January 29, 2007

New Guidelines Issued for Venous Thromboembolism

New Guidelines Issued for Venous Thromboembolism - CME Teaching Brief - MedPage Today

KANSAS CITY, Jan 29 -- New clinical-practice guidelines for the diagnosis and management of venous thromboembolism in primary care were released jointly by the American Academy of Family Physicians here and the American College of Physicians.

Key elements of the diagnostic guidelines include the use of clinical-prediction rules to establish the probability of deep venous thrombosis or pulmonary embolism prior to further testing.

The management guidelines support the use of low-molecular-weight heparin for patients with lower-extremity deep vein thrombosis in an outpatient setting, provided appropriate support services are in place.
Action Points

* Explain to interested patients that the newly released diagnostic guidelines for diagnosis of venous thromboembolism recommend the use of pretesting (with the Wells prediction rules) to determine the probability of DVT or pulmonary embolism before starting further testing.

* Be aware that the management guidelines support the use of low-molecular-weight heparin for patients with lower-extremity deep vein thrombosis in an outpatient setting, provided appropriate support services are available.

The guidelines, as well as a companion diagnostic-evidence review, were published online and in the January-February issue of the Annals of Family Medicine. They will also be published in the Feb. 6, 2007, issue of the Annals of Internal Medicine.

Posted by gruwell at 9:29 PM

October 30, 2006

What Medical Students Need To Know For The Internal Medicine Rotation

What Medical Students Need To Know For The Internal Medicine Rotation

What Medical Students Need To Know For The Internal Medicine Rotation

Posted by gruwell at 12:34 PM

Adhering to clinical guidelines decreases blood clots in the elderly

Adhering to clinical guidelines decreases blood clots in the elderly

Posted by gruwell at 12:33 PM

October 27, 2006

Guide to Clinical Preventive Services, 2006

Guide to Clinical Preventive Services, 2006

The Guide to Clinical Preventive Services includes U.S. Preventive Services Task Force (USPSTF) recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. This new pocket guide provides general practitioners, internists, family practitioners, pediatricians, nurses, and nurse practitioners with an authoritative source for making decisions about preventive services.

Posted by gruwell at 1:45 PM

August 24, 2006

Consensus Guidelines Simplify ICD Recommendations

Consensus Guidelines Simplify ICD Recommendations - CME Teaching Brief� - MedPage Today

Review
DALLAS, Aug. 22 -- Myocardial infarction survivors who have ventricular dysfunction as measured by an ejection fraction of less than 40% should receive implantable cardioverter defibrillators to prevent sudden cardiac death.

That's the uncomplicated and straightforward consensus of major U.S. and European heart groups that is spelled out in guidelines issued today called Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.

Posted by gruwell at 11:50 AM

August 3, 2006

New Atrial Fibrillation Guidelines Emphasize Stroke Prevention

New Atrial Fibrillation Guidelines Emphasize Stroke Prevention - CME Teaching Brief� - MedPage Today

Review
NEW YORK, August 2 -- Stroke risk trumps age, gender or other history of heart disease in determine which atrial fibrillation patients will benefit from anticoagulation, according to revised guidelines issued today by three major heart societies.

Stroke is a natural focus of the new guidelines, said Valentin Fuster, M.D., Ph.D., director of the Mount Sinai Cardiovascular Institute here, because atrial fibrillation is a major risk factor for stroke, and strokes associated with atrial fibrillation "are especially large and disabling."

Dr. Fuster co-chaired the writing committee for the revised guidelines, which were published online by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology. They appeared in Circulation, Journal of the American Heart Association, the Journal of the American College of Cardiology and the European Heart Journal.

Posted by gruwell at 4:34 AM

May 26, 2006

Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?

Arch Intern Med -- Abstract: Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?: An Evidence-Based Approach, May 8, 2006, Kaltenbach et al. 166 (9): 965

An Evidence-Based Approach

Tonya Kaltenbach, MD; Seth Crockett, MD; Lauren B. Gerson, MD, MSc

Arch Intern Med. 2006;166:965-971.

Lifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.

Posted by gruwell at 8:13 AM

April 20, 2006

Cochrane Review Backs Antibiotics for COPD Exacerbations

Cochrane Review Backs Antibiotics for COPD Exacerbations - CME Teaching Brief - MedPage Today

AUCKLAND, New Zealand, April 19 - Exacerbations of chronic obstructive pulmonary disease (COPD) should be treated with antibiotics, according to a systematic review published online today by the Cochrane Collaboration.

The review of 11 trials including 917 patients found that antibiotics reduced the risk of dying from the attack by 77%, decreased the risk of treatment failure by 53%, and decreased the risk of developing purulent sputum by 44%.

There was, however, a small increase in the risk of developing diarrhea with antibiotic therapy, said Felix Ram, M.D., of the Massey University here, and colleagues, online in the Cochrane Library, published by The Cochrane Collaboration, an international organization that evaluates medical research.

Posted by gruwell at 9:50 AM

April 10, 2006

Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Entrez PubMed

Abstract-- OBJECTIVE: To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression? METHODS: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence. Results and CONCLUSIONS: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.

Posted by gruwell at 5:17 AM

AAN: New Parkinson's Disease Treatment Guidelines Issued

AAN: New Parkinson's Disease Treatment Guidelines Issued - CME Teaching Brief - MedPage Today

Review
SAN DIEGO, April 7 - New guidelines for the treatment of Parkinson's disease, issued by the American Academy of Neurology, are more proscriptive than prescriptive.

"We did not describe in what order useful drugs for the treatment of Parkinson's disease should be used," said William Weiner, M.D., of the University of Maryland School of Medicine in Baltimore. "That still remains part of the art of medicine."

Yet the guidelines, released simultaneously in Neurology and at the AAN meeting here, were quite explicit about agents of neuroprotection -- drugs that can prevent or turn back the disease: There are none, the guidelines said.

Posted by gruwell at 5:13 AM

April 4, 2006

AACR: Celebrex Dramatically Reduces Adenoma Recurrence

AACR: Celebrex Dramatically Reduces Adenoma Recurrence - CME Teaching Brief - MedPage Today

WASHINGTON, April 3- The selective Cox-2 inhibitor Celebrex (celecoxib) is effective in reducing recurrence of benign or precancerous adenomas in patients at a high risk of sporadic colorectal cancer, according to two large chemoprevention trials.

One investigator, Nadir Arbor, M.D., of Tel Aviv Sourasky Medical Center, called it "proof of principle that chemoprevention is feasible" in sporadic colon cancer.

Dr. Arbor presented results today of the international Prevention of Sporadic Adematous Polyps (PreSAP) trial at the American Association for Cancer Research meeting. Monica Bertagnolli, M.D., of the Dana-Farber Cancer Institute and Harvard Medical School presented results of the Adenoma Prevention with Celebrex (APC) trial.

Posted by gruwell at 5:51 AM

March 28, 2006

Prescription Flip-Side: Guidelines for Medication Withdrawal

Newswise | Prescription Flip-Side: Guidelines for Medication Withdrawal


Newswise — Although thousands of scientific papers evaluate and compare new and established drugs each year, providing evidence to help doctors prescribe safe and effective doses, almost no studies focus on when or how to stop these medications, even late in life.

In the March 27, 2006, issue of the Archives of Internal Medicine, four University of Chicago physicians propose the first general framework for withholding or discontinuing medications, adding life expectancy, goals of care, treatment targets and time until benefit to the usual equation of drug plusses and minuses.

"Our framework was designed to help patients and physicians decide when to stop taking even safe and effective drugs in situations that are often radically different from those where the medications were started," said geriatrician Holly Holmes, M.D., instructor of medicine at the University of Chicago and lead author of the study.

"We wanted to provide a road map," she said, "that would steer people away from the prescribing cascade that is common for patients late in life and guide them past the barriers that prevent removal of treatments that may no longer be effective."

The impetus for the guidelines came from some misguided advice. The authors care for patients at a nursing home. The pharmacy that supplies the nursing home monitors physician-prescribing practices and offers suggestions. After one review, the pharmacy sent a fax pointing out that, according to accepted guidelines, two patients at the nursing home ought to be taking a statin -- a cholesterol-lowering drug that can, over time, reduce the risk of heart attack.

Posted by gruwell at 5:10 AM

March 21, 2006

New Evidence-Based Thyroid Nodule Guidelines

Newswise | New Evidence-Based Thyroid Nodule Guidelines

Newswise — The American Association of Clinical Endocrinologists (AACE) today announced the release of its medical guidelines for the diagnosis and management of thyroid nodules. The guidelines are published in the January/February 2006 issue of Endocrine Practice, a peer-reviewed journal of AACE.

AACE was the first major endocrine society to publish thyroid nodule guidelines for endocrine practice in 1996. The new guidelines take into account the advances and new strategies that have occurred in the management of thyroid nodules since the original guidelines were created.

The new guidelines were developed by a panel of experts who encompass different disciplines, including endocrinology, nuclear medicine, surgery, and evidence-based medicine. The task force was convened by AACE, the American College of Endocrinology (ACE), and the Associazione Medici Endocrinologi (AME). This document is the first collaborative effort between AACE and AME. The writing committee was comprised of 11 physician members of both societies, who were intentionally selected with the objective of creating a diversely opinionated group in order to strengthen their consensus opinions.

Posted by gruwell at 7:52 AM

November 11, 2005

Decision-Making Tool Reduces Inappropriate Antibiotics

Decision-Making Tool Reduces Inappropriate Antibiotics - CME Teaching Brief - MedPage Today

By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
November 10, 2005
MedPage Today Action Points

* Be aware that about half of antibiotic prescriptions are written for viral respiratory infections for which antibiotics are not indicated.

* Inform patients who request antibiotics for viral infections that not only will the drugs not help, but such unnecessary antibiotic use contributes to the serious public health threat posed by antibiotic resistant bacteria.

Review
SALT LAKE CITY, Nov. 11 - A community intervention aimed at reducing inappropriate antibiotic prescriptions -- plus a handheld digital assistant for doctors -- had a significant success, investigators here reported. But the antibiotic reduction was not necessarily enough to matter.

The intervention consisted of a series of meetings with community leaders, news releases in the print media, distribution of patient-education materials at pharmacies and doctors' offices, and a mailing to parents with children younger than six.

They all added up to an 11% reduction in inappropriate antibiotic use when the doctors were helped by the digital device.

Nevertheless, said Matthew H. Samore, M.D., of the University of Utah here and colleagues, it's unclear whether the 11% reduction would be enough to have any impact on the spread of antibiotic resistant bacteria.

The study included 407,460 inhabitants and 334 primary care clinicians in three sets of six rural communities in Utah and Idaho, the authors reported in the Nov. 9 issue of the Journal of the American Medical Association.

Posted by gruwell at 3:36 AM

November 10, 2005

IOM Report Finds Doctors Ill-Equipped for Cancer Survivors

IOM Report Finds Doctors Ill-Equipped for Cancer Survivors - CME Teaching Brief - MedPage Today

By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
November 09, 2005
Also covered by: CNN, NY Times, USA Today, Yahoo! News
MedPage Today Action Points

* Be aware that patients who survive cancer will require disease-specific follow-up care and should be given a long-term care-plan that includes information about how to reduce the risk of recurrence.

* Discuss with patients the various legal, financial and psychological support programs available to cancer survivors.

Review
WASHINGTON, Nov. 9 - The American health care system is poorly equipped to take care of the growing population of cancer survivors, which has tripled over the past 30 years.

So declared a report by the Institute of Medicine (IOM) issued this week. It was the theme of an all-day meeting at the National Academy of Sciences that brought together the American Society of Clinical Oncology and the IOM to thrash out problems surrounding cancer survivorship.

In "From Cancer Patient to Cancer Survivor: Lost in Transition, 2006," the IOM found that American doctors, particularly primary care physicians, have little training in the "benefits to patients of prevention and lifestyle change, and the complexities of integrating survivorship concerns with care for other chronic conditions."

Posted by gruwell at 9:56 AM

Sleep Disorder Increases Risk of Mortality

Sleep Disorder Increases Risk of Mortality - CME Teaching Brief - MedPage Today

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 09, 2005
Also covered by: ABC News, Forbes, MSNBC
MedPage Today Action Points

* Consider sleep apnea in patients who report restless sleep, loud snoring (with periods of silence followed by gasps), falling asleep during the day, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behavior changes, anxiety, or depression.

* Inform concerned patients that CPAP, while found in one study to be ineffective at increasing survival in patients with heart failure and central (neurologically-based) sleep apnea, has been reported to improve the quality of sleep for patients with obstructive sleep apnea.

Review
NEW HAVEN, Conn., Nov. 9 - Obstructive sleep apnea increases the risk of death from stroke or other causes, whether the sleeper has hypertension or not, according to research reported today.

Equally disquieting was the news that in patients with both central sleep apnea and heart failure, continuous positive airway pressure (CPAP) improves both sleep and cardiovascular function, but does not improve survival.

Those findings were reported in separate sleep apnea studies published in the Nov. 10 issue of the New England Journal of Medicine.

Posted by gruwell at 9:54 AM

November 8, 2005

Daily Aspirin Wards Off Cancer in Barrett's Esophagus

Daily Aspirin Wards Off Cancer in Barrett's Esophagus - CME Teaching Brief - MedPage Today

By Peggy Peck, Managing Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 07, 2005
MedPage Today Action Points

* Advise Barrett's patients that it is too preliminary to recommend NSAIDs as prevention for esophageal cancer.

* Explain to patients who ask about NSAID use that the drugs may increase risk of gastrointestinal bleeding and long-term NSAID use may increase the risk of cardiovascular events.

Review
SEATTLE, Nov. 7 - Patients with Barrett's esophagus who regularly take nonsteroidal anti-inflammatory drugs (NSAIDS) reduce their risk of neoplastic progression by 68% compared with Barrett's patients who never use NSAIDs, according to researchers here.

A prospective study of 350 patients with Barrett's found that the hazard ratio for neoplastic progression to adenocarcinoma was 0.32 (95% CI, 0.14-0.76) but dropped to 0.20 (0.10-0.41) for patients who were NSAID users at baseline and continued during five years of follow-up.

The hazard ratio among former NSAID users was 0.70 (95% CI 0.31-1.58), epidemiologist Thomas Vaughan, M.D., M.P.H., of the Fred Hutchinson Cancer Center here reported online today in Lancet Oncology. NSAID-users also had lower risk of aneuploidy and tetraploidy compared with never- users.

Posted by gruwell at 5:06 AM

November 7, 2005

Revised Guidelines for Hospital Acquired Pneumonia Stress Higher Doses and Shorter Duration of Antibiotic Treatment: Presented at CHEST

News - Revised Guidelines for Hospital Acquired Pneumonia Stress Higher Doses and Shorter Duration of Antibiotic Treatment: Presented at CHEST

By Amanda Strong

MONTREAL, CANADA -- November 4, 2005 -- When faced with a suspected case of pneumonia, hospital physicians should collect a lower respiratory tract culture, initiate antibiotic therapy immediately at high doses, and stop treatment earlier, researchers recommended in a presentation here at CHEST 2005, the American College of Chest Physicians annual meeting.

In addition, treatment should be tailored to culture results, according to newly released evidence-based guidelines for the management of hospital-acquired pneumonia presented on November 3rd.

Presenter Richard G. Wunderink, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States, said the new guidelines also include healthcare-associated pneumonia (HCAP), which was previously included in guidelines for community-acquired disease.

Posted by gruwell at 9:17 AM

Ongoing and Completed Clinical Trials in Pulmonary Hypertension Are Driving the Need for New Practice Guidelines: Presented at CHEST

News - Ongoing and Completed Clinical Trials in Pulmonary Hypertension Are Driving the Need for New Practice Guidelines: Presented at CHEST

By Amanda Strong

MONTREAL, CANADA -- November 4, 2005 -- It's been only a year since the last revision of the evidence-based practice guidelines for the diagnosis and management of pulmonary hypertension, but already much has changed.

"Because treatments have been evolving, we will be updating the treatment algorithm very soon," said Lewis J. Rubin, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of California, San Diego, La Jolla, California, United States.

Dr. Rubin is chair of the international panel of experts who developed the guidelines. He said an update to the medical therapy section of the guidelines is expected to be available mid-2006.

Posted by gruwell at 9:15 AM

Apple Shape Predicts Heart Attack Risk Better than BMI

Apple Shape Predicts Heart Attack Risk Better than BMI - CME Teaching Brief - MedPage Today

By Michael Smith, MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
November 04, 2005
Also covered by: Atlanta Journal-Constitution, Newark Star-Ledger
MedPage Today Action Points

* Advise patients that abdominal obesity is a major cardiovascular risk factor.

* Explain to patients that this study suggests that the key predictor of risk may be how the waist size relates to the hips, a high waist-to-hip ratio appearing to predict an increased risk of heart attack.

* Note also that the study implies that more people will be counted as "at risk" using waist-to-hip ratio criteria than would have been, based on body-mass index.

Review
A pot belly increases the risk of a heart attack.
HAMILTON, Ontario, Nov. 4 - A pot belly increases the risk of a heart attack -- even if the rest of the physique is as skinny as a beanpole.

The person with that build would have a low body mass index (BMI). Based on that, the person would be classified as having a low heart attack risk. But, insist researchers here, it's really the ratio between the distance around that pot belly and the circumference of the hips that tells the tale of risk.

Posted by gruwell at 9:14 AM

October 27, 2005

New AAAAI Guidelines Stress Flexibility in Asthma Therapy

New AAAAI Guidelines Stress Flexibility in Asthma Therapy - CME Teaching Brief - MedPage Today


By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
October 26, 2005
MedPage Today Action Points

* Take note that the new AAAAI asthma guidelines emphasize frequent assessment of symptoms in detail each time a patient sees a physician, with medication increased or decreased

*

Familiarize yourself with the new guidelines, available on the Journal of Allergy & Clinical Immunology web site at www.jacionline.org.

* Explain to patients that they should accept nothing but a well-controlled or completely controlled disease.

Review
MILWAUKEE, Oct. 26 - Rather than a rigid treatment regimen determined by an initial assessment of disease severity, asthma therapy should be flexible, responding to changes in symptoms.

So suggest new guidelines from the American Academy of Allergy, Asthma and Immunology (AAAAI) that emphasize the dynamic nature of the disease.

Posted by gruwell at 9:09 AM

October 3, 2005

Wonder Drugs" May Work Wonders for Pulmonary Arterial Hypertension

"Wonder Drugs" May Work Wonders for Pulmonary Arterial Hypertension - CME Teaching Brief - MedPage Today

Review

GIESSEN, Germany, Sept. 30-The "wonder drugs" Gleevec (imatinib) and Viagra (sildenafil) make strange bedfellows, but they both appear to improve pulmonary function in patients with pulmonary arterial hypertension (PAH), report researchers here.

They described the Gleevec case in a letter published in the Sept. 29 New England Journal of Medicine.

Click on the link above to learn more...

Posted by gruwell at 2:42 AM

September 15, 2005

It's High Blood Pressure That Triggers Heart Disease in Obese

It's High Blood Pressure That Triggers Heart Disease in Obese - CME Teaching Brief - MedPage Today


By Peggy Peck, Senior Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. September 14, 2005
Also covered by: Houston Chronicle, San Francisco Chronicle, Washington Post (Registration Req.)

Review
PARIS, Sept 14-It's not the fat per se that leads to cardiovascular disease mortality among the obese, according to a team of researchers here. The real culprit is the high blood pressure that is part and parcel with obesity.

"The important message in our study is that we observed that cardiovascular risk is not clearly increased unless hypertension is present in these overweight and obese subjects," said Athanases Benetos, M.D., Ph.D., of the Medical School of Nancy. "In our population, if the subject didn't have hypertension we didn't find that the subject had an increased risk of cardiovascular disease."

Posted by gruwell at 6:17 AM

September 14, 2005

New Global Guideline for Type 2 Diabetes Calls for Aggressive Treatment - CME Teaching Brief

EASD: New Global Guideline for Type 2 Diabetes Calls for Aggressive Treatment - CME Teaching Brief - MedPage Today

By Lynne Peterson, Special Correspondent, MedPage Today
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
September 13, 2005

Review
ATHENS, Sept. 13-The first Global Guidelines for Type 2 Diabetes were issued today by the International Diabetes Federation (IDF), and they call for a more aggressive treatment target than the American Diabetes Association guidelines' goal.

The IDF Guidelines, presented at the European Association for the Study of Diabetes meeting here, recommend maintaining glycosylated blood glucose levels (HbA1c) below 6.5%.


Posted by gruwell at 9:12 AM

NLM Mobile

NLM Mobile

Now a page that links you to PDA resources from NLM. Including:

MD on Tap
PubMed for Handhelds
Wireless System for Emergency Responders (WISER)
NCBI Bookshelf

Posted by gruwell at 8:42 AM

September 13, 2005

Heavy Drinking Increases Risk of Atrial Fibrillation

Heavy Drinking Increases Risk of Atrial Fibrillation - CME Teaching Brief - MedPage Today

Heavy Drinking Increases Risk of Atrial Fibrillation.
Click on the link above to read more...

Posted by gruwell at 6:09 AM

April 9, 2005

A blueprint for a sepsis protocol

A blueprint for a sepsis protocol.

Author: Shapiro Nathan I NI
From: Academic emergency medicine
Date: 20054
Volume: 12
Issue: 4
ISSN: 1069-6563
Pages: 352-359

Posted by gruwell at 12:18 PM

April 7, 2005

Clinical presentation, diagnosis, and management of gastroesophageal reflux disease

Clinical presentation, diagnosis, and management of gastroesophageal reflux disease.

Author: Cappell Mitchell S MS
From: The Medical clinics of North America
Date: 20053
Volume: 89
Issue: 2
ISSN: 0025-7125
Pages: 243-291

Posted by gruwell at 10:28 AM

Parenteral dihydroergotamine for acute migraine headache: a systematic review of the literature

Parenteral dihydroergotamine for acute migraine headache: a systematic review of the literature.

Author: Colman Ian I
From: Annals of emergency medicine
Date: 20054
Volume: 45
Issue: 4
ISSN: 0196-0644
Pages: 393-401

Posted by gruwell at 10:22 AM

April 4, 2005

Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field

Best practice guidelines in pediatric/adolescent weight loss surgery.

Author: Apovian Caroline M CM
From: Obesity research
Date: 20052
Volume: 13
Issue: 2
ISSN: 1071-7323
Pages: 274-282

Posted by gruwell at 10:03 AM

Best practice recommendations for surgical care in weight loss surgery

Best practice recommendations for surgical care in weight loss surgery.

Author: Kelly John J
From: Obesity research
Date: 20052
Volume: 13
Issue: 2
ISSN: 1071-7323
Pages: 227-233

Posted by gruwell at 9:59 AM

March 21, 2005

New Science.gov Service Delivers Science Information to Desktops

Alliance helps public stay alert to the latest science discoveries from 12 federal
science agencies, introduces Science.gov Alert Service

Science.gov, the go to Web portal for federal science information, now provides a free and convenient Alert service that delivers information about the most current science developments right to desktops each Monday.

Launched at the annual meeting of the American Association for the Advancement of Science (Feb. 17-21, 2005) in Washington, D.C., the Science.gov Alert Service provides weekly emails to those interested in science across the nation.

From the Science.gov homepage (www.science.gov), individuals can set up an account and let Science.gov do the searching for them. Each week, up to 25 relevant results from selected information sources will be sent to the subscriber's email account. Results are displayed in the Alert email and in a personalized Alert Archive, which stores six weeks of alerts results. In the Archive, past activity can be reviewed and Alert profiles edited.

Read more...Science.gov

Posted by gruwell at 10:46 AM

March 1, 2005

POEMs and Tips

Resources from the American Family Physician

http://www.aafp.org/afp/20050215/tips/index.html

Posted by gruwell at 11:27 AM

Excerpta Medica Launches Interactive Learning Tool for Health Care Practitioners

ThrombosisClinic.com is an educational web site for healthcare practitioners with an interest in the prevention and management of thrombosis, which remains one of the leading causes of death in the United States. By offering CME/CE programs and key resources, we address the many clinical challenges facing healthcare professionals and their patients. Aimed at being the primary resource for thrombosis education, our daily updates and input from leading experts in the field provide the latest advances in treatment, as well as tools and materials to help answer practical questions.

ThrobosisClinic.com

Posted by gruwell at 11:25 AM

September 1, 2004

March of Dimes Perinatal Data Center launches new PeriStats Web site

NEW PERISTATS WEBSITE PROVIDES EASY ACCESS TO MORE THAN 60,000 GRAPHS, MAPS, AND TABLES ON PERINATAL HEALTH

WHITE PLAINS, N.Y., AUGUST 17, 2004 - The March of Dimes announced today that it has released a complete redesign of its popular PeriStats Web site, offering the most current and detailed maternal and infant health statistics available in the United States. Funding was provided by the National Library of Medicine, National Institutes of Health through a 2-year grant collaboration with the New York Academy of Medicine.

The new PeriStats Web site offers state-specific perinatal data, including detailed data for the largest cities and counties in the United States, and is available free of charge at www.marchofdimes.com/peristats. Founded on research aimed to understand how different audiences use health-related data, the new PeriStats system was designed to compile vast amounts of information, and make it useful and accessible for health professionals, researchers and the news media. Despite the large volume of information, all data is available within two clicks of any Web page.

March of Dimes Link

Posted by gruwell at 4:30 PM

August 18, 2004

MedlinePlus tour

Usted puede optar por hacer el tour en forma continua o seleccionar slo las secciones que son de su inters. En este ltimo caso usted podr navegar la seccin elegida y familiarizase con todas sus caractersticas.

Link: http://www.nlm.nih.gov/medlineplus/spanish/tour/tour.html

Posted by gruwell at 11:15 AM

July 16, 2004

Best Practice of Medicine: from Merck Medicus

Check out the new format from Merck Medicus, its free!

We are currently updating our database of articles in Best Practice of Medicine to include the following features, for quick access to the information you need:
Briefs & Reports
Best Practice Briefs list clinical action points that link to how-and-why details in the full Report for quick access to the level of information you need.
Evidence Highlights
Clinical recommendations that are strongly supported by research evidence are flagged in Briefs and Reports. All evidence highlights are linked to the original research abstracts or full text, and our experts provide insightful commentary.
News and Alerts
Breaking clinical news, with links to original literature, is added daily to relevant articles. News stories with immediate implications for your practice become Alertsincluding analysis and targeted recommendations from the Best Practice Of Medicine experts. Alerts are highlighted in relevant Best Practice of Medicine articles.
Patient Handouts and Emails
Parallel articles from our Patient Guide can be printed or emailed with your customized instructions.
What Your Patients and Colleagues Are Asking
Questions stimulated by the article are given detailed answers by our experts.

Web Link

Posted by gruwell at 7:30 AM

July 8, 2004

Clinical Trials for Complementary and Alternative Medicine

NCAM: National Center for Complementary and Alternative Medicine

This sites extracts complementary and alternative medicine
clinical trials from ClinicalTrials.gov.

http://nccam.nih.gov/clinicaltrials

Posted by gruwell at 5:01 PM

June 4, 2004

ICD-9 Codes for your PDA or PocketPC

"Keeping up-to-date in this age of information overload can be difficult. But not anymore. Mobile Medica has a convenient, cost-effective solution - APPRISOR. APPRISOR is a world class content delivery system specifically designed for medical organizations. In the APPRISOR system, Mobile Medica provides a single source for document creation and delivery via our robust and freely distributed document viewers for either Palm OS or Microsoft Pocket PC handhelds. Each APPRISOR document can be read on both Palm OS or Pocket PC OS systems, and even transferred between the two. APPRISOR supports Palm OS 3.0 and above including OS 5 and Pocket PC 2002 on ARM, XScale, MIPS, or SH3 processors."

Link: http://www.apprisor.com/information.cfm

This site does require registration, however the downloads are free.

For registration go to: http://www.apprisor.com/information.cfm

For downloads go to: http://www.apprisor.com/dlselect.cfm

The Apprisor reader and the Common ICD9 Codes, 2004 Edition files may be downloaded at the same time. Clinical Practice Guidelines are also available at this site.


Posted by gruwell at 8:46 AM

May 19, 2004

University of Cincinnati: Selected List of Free Medical PDA Software

The following Web site contains links to a variety of "Free" medical software including alters, calculators, databases, EBM, infectious disease, and Practice Guidelines.

Link: http://aitl.uc.edu/reference/elec/pda.cfm#Alerts

Also, check out "MedNotes to be sure"
Link: http://www.smartie-ist.org/en/presentation/index.php

Posted by gruwell at 8:40 AM

May 14, 2004

Bandolier: Evidence based thinking about healthcare

What is Bandolier?

The first issue of Bandolier, an independent journal about evidence-based healthcare, written by Oxford scientists, (RAM AND HJM) was printed in February 1994. It has appeared monthly ever since and has become the premier source of evidence based healthcare information in the UK and worldwide for both healthcare professionals and consumers.

The award winning electronic version of Bandolier (www.ebandolier.com) now has over one million visitors each month from all over the world. Whilst many visitors are healthcare professionals, Bandolier is also a source of high quality information for many patients and their carers, as well as for organisations that commission and pay for healthcare.

The impetus behind Bandolier was to find information about evidence of effectiveness (or lack of it), and put the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.

Each month PubMed and the Cochrane Library are searched for systematic reviews and meta-analyses published in the recent past. Those that look remotely interesting are read, and where they are both interesting and make sense, they appear in Bandolier, first in the paper version and, after two months or so, on the website.

For other web content (such as the specialist resource areas) we search over all times, and where necessary, do systematic reviews ourselves. Other types of information, like large epidemiological studies, may be included if they shed important light on a topic.

Link: http://www.jr2.ox.ac.uk/bandolier/index.html

Spanish Version: http://www.infodoctor.org/bandolera/

Posted by gruwell at 3:39 PM

May 11, 2004

TRIP Database Plus

About TRIP

From a small beginning the TRIP Database has developed and grown into one of the world's foremost medical internet resources. The ethos behind its creation is as applicable today, and perhaps more so, than in 1997 when it was launched. The TRIP Database was created as a result of the explosion of 'evidence based materials being published. Unfortunately, for the health professionals, this high-quality material was being placed on the separate publishers websites which made locating the material difficult. Has a busy health professional got the time to visit 15 websites looking for the material they need?

Initially, the site contained 1,100 links to evidence based articles from 15 separate sources. Since then it has grown in terms of both coverage and usability. This expansion has also encompassed the addition of new forms of material including 'eTextbooks' and medical images giving the site a more rounded clinical appeal.

The basic principle has stayed the same since the start of the site. A high-quality resource is identified that allows unhindered access to the publication. The Title, URL and Date of Publication is recorded and added to the database. Subsequently the URL is 'spidered' and this process 'captures' the relevant text from the site and uses that to allow text searching.

(Allows 5 free searches a week)

More info at: http://www.tripdatabase.com/index.cfm?method=application.home

Posted by gruwell at 12:32 PM