Can children really have bipolar disorder?

Conditions and Diseases
June 4, 2010

by James Baker, MD

Using the diagnosis “bipolar disorder” for children with problems in mood has been controversial ever since a surge in its use in the mid-1990’s.

A recent article in the Los Angeles Times gives the pros and cons on the use of “bipolar disorder” in children through the opinions of two psychiatrists on opposite sides of the controversy.

The problem with using “bipolar” is that it requires a too-loose interpretation …

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Can children really have bipolar disorder?

Shingles vaccine and the price of preventive care

Conditions and Diseases
June 3, 2010

They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.

Mr. GR, as I will call him, had recently turned 60 years young. Though he …

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Shingles vaccine and the price of preventive care

MKSAP: A 50-year-old woman is evaluated for a rash on the back of her elbows and knees

Conditions and Diseases
June 3, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old woman is evaluated for a rash on the back of her elbows and knees. A similar rash has occurred in the past, with her first episode as a young adult. She has used over-the-counter hydrocortisone cream without relief. She does not smoke or drink and is otherwise healthy.

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MKSAP: A 50-year-old woman is evaluated for a rash on the back of her elbows and knees

BMI should be routinely measured in pediatric patients

Physician
June 3, 2010

by Emily P. Walker

Physicians should record body mass index (BMI) of their pediatric patients during routine offices visits, according to a sweeping new plan laid out by a White House task force on ways to shrink childhood obesity rates over the next 20 years.

The inter-agency President’s Task Force on Childhood Obesity was formed three months ago as part of the Let’s Move! initiative and was given 90 days to draft …

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BMI should be routinely measured in pediatric patients

Patients who attempt suicide and withdrawal of medical care

Conditions and Diseases
June 2, 2010

If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?

Not from a legal standpoint, and not if you are living in the United States.

A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …

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Patients who attempt suicide and withdrawal of medical care

Patients who are dying and their awareness of death

Patient
June 2, 2010

by Brad Stuart, MD

Rob Pardi’s comments in Pallimed affected me deeply. His honesty, integrity, and willingness to share were so impressive that I feel reluctant to take issue with anything he had to say. Yet today I find myself somewhat in conflict with his message.

Rob’s wife, a palliative care doctor, died of cancer recently and her story, published in the New York Times made it sound as if …

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Patients who are dying and their awareness of death

Questions patients should be asking their doctors

Patient
June 2, 2010

An excerpt from Top 5 Questions to Ask Your Doctor

by Sagar Nigwekar, MD and James Sutton, RPA-C

Tips for Talking to Your Doctor

Entering a doctor’s office can be like entering a different world. There are often “rules” and “protocols” that the doctor, nurses, and staff follow that you may not be familiar with. This book offers some very helpful questions for you to have an intelligent conversation with …

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Questions patients should be asking their doctors

Working overtime can increase coronary artery disease risk

Physician
June 2, 2010

by Todd Neale

British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed.

After accounting for traditional cardiovascular risk factors and other variables, those working 11 to 12 hours per day had a 56 percent greater risk of coronary death, nonfatal myocardial infarction, or angina than those who worked normal hours, …

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Working overtime can increase coronary artery disease risk

Prevention improves health and lowers healthcare costs

Health Policy
June 2, 2010

Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.

Today, the U.S. basically has a medical care system rather than a health care …

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Prevention improves health and lowers healthcare costs

Academic internal medicine as a physician career choice

Medical Education
June 1, 2010

I received a wonderful inquisitive e-mail from a 1st year medical student.  He aspires to an academic internal medicine career and, as a non-traditional student with an MPH, has realistic goals.  He asks:

What scares me is the prospect of going into a relatively low-paying specialty in such a non-lucrative practice environment with such massive educational debt.  Are there any other challenges to going into internal medicine that are unique to …

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Academic internal medicine as a physician career choice

Nurse practitioners, doctors, and the lost art of diagnosis

Conditions and Diseases
June 1, 2010

The topic of nurse practitioners in the context of primary care has been resurgent of late, most notably in this post by Maggie Mahar. Much of the conversation is dominated by assertions such as this:

…Nurse Practitioners have the needed training and that, in fact, doctors who have gone through the full medical school curriculum are over-qualified for a job that, today, is more about coordinating …

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Nurse practitioners, doctors, and the lost art of diagnosis

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Cholesterol can be improved by eating nuts

Physician
June 1, 2010

by Todd Neale

Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found.

In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total cholesterol by 5.9% and LDL cholesterol by 7.4% (P<0.001 for both), according to Joan Sabaté, MD, DrPH, of Loma Linda University in California, and colleagues.

The ratios of total to HDL cholesterol and …

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Cholesterol can be improved by eating nuts

Clean your healthcare site to become more efficient

Physician
June 1, 2010

Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.

Is this something that you do at your healthcare site …

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Clean your healthcare site to become more efficient

Medical compliance from a patient perspective

Patient
May 31, 2010

The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must include a hefty dose of listening by both parties.

I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about …

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Medical compliance from a patient perspective

Proton pump inhibitors associated with fracture and C. difficile

Medications
May 31, 2010

by Charles Bankhead

Proton pump inhibitors (PPIs) significantly increased the risk of both fracture and recurrent infection with Clostridium difficile, investigators in separate studies reported.

PPI use increased the odds of spine, forearm/wrist, and total fractures by 25% to 50% over three years, but had no effect on the risk of hip fracture. Overall, the acid-fighters had a modest effect on bone mineral density (BMD), Seattle researchers reported in the May 10 …

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Proton pump inhibitors associated with fracture and C. difficile

How the oil shortage will affect hospitals and healthcare

Physician
May 31, 2010

I believe in the peak oil theory.

Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …

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How the oil shortage will affect hospitals and healthcare

Paperwork results in wasted work for doctors, insurers and patients

Health Policy
May 30, 2010

by Marianne Mattera

“I Hate [Insert Health Insurer Here]”

Not long ago I sent an e-mail with those headline words as the subject line — I have withheld the name of the insurer to protect . . . , well, myself.

A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. …

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Paperwork results in wasted work for doctors, insurers and patients

Waiting is a part of surgery, and how a surgeon perceives time

Physician
May 30, 2010

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …

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Waiting is a part of surgery, and how a surgeon perceives time

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