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Contemplating Suicide: A Physician's Guide to Dealing with the Suicidal PatientSuicide is often viewed as "a permanent fix to a temporary problem." Unfortunately, for many individuals, attempting suicide is the answer. Estimates suggest there are from 8 to 25 suicide attempts for every one completion. As more lethal methods are used, the number of completed suicides increases. Physicians often see patients in the month before completion of the act. To provide effective treatment, they must be aware of the risks, particularly the red flags that indicate imminent risk in their patients.
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Is Lung Cancer Screening Cost Effective?The National Lung Screening Trial, published in 2011, demonstrated that annual screening with low-dose computed tomography reduced lung cancer mortality by 20% among people aged 55-74 years. This data applied to people who had a smoking history of at least 30 pack-years and either continued to smoke or had quit within the last 15 years. This study examined the cost-effectiveness of this program.
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Honesty Is the Best Policy: Effective communication is essential for achieving a good death.Every day, an oncology nurse has a conversation with a patient that goes something like this: The patient asks, How much longer do you think I can live with this aggressive tumor?
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Are Gaucher Disease and Parkinsons Linked?Rare Disease Report sits down with Simon Heales, Ph.D., Professor of Clinical Chemistry at Great Ormond Street Children’s Hospital in London who discusses a potential link between Gaucher disease and Parkinson’s disease.
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Asystole during sleep in a 46-year-old male athleteA number of electrocardiographic abnormalities have been described in athletes.1 Among these are sinus bradycardia and varying degrees of atrioventricular (AV) block. These findings have been attributed to the "athlete's heart," and are felt to be due to enhanced vagal tone seen with excellent physical conditioning. Secondarily it has also been suggested that there are intrinsic changes within the sinoatrial and AV nodes themselves, including prolonged sinus node recovery time and AV nodal Wenckebach, and these abnormalities persist following autonomic blockade.
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Incidence of death and MI associated with stopping clopidogrel after ACSRates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.
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The Generalist's Approach to the Assessment and Management of Patients Suffering with Chronic PainCommunication skills, a better understanding of the presentation of chronic pain, and a methodical approach to evaluation and treatment are the keys providing better pain care. Chronic pain is a common clinical presentation, yet many physicians remain apprehensive and feel reluctant about caring for patients with this condition.
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Clinical Pearls on Lipid ManagementA panel of expert cardiologists share their clinical pearls for managing patients with hyperlipidemia.
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FCS and the Need for TreatmentsThis past year, James A. Underberg, MD, MS, FACPM, FACP, FASPC, FNLA, President of the National Lipid Association (NLA), outlines familial chylomicronemia syndrome (FCS) and the need for treatments, which may not be far.
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Incidence of death and MI associated with stopping clopidogrel after ACSRates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.
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Iatrogenic dilated cardiomyopathy and spectrum of current treatment modalitiesOur increasing ability to intervene in high-risk patients—with lower risks and greater chances for successful outcomes—is felt across the broad spectrum of cardiovascular disease. This is particularly evident in patients with dilated cardiomyopathy (DCM).
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Improved retinopathy in a patient with type 1 diabetes: A review of the role for HMG-CoA reductase inhibitors in the treatment of diabetic retinopathyA 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.
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Predictive Analytics: How Big Data Will Improve Outcomes and Efficiencies in Diagnosing and Treating PatientsWhat if insights from population data were able to help doctors predict a potential diagnosis months or even years earlier and be used to monitor these patients after a diagnosis is made?
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Fish Consumption and ACS: A Meta-AnalysisThe American Heart Association was one of the first organizations to advocate dietary changes to decrease the risk of coronary heart disease (CHD). The organization's first recommendation appeared in 1957 advising a decrease in the amount of fat intake to decrease atherosclerosis risk. Today, a different approach is recommended, which considers the diet as a whole, with recommendations of what to both include and avoid. Among other nutritional and lifestyle recommendations, the AHA advises the consumption of 2 servings of fish weekly for both men and women.
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Investigators Find Demographic Predictors of Up-to-Date Colorectal Cancer ScreeningsThere were several individual predictors including sex, age, recent visits with a primary care provider, distance to nearest endoscopy facility, and insurance type, as well as county-level predictors, such as percentage of residents with a high school education, without insurance, and unemployed as being up-to-date.
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Understanding the Obese PatientObesity rates have climbed nearly 50 percent since 1997, with as much as 30 percent of the population classified as obese. There is strong belief within the health care industry that obesity should be treated as a primary medical condition, with physicians playing a major role. Evidence suggests that patients are more likely to lose weight when they are advised by their primary care physicians to do so.
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Gender Disparities in Partner Abandonment Following Life-threatening DiagnosesWomen who have been diagnosed recently with cancer or multiple sclerosis are six times more likely to be separated or divorced than their recently diagnosed male counterparts, according to a study in Cancer.
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The World Beneath: Modern Psychiatry and the Folly of Self-diagnosisA patient recently sent me an e-mail explaining that, after consulting with her spouse and parents, she had changed her mind about taking the medication we discussed during her appointment.
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Mortality of patients with diabetes mellitus and acute myocardial infarctionWe evaluated trends in the treatment and mortality of patients with and without diabetes mellitus and acute myocardial infarction over the last decade. Despite improvements in the provision of evidence-based care, patients with diabetes did not derive improvements in long-term survival.
