The US House of Representatives and the US Senate versions of the health care reform bill have grown further apart. Although a bill containing a public option has passed in the House, Senate Democrats announced that they have agreed on a package of provisions to replace the public option.
For 1 month, a 60-year-old white man has had increasing fatigue, generalized weakness, and exertional dyspnea. He becomes short of breath after he walks only 100 to 150 yards on level ground or climbs only 1 flight of stairs. In addition, he has unintentionally lost 12 lb in the past month and has experienced intermittent dysphagia with solid foods. He attributes this last symptom to long-standing gastroesophageal reflux disease (GERD), for which he regularly takes over-the-counter omeprazole.
When taking a patient’s sexual history, I find that the question “How many partners do you have?” rarely elicits a complete picture. Instead, I ask, “How many partners have you had in the past 6 months?” This usually reveals when patients have engaged in serial monogamy and creates an environment in which they feel they can disclose one-night stands and sexual activity outside their marriage. The stage is then set for delivering appropriate safe sex messages and screening for sexually transmitted infections.
To help ensure that the annual foot examinations required in patients with diabetes are performed, we have a sign at the front of each examination room that says, “If you have diabetes, please take off your shoes before seeing the provider.” We have also instructed our nurses to ask all patients with diabetes to remove their footwear. These measures have saved physicians time and increased the rates of diabetic foot examinations and neuropathy screenings.
Irrigating a child’s eye to wash out a toxic substance can be difficult. An effective way for a parent to do this is to put the child in the bathtub, turn on the water, and let the water run onto his or her own arm, starting at the elbow and running down to the hand. If the parent then holds his fingers over the child’s eye while gently opening the lid, the water will run down his arm, off the tip of his index finger, and into the child’s slightly opened eye.
The multiple, symmetrically distributed, soft, nontender swellings on the shoulders and torso of a 56-year-old Hispanic man are characteristic of multiple symmetric lipomatosis (MSL), also known as Madelung disease or Launois- Bensaude syndrome.
My interest in mental health began before I was a psychiatrist-it started in a small Central American country where I arrived as a primary care physician in the early years of the Peace Corps.
The results of a recent study showed that children and adolescents with serious mental illness treated with second-generation antipsychotic medications are likely to experience rapid weight gain.
Dozens of guidelines and algorithms are available from a range of authoritative sources to guide selection of psychopharmacology.
Health care reform is the topic of every conversation, it seems, and many of these conversations are quite impassioned.
In early November, the FDA announced the launch of the Safe Use Initiative, a program to protect patients from injury and death caused by improper use of over-the-counter and prescription medications.
Only 25% of adults in the United States aged 50 to 64 years receive recommended preventive health services, including influenza vaccination, cholesterol screening, and breast and cervical cancer screening.
At Consultant, our goal is to provide the practical, authoritative information you need to best serve your patients. That is why we “pre-test” article ideas (before we invite articles on those topics) to be sure they are of real interest to you and your colleagues. It is also why we take great care in checking facts, creating useful tables and figures, and choosing illustrations and photographs to enhance teaching messages.
SSRIs and related antidepressants are great drugs for the treatment of depression, anxiety, premenstrual disorders, and other conditions. However, sexual dysfunction is very common and affects 30% to 70% of patients,1 or 36% to 43% of patients depending on the particular medications and the study protocol.2 Men are somewhat more likely than women to have difficulty, especially with the desire phase of sexual function. However, it is clear that patients of both sexes may have either phase-specific or global sexual dysfunction while taking antidepressants.
Huskamp and associates recently reported that in the year following the implementation of Part D, many patients dually eligible for Medicaid and Medicare benefits had difficulty gaining access to psychiatric medications.
The Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) was held in Cape Town, South Africa, from July 19 to 22, 2009. More than 5500 delegates from more than 100 countries attended this annual event.
To ensure accurate joint injections, mark the site by firmly pressing the end of a closed ballpoint pen against the patient's skin.
Neurosarcoidosis has not been reported in patients with HIV infection. We present the case of a patient with AIDS in whom spinal cord sarcoidosis developed years after highly active antiretroviral therapy was initiated and her immune system was reconstituted. Treatment with prednisone resulted in resolution of MRI lesions and symptoms. Since patients with HIV-1 infection who are receiving antiretroviral therapy can survive for many years, physicians should be aware of chronic immune restoration disease involving the CNS.
As even the busiest clinician knows, patients are using the Internet for medical information.
Bilateral retrobulbar optic neuritis developed in a 38-year-old woman with advanced HIV infection. This was secondary to varicella-zoster virus (VZV) infection, confirmed by polymerase chain reaction detection of VZV in the patient's cerebrospinal fluid. There was no evidence of retinitis, and the ocular symptoms preceded the rash. This case illustrates that a new onset of unexplained visual loss resulting from optic neuritis in an HIV-positive patient may be caused by VZV infection. Clinicians should be aware of this unusual manifestation of VZV infection. Prompt recognition and early intervention with antivirals are needed, but it is unclear how much vision can be preserved.
