Is the stethoscope becoming outdated? | Obesity and asthma impairment | Anxiety and pediatric cyclic vomiting syndrome
July 23, 2015
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Is the stethoscope becoming outdated?
During the past hundred years, the three major symbols representing the bedside physician have been the "black bag," the white coat, and the stethoscope. It was a badge of honor during my second year of medical school to obtain all three items in anticipation of seeing patients on the hospital wards after the preclinical lecture hall experience. The stethoscope dangling from the pocket of the white coat or wrapped around the back of the neck meant to the outside world that you were now a member of the healing profession. The American Journal of Medicine (7/2015) Share: Email
Clinical Updates
Obesity and asthma impairment
Although obesity is associated with increased asthma incidence, its role in asthma control is less clear. This study identified adults with persistent asthma in 2006 with a BMI measurement in 2006 or 2007, categorized as normal (<25 kg/m2), overweight (25-29.9 kg/m2), or obese (≥30 kg/m2). In the 10,233 eligible adults -- after adjusting for potential confounders -- the authors found an increased relative risk (RR) of asthma hospitalizations or emergency department visits in overweight and obese individuals (RR 1.40, 95 % CI 1.10-1.78). Only obesity was associated with a significant increased RR of dispensing of ≥7 short-acting beta-agonist canisters (RR 1.27, 95 % CI 1.15-1.40). These findings further support the importance of facilitating weight loss in overweight and obese adults with asthma. The Journal of Allergy and Clinical Immunology: In Practice (7/2015) Share: Email
Anxiety and pediatric cyclic vomiting syndrome
Cyclic vomiting syndrome (CVS) is characterized by recurring episodes of high-intensity vomiting that can last for hours or days; between episodes, patients typically are healthy. Children with pediatric CVS and their parents completed screens for emotional disorders and health-related quality of life (HRQOL). Children with CVS appear to be at an increased risk for anxiety, which is a strong predictor of their HRQOL. Assessment and treatment for anxiety in children with CVS may positively impact HRQOL. The Journal of Pediatrics (7/2015) Share: Email
Egg consumption in attention deficit disorder or low IQ
In this three-month Chinese study of 171 school-age children with low IQ scores or diagnosed with attention deficit disorder, dietary supplementation with eggs rich in ω-3 polyunsaturated fatty acids, in contrast to ω-3-deficient eggs, was found to improve significantly visual acuity and red blood cell fatty acid profiles. Docosahexaenoic acid profiles in the two groups showed no significant difference. Nutrition (7/2015) Share: Email
Nursing home organization and overprescription
Can large numbers of physicians on a nursing home's faculty lead to an overabundance of neuroleptic drug prescribing? French researchers who looked at nursing home characteristics and prescribing patterns found that organizational difficulties due to a large number of physicians writing prescriptions may well explain inappropriate neuroleptic drug prescriptions. The structure of the nursing home in France differs in that the general practitioner writes the drug prescriptions, while the geriatrician plays a more administrative role. Journal of the American Medical Directors Association (7/2015) Share: Email
Cardiorespiratory fitness protects against depression
Adolescents with greater cardiorespiratory fitness have fewer depressive symptoms at any given point in time. In addition, cardiorespiratory fitness, particularly among girls, may help prevent the onset of new depressive symptoms during middle school. Journal of Adolescent Health (7/2015) Share: Email
Death delusions and acyclovir toxicity
Patients with a recent history of herpes zoster infection and underlying chronic kidney disease are most vulnerable to developing acyclovir-induced neurotoxicity. Altered mental status in the setting of acyclovir or valacyclovir use for herpes zoster infection can suggest either drug toxicity or viral encephalitis, but certain symptoms have increased specificity for toxicity. These include myoclonus and neuropsychiatric symptoms, such as death delusions and depression. Together, recognition of these symptoms, accurate medication reconciliation, and assessment of clinical context -- especially identification of the risk factor of renal insufficiency -- result in prompt recognition of drug toxicity, early initiation of treatment, and improved clinical outcomes. The American Journal of Medicine (7/2015) Share: Email
Medical News
Study finds greater likelihood of cardiac arrest among black patients
Researchers who looked at cardiac arrest data from Oregon found black patients are more likely than white patients to experience sudden cardiac arrest, and black patients tend to be more than six years younger when the event occurs. The study, reported in the journal Circulation, found more heart problems among black patients, such as thickened ventricle walls, rhythm disorders and conditions that impair the pumping of blood. Black patients also were more likely to have diabetes, kidney disease and high blood pressure. Reuters (7/20) Share: Email
Study links daily soda consumption to increased type 2 diabetes risk
A review in The BMJ found a daily serving of sugar-sweetened drinks increases type 2 diabetes risk by 13% over a decade, after accounting for weight. Lead author Fumiaki Imamura said that the regular consumption of refined sugar can raise insulin resistance even in normal-weight people. HealthDay News (7/21) Share: Email
Report shows increasing rates of children living in poverty
The Annie E. Casey Foundation's annual Kids Count report on child well-being found 22% of U.S. children lived in poverty in 2013, up from 18% in 2008. Minnesota ranked at the top of the list for well-being, while areas of the South and Southwest had the most serious problems, and poverty rates almost doubled for African-Americans and American Indians. WOIO-TV (Cleveland)/The Associated Press (7/21) Share: Email
Business Practice News
AHRQ seeks to establish "learning network" for clinical decision support
The Agency for Healthcare Research and Quality is seeking approval and funding for a new clinical decision support program. The patient-centered outcomes research CDS Learning Network will be designed to engage stakeholders, identify roadblocks and facilitators of CDS for PCOR findings, and establish recommendations for best clinical practices. (7/15) Share: Email
Health groups developing patient matching, registration program
The specifications and design for the Virtual Clipboard Initiative's patient matching and patient registration pilot program have been released. The Sullivan Institute for Healthcare Innovation is working with the Workgroup for Electronic Data Interchange, HIMSS and the Medical Group Management Association on the project. Healthcare IT News (7/17) Share: Email
Patient's Perspective
Pills' appearances color patients' expectations, study finds
Patients in the U.S., China and Colombia estimate a pill's effectiveness and ease of use based on its color and shape, according to a study in the journal Food Quality and Preference. Study participants viewed white pills as most effective for headaches and rated red and blue pills as harder to swallow. The Wall Street Journal (tiered subscription model) (7/20) Share: Email
Success depends upon previous preparation, and without such preparation there is sure to be failure."
-- Confucius,
philosopher and teacher Share: Email
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