers. Current practices in the surgical management of renal masses are detailed, and the decision as to whether or not to treat the smaller of these masses, when discovered, is also at issue. Longer-term outcomes of radiofrequency ablation and cryotherapy as treatment options are covered, and individualized treatment strategies for metastatic renal cell carcinoma are also studied in this issue. Otolaryngologic Clinics of North America is back with a new issue as well, this time featuring papers relating to acoustic neuromas. The epidemiology and natural history of these tumors is laid out, as is a look at newer diagnostic techniques and recent trends. The special challenges in this regard that accompany neurofibromatosis 2 are studied, and a variety of treatment options are examined, including radiation therapy and neuroendoscopy as part of a surgical approach, among others.

Check back next week for more of what’s new on MD Consult.

image by Sara Björk

Much of the news on MD Consult this week comes from the annual meeting of the American College of Cardiology. Research on a wide variety of heart-related topics has been presented: one story warns against both too little and too much sleep, while in a more encouraging report, elective angioplasty seems safe at hospitals without surgical backup. A number of common comorbidities were demonstrated to raise the risk of death after transcatheter aortic valve implantation, but the use of the CoreValve systemin the same procedure showed positive results. Expect more content from the conference to appear over the next few days.

There are still a few March Journals going up, including the Journal of Clinical Anesthesia. One of the subjects explored in this issue is unexpected disposition status after ambulatory surgery; while the study was limited to knee and shoulder surgery patients, it seemed that one of the major factors worth analyzing was who the anesthesia provider was. Another article linked postoperative delirium with low social support, while other researchers noted that the history of anesthesia is largely ignored in US residency programs, although there was interest in the field. Spanning both March and April, the latest Family Practice Management features a number of practical articles. Among the subjects detailed in this issue are using a clinical decision support system to identify unmet patient needs, understanding the transition to ICD-10 as well as providing a number of resources for the new Medicare annual wellness exam benefit.

Going back to surgery with the Clinics, we have the April issue of Surgical Clinics of North America, which has a focus on peri-operative complications. Alarming conditions and their management range from profound hemorrhage and massive transfusion to multidrug-resistant infections and the subsequent use of a variety of antibiotic agents. Also discussed (and mentioned above) is postoperative delirium and the use of fluids and electrolytes to guard against and to mitigate some complications.

What’s New on MD Consult will be taking a break next week (this is code for ‘Lisa will be out of the office’), but please do come back in April for more of the most recent additions to the site.

Match Day as seen by the Greater Louisville Medical Society

The news on MD Consult has covered a wide range of topics and specialities, but a report on this year’s Match Day will certainly hold special interest for those soon-to-be residents who have just discovered where the next step in their careers will be taking them. It seems that interest in primary care is holding steady compared to last year, while emergency medicine was one of the more popular options this time around. Also not unlike last year, certain fields were particularly competitive – dermatology, orthopedic surgery, otolaryngology and plastic surgery were among the most popular choices. In other news, the CDC announced that gastroenteritis deaths more than doubled between 1999 and 2007, with C. difficile playing a prominent role in the unfortunate statistics. But in a more cheerful bulletin, physicians were encouraged to get involved with social media – at least, within certain guidelines.

The March 15 American Family Physician appeared early this week. Topics covered in this issue include strategies for promoting smoking cessation, as well as a look at what weight loss medications might be appropriate – and effective – for patients with type 2 diabetes. Psychiatric conditions are also addressed, with guidelines for evaluating and treating suicidal patients in the family practice setting. Also new this week is March’s Mayo Clinic Proceedings, which features an editorial about the tricky issue of medical practictioners with opioid dependence issues – is buprenorphine maintenance treatment a successful way to help them return to work? A special article looks at the subject in considerable depth. Another paper reviews brain-computer interfaces that may help patients disabled by neuromuscular disorders, and there is also a timely exploration of human granulocytic anaplasmosis, an emerging tick-borne disease that is likely under-diagnosed.

Recently added to the Clinics is the April edition of Dermatologic Clinics, which focuses on quality of life (QOL) measures. An overview of the QOL concept points out that since many (though certainly not all) skin conditions are less likely to affect length of life versus quality, it is a particularly important topic. Skindex-29 and Skindex-16 are reviewed for their utility to dermatologic research, and QOL measures for a number of specific conditions are also examined, among them psoriasis, acne, blistering diseases and melasma. March’s Gastroenterology Clinics was added to MD Consult in the not-so-distant past as well, and this issue explores pancreatic disease. The diagnosis and management of autoimmune pancreatitis is detailed, as is modern treatment of patients with chronic pancreatitis. New approaches to the medical management of pancreatic cancer come in for review, and a minimally invasive approach to the surgical management of pancreatic diseases is examined as well.

Check back next week for more of what’s new on MD Consult.

Also new this week is the March issue of The Lancet Oncology. Articles cover a wide range of topics, with a largely encouraging study on long-term outcomes for children exposed to chemotherapy in utero, and results from the Diagnosing Ovarian Cancer Early (DOvE) study were also discussed. Ginger’s potential role in cancer prevention was briefly explored, and the use of exemestane to prevent breast cancer was weighed against its possible effect on bone health. One of the newer journals on the site, the Journal of the Academy of Nutrition and Dietetics, is also updated this week. There is a review of the role of diet in nonalcoholic fatty liver disease, and a look at the impact of nutrition labels on college students’ eating patterns. A supplemental issue of the same title is another novel addition, with a closer look at the dietetics workforce.

Returning to the OB/GYN arena, we find the latest Obstetrics and Gynecology Clinics. This issue’s theme is preterm birth, and strategies for prevention as well as management are elucidated. The relationship between periodontal disease and preterm birth is examined, and corticosteroid treatment in both current and historical contexts is reviewed. The growing issue of early term births also comes in for consideration. Another Clinic with a specific focus for March is Clinics in Chest Medicine, which takes on interstitial lung diseases (ILDs). Diagnostic and radiological approaches to these diseases are detailed, as are genetic ILDs and those caused by smoking. Finally, lung transplantation is offered as a possibility for patients who fail to respond to other treatments.

Check back next week for more of what’s new on MD Consult.

photo by david__jones on flickr

This week, MD Consult published a number of asthma and allergy-related news stories. One of those articles followed up on recent research into the hygiene hypothesis of allergy and asthma, with a comparison of Amish children in the US and Swiss children in both farming and non-farming settings; both the rural Amish children and the Swiss farmers’ children had low rates of asthma, offering further support for the notion that early exposure to the wide range of potential allergens encountered in such settings helps ward off development of the disease. For those who do go on to suffer from asthma, a structured exercise program offered quality-of-life improvements, reported another news story, but it was also noted elsewhere that asthma guidelines are not always followed, for a variety of reasons.

In the Journals, the latest Annals of Emergency Medicine joined the site this week, and it features a number of articles examining disaster medicine from the emergency department perspective. Basic resource allocation principles are examined, and an editorial looks specifically at earthquakes; the authors feel that a new paradigm for response is long overdue. A further paper warns against changing standards of care in disasters, while another calls for national standardized all-hazard disaster core competencies for medical professionals. Also new for March is General Hospital Psychiatry, which includes globe-spanning articles examining subjects such as patients with somatic symptoms presenting to general hospitals in China, suicide risk among indigenous Australians and a mobile health clinic in India. A secondary analysis of the data generated in the COMET trial looked at feedback and prescribing patterns, and there is an unusual case report of thyroid storm being masked by acute psychosis.

Going back to the earlier allergy theme, there are a number of interesting articles in press for Immunology and Allergy Clinics of North America: one examines mental health quality-of-life issues in patients with food allergies, while another looks at the epidemiology of IgE-mediated food allergy and anaphylaxis. Other articles in press may be found in Anesthesiology Clinics, which will be covering pediatric pain management and recent advances in multimodal analgesia in future issues.

Check back next week for more of what’s new on MD Consult.