Patient Mgmt

May 17, 2015

Could a commonly prescribed antibiotic, when combined with a renin-angiotensin system inhibitor, lead to sudden death?  Angiotensin converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and spironolactone are frequently used in older adults for a variety of indications.

Comments: 0
May 4, 2015

We all have an innate desire for clarity in our decisions. Often, however, we are faced with controversy and uncertainty.  Grey areas where there is a gap between clinical practice, logical reasoning, and evidence.  One of these grey areas is the “right” approach to the peri-procedural management of chronic anticoagulation.  There are so many clinical decisions involved (See Table 1) and little clarity about any of them!


Comments: 0
Mar 30, 2015

To some, “home-based primary care” (HBPC) may evoke images of frail shut ins — unable to leave their homes due to physical, mental, or cognitive impairments.  Others imagine a nostalgic past when physicians made house calls to acutely ill patients.

Comments: 0
Jan 27, 2015

The American Heart Association reports that 1 out of 3 adults in the Unites States have high blood pressure and the direct and indirect costs exceeded $50 billion in 2009.

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Nov 4, 2014

Have you ever had difficulty convincing some of your patients that generic medications work just as well as their brand-name counterparts?  While there is little evidence to suggest that generic medications aren’t therapeutically equivalent, a more subtle and perhaps more vexing problem is now emerging.

Comments: 0
Jun 8, 2014

According to the Centers for Disease Control, the percentage of children diagnosed with attention deficit hyperactivity disorder (ADHD) has risen significantly from 7.8% in 2003 to 9.5% in 2007 and 11% in 2011.1 Could a common over-the-counter medication be to blame?  Acetaminophen is used by more than 50% of pregnant women in the United States for pain during pregnancy and is considered the first-line drug of choice.2 Historically it is regarded as safe, although a prev

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Dec 18, 2013

As baby boomers age, meeting their primary care needs will become increasingly difficult due to a diminishing number of physicians entering primary care practice, the increasing complexity of available diagnostic tools and treatments, and expanded access to care under the Patient Protection and Affordable Care Act.

Comments: 0
Dec 6, 2013

We’ve all encountered patients who’ve had difficulty taking their medications as prescribed.  Many of our patients don’t achieve the recommended treatment goals or derive much benefit their medications.  There are many reasons why patients don’t take their medications in an ideal manner — including cost barriers, unpleasant side effects, treatment complexity, and forgetfulness.  

Comments: 1
Nov 24, 2013

The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.”  - William Arthur Ward.

After a decade of waiting, new treatment guidelines on the management of cholesterol in adults were published on November 12, 2013.1,2,3 These guidelines depart quite significantly from previous recommendations and have already generated some controversy. Here are the top ten things every clinician should know and do.

Comments: 5
Sep 29, 2013

A 65 year old patient presents to your clinic with an A1C of 7.2%, a blood pressure of 146/80 mmHg and a LDL cholesterol of 103 mg/dL. Should you order a BNP level to determine the patient’s risk of developing heart failure?

Comments: 1
Sep 14, 2013

The recently published Look AHEAD trial found intensive lifestyle interventions had no benefit on cardiovascular (CV) morbidity and mortality in patients with diabetes mellitus (DM).  Could the results possibly be valid?  Should we stop emphasizing diet and exercise?

Comments: 1
Jun 21, 2013

When estimating a patient's renal function to determine an appropriate medication dose, many clinicians turn to the Cockcroft-Gault (CG) equation. But is this equation the best method to quickly assess and characterize renal function?

Comments: 0
Jun 14, 2013

Millions of Americans take a multivitamin daily. Millions do not. Should healthcare providers recommend a daily multivitamin to patients who do not already take one? Or discourage those who do?

Comments: 0
Aug 14, 2012

The Patient Protection and Affordable Care Act (PPACA but often called the ACA) was signed into law by President Barack Obama on March 23, 2010 after it passed both the House and Senate following 2 years of debate in Congress. On June 28, 2012, the US Supreme Court upheld the constitutionality of many of the most controversial provisions of the law – including the so-called “individual mandate” to purchase health insurance.

Comments: 4
Feb 29, 2012

“See you in four weeks!” This has been a common ending to most anticoagulation clinic appointments over the years.  But perhaps it’s time for this routine to change?

Comments: 1
Oct 20, 2011

Do you tell your patients to take levothyroxine in the morning 30 to 60 minutes before food and at least 4 hours apart from other medications?  It is well known that many medications and foods influence the absorption and distribution of thyroxine (T4).  Morning administration of levothyroxine, before meals and other medications, is recommended by expert consensus and the package insert

Comments: 2
Sep 29, 2011

The evidence regarding the benefits of statin therapy in patients with chronic kidney disease has been far from clear.

Comments: 1
May 10, 2011

For patients with atrial fibrillation, what’s the best scoring system to estimate stroke risk? Clinicians have long relied on the CHADS2 [congestive heart failure, hypertension, age ≥ 75 years, diabetes, and previous stroke or TIA] scoring system to make antithrombotic treatment decisions.

Comments: 2
Apr 26, 2011

Nearly two-thirds of all Americans diagnosed with high blood pressure are treated with medications - but fewer than half are controlled to their goal.

Comments: 1
Dec 7, 2010

If you are like me, you probably received a lot of phone calls from patients and prescribers when the news hit about the potential interaction between clopidogrel and proton pump inhibitors (PPIs).  In January 2009, the Food and Drug Administration (FDA) published data from an ongoing safety review of clopidogrel effectiveness, which resulted in a November 2009 Public Health Advisory that recommended avoiding of the combination of clopidogrel and any PPIs excep

Comments: 3