Clinical Issues
Abuse/violence | Addiction/substance abuse | Adolescent medicine | Aging | Alternative & complementary therapies | Alzheimer's/aging | Autoimmune diseases/disease management | Bioterrorism | Cardiovascular disease | Cancer | Communication | Diabetes | Diagnosis | Disaster response | Disease Management | End of life | Gastrointestinal illness | Gender-based medicine | Genetics | Guidelines/evidence-based medicine | Headache | Health care access | Hospital medicine | Infectious diseases | Lung diseases | Mental health | Nephrology | Obesity | Pain management | Patient safety | Pulmonary medicine | Referrals | Revitalization | Screening tests | Sleep disorders | Stroke rehabilitation | Titration | Miscellaneous
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Abuse/violence
Recognizing the signs of domestic violence
Abuse may cause many complaints—but few patients will volunteer their story. (June 2006)
Tips to recognize—and respond to—domestic violence
Learning how to gently ask for information is the first step toward helping abused patients (March 2001)
Tips for detecting and preventing violent behavior in teens
Recent school shootings should serve as a wake-up call to screen all teenagers for psychosocial risk factors (May 1998)
Tips for detecting—and treating—domestic abuse
By asking the right questions and using some simple strategies, physicians can do a better job (February 1998)
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Addiction/substance abuse
Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)
Smoking Cessation
For patients, smoking represents a physical and psychological dependency; for physicians, smoking cessation is a frequent source of frustration. (October 2005)
Empathy, engagement are key to treating alcoholism
It is important to screen and identify every patient for substance abuse. (June 2005)
Strategies to help patients change their behavior
While relapses may be seen as a failure, they are a critical time for physicians to intervene. (June 2004)
When it comes to smoking cessation, more is better
From counseling to combination therapies, sustained engagement and education can break a ferocious habit. (June 2004)
With smoking cessation drugs, dosing is key
By using the right drug doses and combining therapies you can take some concrete steps to help patients stop smoking for good. (April 2002)
How to convince patients it's time to quit
To help patients stop smoking, you must find the motivation that best fits each patient's individual circumstances. (Web only)
Tips to spot patients who abuse prescription drugs
An addiction specialist gives pointers on how to spot drug-seeking patients—and how to avoid becoming entangled with them. (April 2002)
Treating alcohol problems in primary care settings
Physicians should be empathetic and optimistic about the efficacy of treatment (June 2000)
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Adolescent medicine
More teens are on drugs—the legal kind
Survey shows increases in adolescent prescriptions for chronic and mental illness (November/December 2007)
Internists wanted for complex adolescent care
A growing number of childhood disease survivors need to transition from pediatric care. (December 2004)
Struggling to treat teens? Try talking to them
How physicians can help adolescent patients dealing with risky behaviors and psychosocial stress (May 2001)
Tips for detecting and preventing violent behavior in teens
Recent school shootings should serve as a wake-up call to screen all teenagers for psychosocial risk factors (May 1998)
With teens, talk is the most valuable treatment tool
How to ask the right questions to get the real answers about sex, drugs and other issues (July/August 1997)
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Aging
Simple assessment helps doctors break patient’s falls
Medicare to add assessments to its quality reporting initiative and pay more to doctors who make it routine (June 2007)
Geriatric guidelines help—until there are too many
The studies used to create guidelines don’t always include elderly patients. (June 2007)
A new look at the elderly and how to care for them
Medical groups band together in an effort to convince internists to improve their knowledge of geriatric issues. (January-February 2007)
Ranks of disabled elderly drop sharply. (January-February 2007)
Patients' fears help keep incontinence in the closet
Bringing up the issue in annual exams and suggesting simple solutions can help patients gain better control. (March 2006)
How to detect and treat gait disorders
Taking time to assess gait is an important part of patient evaluation. (November 2005)
New advisory on antipsychotics may limit care options
If the drugs' risks now outweigh their benefits, where do physicians and patients go for help? (July-August 2005)
Letters
Readers discuss substance abuse in the elderly, coding issues. (December 2003)
Alzheimer's or age? Some tips to make the right diagnosis
Tips to recognize dementia—and strategies to avoid mistaking common conditions for Alzheimer's. (September 2003)
Caring for seniors: making the most of 20-minute visits
Innovative ways to save time while improving patient care for the elderly. (July-August 2003)
Geriatric assessment tools
A collection of forms to help you assess elderly patients for common geriatric conditions. (Web only)
The MKSAP Challenge
How do you prevent fractures in an elderly patient on a multi-drug regimen? (June 2003)
Strategies to prevent falls in high-risk elderly patients
Assessing patients' risk factors, managing patients with a history of falls and educating patients to reduce those risks. (May 2003)
Three developments that could change how you treat osteoporosis
New screening guidelines, fears about HRT and a breakthrough medication bring changes to skeletal care (January 2003)
Do you know what to look for in Alzheimer's patients?
Generalists rarely catch the diagnosis. Here are tips to help identify—and treat—Alzheimer's disease (June 2001)
Working in geriatrics: Look beyond chronic conditions
Internists need to use screening tools to focus on geriatric patients' overall health and function (May 1997)
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Alternative & complementary therapies
Proof or promise? Get the facts on CAM
Growing evidence base helps doctors advise patients about alternative therapies (November/December 2007)
If physicians don't ask, patients won't tell about CAM
Reassuring patients that they won't be judged or dismissed can help open up the lines of communication (November/December 2007)
How to help patients who use alternative medicine
With alternative therapies booming, you need to identify patients' nonconventional treatments (June 2001)
Do 'natural' treatments put your patients at risk?
Unlike complementary therapies, alternative medicine offers products and techniques that may be hazardous (May 2001)
What you need to know about herbal supplements
The number substances available continues to grow, creating confusion among physicians (June 2000)
Safety, communication issues slowing internists' use of alternative medicine
Physicians must view alternative medicine as a reality in today's practice environment (June 1999)
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Alzheimer's/aging
Alzheimer's Disease
Prevention, diagnosis and treatment overview
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Autoimmune diseases/disease management
New research evaluates RA patients’ cardiovascular risks (January 2008)
Options and challenges in treating RA
Drugs give better control of a once-crippling disease—but need close monitoring. (October 2004)
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Bioterrorism
Bioterrorism agents physicians should know
An overview of major symptoms and treatments for six biological agents (Annual Session News 2003)
New CDC guide to smallpox vaccination has photos of normal and adverse reactions (March 2003)
As the country gears up for smallpox vaccinations, physicians find themselves on the front lines
Prophylactic immunizations may protect you, but are they necessary—or safe? (January 2003)
The trouble with vaccines to fight bioterrorism
While vaccines seem like an obvious line of defense against bioterrorism, available drugs are not viable options (June 2002)
Lessons learned from last fall's anthrax attacks
Maryland's bioterrorism coordinator talks about her state's response to the anthrax attacks—and their plans to prepare for future attacks (April 2002)
Are you prepared to respond to bioterrorism?
Doctors will have to trigger the alarm—and make tough calls about patient care (December 2001)
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Cancer
'Tumor boards' take team approach to breast cancer (October 2007)
Genomic tests may allow some breast cancer patients to avoid chemotherapy (October 2007)
Breast density stirs debate over screening standards (September 2007)
Despite the evidence, PSA testing sparks controversy. (July-August 2007)
Author speaks out about controversial lung cancer study
New data suggest that routinely screening high-risk patients pays off in early diagnoses, but critics are skeptical. (January-February 2007)
Breast Cancer
Sorting through the options for screening and treatment. (October 2006)
Recurrence, side effect challenges in colon, breast cancer
As more cancer patients survive, internists must be ready to switch gears from treatment to surveillance. (June 2006)
Colorectal cancer
Early detection, usually before any symptoms occur, correlates with curability. (May 2006)
Cancer survivors are getting lost to follow-up
Late effects among survivors have become more common, due to the increasing complexity of cancer treatments. (March 2006)
Medicare's new office-drug payment policy has oncologists concerned about access
Because of reduced fees, physicians say office infusion services may be at risk. (April 2004)
In cancer treatment, targeted therapies are giving physicians and patients hope
New, focused drugs have produced dramatic results, but more challenges remain. (December 2003)
New thinking on 'precancers' shows promise
Armed with data and drugs, researchers' focus is on prevention, not just treatment (February 2003)
Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure. (September 2002)
The pros and cons of screening for three cancers
New research calls into question the assumption that detecting cancers earlier saves lives. (June 2002)
In prostate debate, doctors and patients often at odds
Treatment is not always necessary and therapies can have serious side effects, but patients demand action (May 1997)
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Cardiovascular disease
New research evaluates RA patients’ cardiovascular risks (January 2008)
Think outside the box when faced with difficult hypertension (June 2007)
Failures become lessons learned in cardiology research. (May 2007)
Coronary artery disease in women
Evidence-based recommendations about care. (May 2007)
Teamwork helps close the gaps in cardiovascular care
One internist's advice for getting lipid screenings to 100%—give up the idea that doctors have all the answers. (December 2006)
Chronic Heart Failure
Current recommendations about care. (November 2006)
Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)
Stroke and transient ischemic attack
Ten years after the approval of tissue-plasminogen activator (tPA), only a small percentage of patients experiencing an ischemic stroke receive the clot-busting drug. (September 2006)
ACS
Acute coronary syndromes may account for as many as 2 million hospitalizations in the U.S. every year. (March 2006)
Taking the pulse of women's heart health
Despite heart disease's toll on women, many fail to heed early warning signs. (January-February 2006)
Heart disease risk: men vs. women
Heart disease risks: the differences between men and women are significant. (Web exclusive)
Hypertension
Hypertension continues to wreak cardiovascular havoc among Americans. (December 2005)
Managing patients in the critical month after heart attack
A recent study underscores the need for aggressive management to avoid sudden death. (September 2005)
Lipid disorders
Usually treatable and arguably preventable, lipid disorders are rarely isolated medical conditions. (September 2005)
From bench to bedside: Does race count?
With 'ethnic' drugs on the horizon, there is growing controversy over how race affects treatment. (November 2004)
Is it time to expand your use of statins?
New update gives doctors the option of a lower LDL goal for patients at very high risk. (September 2004)
A look at ACP's guideline on managing chronic angina
New algorithms can help you evaluate suspected cases, choose the right diagnostic test and stratify patient risk. (September 2004)
The MKSAP Challenge
A 55-year-old woman with mild hypertension and blood pressure that ranges from 140-151/90-96 mm Hg asks about alternatives to drugs to lower her blood pressure. (November 2003)
The MKSAP Challenge
A 43-year-old man comes to the emergency room for evaluation of severe chest pain that awoke him from sleep. (September 2003)
A look at how three groups have kept their patients' hypertension in check
Improving blood pressure control through nurse-led clinics, local guidelines and healthy lifestyle campaigns. (July-August 2003)
Diuretics for hypertension get a big boost, but will data change prescribing patterns?
While experts say diuretics are underused, some physicians remain skeptical (April 2003)
Testing for CRP: red flag or red herring?
While some say the test can predict cardiovascular problems, others want more data (March 2003)
Some surprising uses for ACE inhibitors
Besides preventing heart attacks, the drugs can delay kidney problems and diabetes (December 2002)
When can statins be too much of a good thing?
Statins are often touted as a miracle drug, but these cholesterol-busters may not be for everyone (March 2002)
Do your patients need aspirin therapy? Ask them
Physicians trying to decide which patients to put on aspirin face a more difficult task than they might think (March 2002)
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Communication
Visits can be more productive when patients set the agenda
First in a three-part series: Motivational interviewing is one technique for engaging patients and developing strategies that work
March ’08
Computer screen can be barrier between doctor and patient
February '08
Put patients in the driver’s seat to steer toward better health
Engaging patients in managing their own chronic diseases can be the key to helping them achieve their goals and improve outcomes
February '08
Teamwork helps close the gaps in cardiovascular care
One internist's advice for getting lipid screenings to 100%—give up the idea that doctors have all the answers. (December 2006)
Listening and prioritizing help keep the visit on track
Tips for finding out what’s really wrong with your patients before they have their 'hand on the doorknob.' (October 2006)
Tune into patients' 'emotional channel' to deliver bad news
Patients with serious illnesses need to hear more than the facts as you guide them through difficult decisions. (April 2006)
Letters
Readers comment on care coordination codes, patient communication, and end-of-life care. (March 2006)
Hospitals adopt new protocols for stroke care
Advances in treatment and communication aim to improve stroke outcomes. (November 2005)
Talking to healthy patients about flu shot alternatives
A Mayo internist and vaccine researcher comments on the country's fifth straight year of scarce flu vaccine. (November 2004)
Strategies to help tackle poor health care communication
Three projects are designed to remove major communication barriers between physicians and their patients. (May 2004)
How to tell patients you've made a serious mistake
Pointers on communicating with patients about medical errors (Annual Session News 2003)
How do you know if your patient is truly informed?
Exploring the sometimes-thorny issues that can surround informed consent (Annual Session News 2003)
Tips to talk to patients in terms they'll understand
Low levels of "health literacy" mean that most patients understand less than half of what you tell them (February 2003)
Bearing bad tidings? Try these communication tips
Communicating bad news with frankness and empathy can help improve your bond with patients (January 2003)
Talking about risk with your patients? Try these tips
Statistics can mislead and confuse, but you can cut through the clutter and communicate more clearly (September 2002)
Patients uncooperative? Try these communication tips
By recognizing important issues and helping set expectations, residents can improve patient encounters (May 2002)
Strategies to make the most of patient appointments
Active listening, the right questions and collaborative decision-making can save time in the long run (June 2001)
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Diabetes
Diabetes project narrows gap between theory and practice
Following a successful first phase, the College’s diabetes programs reach out to a wider audience of members, residents and patients
March ’08
Rosiglitazone drama has internists scratching their heads
E. Victor Adlin, FACP, an endocrinologist at Temple University School of Medicine, discusses how the rosiglitazone drama has affected internists’ prescribing habits
March ’08
Specialists mull incretin-based therapies for diabetics (September 2007)
Coordination is key in caring for complex diabetes. (January-February 2007)
Better drugs, new devices help keep diabetes in check. (December 2006)
Type 2 diabetes mellitus
The prevalence and complications of diabetes point to major gaps in the care of chronic disease. (November 2005)
How small changes can bring big rewards in diabetes care.
When it comes to incorporating evidence into daily practice, physicians admit there may be a gap between best practices and the care they can provide. (September 2004)
Taking a new approach to type 2 diabetes
Recognizing clues like metabolic syndrome is one key to catching 'prediabetes' (May 2002)
New questions about diabetes management: How far is it from type 1 to type 2?
Certain inferences regarding treatments for type 1 disease can be extrapolated to type 2 diabetes (January 1996)
A rich resource for diabetes education
Dieticians and nurses can help diabetics better understand the disease and how to manage it (January 1996)
The latest on managing cardiovascular disease in type 2 diabetics
Diabetics with heart disease have atypical symptoms and don't respond to some treatments—like aspirin (January 1996)
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Diagnosis
Mindful Medicine, by Jerome Groopman, FACP, and Pamela Hartzband, FACP
May '08
Mindful Medicine, by Jerome Groopman, FACP, and Pamela Hartzband, FACP
Case study: Patient’s doubts about diagnosis prompt a second opinion
March ’08
Mindful Medicine: Send in your cases of medical diagnosis
Jerome Groopman, FACP, author of the bestselling "How Doctors Think," and his wife, endocrinologist Pamela Hartzband, ACP Member, discuss the art of medical diagnosis and decision making through a series of case studies suggested by readers. (January 2008)
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Disaster response
New disaster response plans build on past lessons
Post-Katrina, officials outline key strategies to bolster emergency preparedness. (June 2006)
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Disease Management
Make path to health one of least resistance
Behavioral economics explains why patients sacrifice their long-term health for short term rewards, and suggests ways that internists can easily convince them to change.
May '08
Is your staff prepared to respond to a stroke?
Education about symptoms should target office staff with patient contact, as well as patients and relatives of those at risk.
May '08
Latest in stroke research is both suspected and surprising
Conference coverage focuses on studies about abdominal obesity, symptoms and the importance of dialing 911 first.
May '08
The best self-management is ‘specific, do-able and realistic’
Second in a three-part series: Simple ways to engage patients in their own health care
April ’08
Barrett’s esophagus: screening guides are in flux over reflux
April ’08
Web extra: Hypothyroid treatments may help, but without resolving symptoms (September 2007)
Web extra: Benefits of statins may outweigh the risks for many patients (September 2007)
Dialysis might not be the right call for the very old. (September 2007)
Weight training lightens physical, psychological loads
Study shows that resistance training during dialysis can counteract muscle wasting better than aerobic exercise (September 2007)
Treat rheumatoid arthritis early, aggressively for best outcomes (June 2007)
Alcohol abuse and related disorders
Evidence-based recommendations about care. (April 2007)
To conquer depression, try and try again
The majority of depression sufferers are initially seen by primary care doctors. (April 2007)
HPV vaccine raises questions and debate
Supply, cost issues and ethical controversies are having a major impact on internists. (March 2007)
Merits of group visits can be tough sell for small practices. (March 2007)
Readers express views on dialysis alternatives, electronic medial record systems. (December 2006)
New kidney disease strategy aimed at earlier intervention
The goal is to slow, halt, prevent or partially reverse kidney disease through medical treatments and lifestyle changes. (October 2006)
Study finds generation gap in guidelines
Single-disease focus may leave complex patients out of pay-for-performance pool. (December 2005)
Metabolic syndrome: flawed science or clinical tool?
As experts debate the validity of a label, clinicians weigh in on using it in practice. (December 2005)
Is it time for universal HIV screening?
With HIV becoming a chronic disease, internists need to manage complex care. (June 2005)
Asthma
Asthma is the paradigm illness for self-management, owing to its unpredictable nature. (May 2005)
Overcoming resistance to disease management
Key factors that drive acceptance are collaboration, competition and positive results. (January-February 2005)
Web only:
Managing disease: a healthy—and growing—trend? (January-February 2005)
From bench to bedside: Does race count?
With 'ethnic' drugs on the horizon, there is growing controversy over how race affects treatment. (November 2004)
Group visits can save time, but are they right for you?
The new trend in scheduling group visits makes both physicians and patients happy. (April 2004)
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End of life
New end-of-life guidelines recommend earlier palliative care
The College’s new guidelines recommend that clinicians regularly assess end-of-life patients for symptoms of pain, dyspnea and depression, and use proven therapies to treat these conditions
March ’08
Better communication at the end of life
New form ensures that dying patient's wishes are carried out as medical orders. (July-August 2007)
Guidelines aimed at changing end-of-life conversation
Physicians can ease relatives' anxieties by listening more, asking questions and acknowledging guilt and sorrow. (July-August 2007)
Treatment vs. harm: How to care for seriously ill patients
Ditching the 'either/or' model can help reduce patient suffering—and ease hospitalists' palliative care role. (June 2006)
Letters
Readers comment on care coordination codes, patient communication, and end-of-life care. (March 2006)
Dying patients deserve to live final days with dignity
Physicians should be consensus builders, laying out the available options and working with family members. (June 2005)
Surrogate decision-makers and end-of-life care: no 'right' answers, but plenty of tough choices
Helping families make decisions about palliative care when dying patients' wishes aren't known. (June 2003)
Avoiding trouble when using opiates to treat patient pain
Overcome fears about sanctions for overprescribing painkillers and patient addiction to better ease your patients' pain. (June 2003)
How to address spirituality issues at the end of life
To provide patients truly compassionate care, physicians need to look beyond the medical aspects of dying. (June 2003)
Tips to talk to patients about end-of-life care
Tips to help steer families—and colleagues—clear of futile care. (Web Only)
Issues to consider when ending life support
Hospital-or hospice-based caregivers must make tough decisions in order to ease the dying process for terminally ill patients (May 2001)
How teams can help during end-of-life care
A team-oriented approach helps patients and physicians better deal with the dying process (May 2001)
How to avoid conflicts with patients and families during end-of-life care
End-of-life discussions ideally begin when patients are still healthy (June 2000)
Tips on talking to patients about advance directives
Getting beyond simplistic statements like 'no machines' can dramatically improve end-of-life planning (March 1999)
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Gastrointestinal illness
The Colonoscopy Conundrum: Studies suggest the importance of screening, but convincing patients is another matter (January 2008)
Tips for weaning your patients off PPIs
Cutting back on medications can save patients money—and reduce side effect risks. (July-August 2004)
New drugs—and some respect—for IBS
Revised guidelines and targeted therapies are leading to a new view of the condition. (September 2003)
Does diet affect IBS?
While many patients suspect that what they eat is a factor, physicians aren't so sure. (Web Only)
The MKSAP Challenge
Test your knowledge of treatment for persistent GERD (February 2003)
Should you test for H. pylori to treat dyspepsia?
The strategy appears to be popular, but the evidence is unclear on how many patients you can expect to help (January 2002)
Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure (September 2002)
When it comes to screening, what is cost effective?
A look at the cost effectiveness of colorectal cancer screening options (Web Only)
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Gender-based medicine
Sexual Dysfunction
When to screen, how to treat, what to ask. (March 2005)
Referring a patient with breast problems? You can manage many common complaints
Breast specialists say that they see many cases that can be successfully dealt with in the primary care setting. (October 2004)
New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)
The MKSAP Challenge
A pregnant patient is short of breath and coughing pink sputum. What's the likely diagnosis? (April 2003)
Weighing the risks of hormone therapy
New data on estrogen/progestin therapy have researchers urging caution (September 2002)
Menstrual cycles and patient care: a new view
When research is still preliminary, some are treating patients with menstruation in mind (May 2002)
A new solution to confusing Pap smear reports
Revised terminology on lab reports aims to clarify which patients need follow-up care (November 2001)
The key to understanding gender-based biology
Sexual differences affect every organ and system in the body (May 2001)
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Genetics
Practical Genomics, by W. Gregory Feero, MD, PhD
Even the rarest cancer syndromes exist among your patient panel
May '08
Practical Genomics, by W. Gregory Feero, MD, PhD
Mustard plants have more genes than humans, so how can we possibly ‘ketchup’
April ’08
Practical Genomics, by W. Gregory Feero, MD, PhD
Fleshing out the debate over meat from cloned animals
March ’08
Practical Genomics
Companies may bring genetic scans direct to consumers
February '08
Practical Genomics
Personalized medicine with a genomic twist (January 2008)
Family history may be primary care's best genetic test (November/December 2007)
Perceived risks have chilling effect on genetic testing (October 2007)
Genetic discoveries are in the news and on their way (September 2007)
Genomic frontiers: dashboards, Detroit and DNA
New series offers primary care physicians a roadmap to steer patients toward promising genetic therapies. (July-August 2007)
Q&A: Heart-disease physician leads new research on genetics
Eric J. Topol, FACP, heads up cutting edge-search for connections that could alter cardiac screening and treatment. (July-August 2006)
Promise, problems for molecular medicine
Researchers say they're getting close to bringing genomic testing into clinical practice. (January-February 2004)
When should you test your patients for breast cancer genes?
Many women want the test, but the results often raise difficult questions (December 2001)
Why you need to start thinking about the 'new genetics'
The legal system is beginning to recognize genetics as part of the standard of care (July/August 1999)
The dilemma of genetic testing
The 'breast cancer gene' and the physician's role: an ethics case study (March 1998)
Genetic counseling: Your new job
Are you ready to handle public misconceptions, confidentiality dilemmas? (February 1995)
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Guidelines/evidence-based medicine
Irritable Bowel Syndrome
Evidence-based recommendations about care (November/December 2007)
Chronic kidney disease
Evidence-based recommendations about care (October 2007)
Osteoarthritis
Evidence-based recommendations about care (September 2007)
Pressure Ulcers
Evidence-based recommendations about care (July-August 2007)
Butterflies, happy couples and prescription decisions (June 2007)
Experts spar over treatment for 'chronic' Lyme disease. (January-February 2007)
Universal HIV screening opens up new set of problems for primary care doctors
Access to specialists and counseling after diagnosis are high on list of concerns. (January-February 2007)
CMS tests ways to help sickest patients
Home visits and innovative technology are helping improve care—at less cost. (November 2006)
Prehypertension: Is new evidence a call to action?
Internists debate whether early drug treatment can ward off more serious problems down the road. (September 2006)
Research spurs new thinking on hormone use
WHI data have changed physicians' risk-benefit conversations with menopausal women. (July-August 2006)
Internists play key role in DVT prevention
Experts urge wider prophylaxis but leave doctors to work out clinical details. (March 2006)
Physicians make new push for better glycemic control
With guidelines now available for inpatient glycemic control, the next step is to coordinate hospital staff to implement those standards. (January-February 2006)
Study finds generation gap in guidelines
Single-disease focus may leave complex patients out of pay-for-performance pool. (December 2005)
Common symptoms: When to test, treat
Common complaints can be frustrating, but knowing when to refrain from testing is key. (June 2004)
New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)
COX-2s get a boost for treating osteoarthritis pain
New guidelines urging the use of more aggressive drug therapies are raising serious questions (November 2002)
Under new chief, AHCPR finds life after guidelines
The agency shifts from creating clinical protocols to sponsoring evidence-based outcomes research (November 1997)
Doctors' new focus on evidence
Clinical decisions should be based on the best available scientific evidence, but not all evidence is equal (March 1997)
Putting guidelines to work—lessons from the real world
Moving towards the "second phase" of the clinical practice guidelines movement: actually using them (March 1995)
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Headache
Diagnosing headaches a pain for doctors
Gaining confidence in headache management is first step to successful treatment. (June 2007)
Headache specialist tackles 'undertreated' condition
Co-editor of new College book outlines strategies for treating a disorder that may affect one in four patients. (December 2004)
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Health care access
Internists taking primary care to the streets
Practicing medicine changes when homeless patients don’t have a phone, food or access to first aid
Free health care programs have been converting buses and vans into clinics on wheels as they discover that mobile care is an effective way to reach homeless patients.
March ’08
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Hospital medicine
Weighing the risks of anticoagulant bridging post-op
Experts debate how to interpret the data on whether to offer pre- and post-operative bridging therapy. (July-August 2006)
A quick checklist for rounding on hospitalized seniors
Here are eight areas you should cover to reduce complications and speed up discharge. (June 2006)
To prevent ICU infections, try doing less to patients
Heading off common complications calls for fewer interventions and strategic use of ventilators, sedatives. (June 2006)
The new thinking on perioperative medicine
Recent results question some benefits of beta-blockers and revascularization. (May 2006)
Imaging hand-offs: tips to help prevent medication errors
Many errors listed in a recent USP report were linked to patient hand-offs and communication lapses. (April 2006)
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Infectious diseases
Infectious disease doctors tackle bad bugs with fewer drugs
Annual meeting unveils research, techniques that could help stem the tide of resistance and disease, particularly with the increase of 'C-diff' (January 2008)
Spring is crawling with critter-borne infections
With warm weather—and tick season—upon us, the good news is that physicians now are spotting infections like Lyme disease earlier in their progression. (June 2007)
Protect vulnerable seniors by vaccinating their juniors. (April 2007)
U.S. looks at 'social distancing' response to pandemic. (March 2007)
HIV screening
Evidence-based recommendations about care. (March 2007)
Experts spar over treatment for 'chronic' Lyme disease. (January-February 2007)
Universal HIV screening opens up new set of problems for primary care doctors
Access to specialists and counseling after diagnosis are high on list of concerns. (January-February 2007)
Acute sinusitis
Current recommendations about care. (January-February 2007)
Community Acquired Pneumonia
Current recommendations about care. (December 2006)
More people feel the bite of MRSA bug. (December 2006)
Next weapon in war on AIDS: universal HIV screening
Aggressive testing may slow transmission but some say resources would be better spent elsewhere. (December 2006)
Q&A: Education plays key role in making flu shots routine
Gregory A. Poland, FACP, talks about the barriers to achieving widespread immunization. (September 2006)
Hepatitis C
Hepatitis C, considered a stealth virus, can infect a patient for up to 30 years without causing symptoms. (April 2006)
Hospital medicine fast facts: HIV hospital admissions
The number of U.S. hospital admissions for HIV infections has fallen by half since 1995. (January-February 2006)
Is it time for universal HIV screening?
With HIV becoming a chronic disease, internists need to manage complex care. (June 2005)
Rising pertussis rates spark new public health concern
Misdiagnoses and undertreatment among adults and adolescents may warrant revised vaccination strategies. (March 2005)
Letters
Readers discuss pay for performance, tort reform and access to care, community-acquired MRSA, the flu vaccine shortage and the death of Craig W. Borden, MACP. (March 2005)
In a difficult flu season, another bug is a big worry
Potent MRSA clones may take advantage of higher flu rates and cause more cases of necrotizing pneumonia. (December 2004)
Strategies for coping with the flu vaccine shortage
Health officials say some vaccine may still arrive in time to help with the worst of the flu season. (November 2004)
Talking to healthy patients about flu shot alternatives
A Mayo internist and vaccine researcher comments on the country's fifth straight year of scarce flu vaccine. (November 2004)
Physicians prepare for a busy flu season
Officials say last year's vaccine shortages could boost this season's demand. (July-August 2004)
A look at the new needle-free flu vaccine
No shots may be good news, but concerns about cost and contraindications remain. (October 2003)
The MKSAP Challenge
A 37-year-old male respiratory therapist complains of fever, rigors, generalized muscle aches and mild respiratory symptoms. (October 2003)
Tips to combat three common drug-resistant infections
Dealing with antibiotic-resistant UTIs, pneumonia and gonorrhea is proving a challenge for physicians (March 2003)
Quiz
The MKSAP Challenge: influenza (January 2003)
CDC hopes new immunization charts will give vaccines for adults a boost
For the first time, the CDC has compiled all of its recommendations on adult vaccines into easy-to-use charts (December 2002)
New evidence to relieve fears about Lyme disease
Despite the public's anxiety, Lyme disease is difficult to catch and easy to treat (July-August 2002)
Your patients are sick, but do they need antibiotics?
Despite some improvement, physicians need to cut back on inappropriate antibiotics. Here are some tips (November 2001)
The changing face of therapy for HIV
How soon should asymptomatic HIV patients start antiretroviral therapy? (October 2001)
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Lung diseases
Smokers take heart when doctors believe they can quit
Survey finds physicians devote little time to counseling and rarely give smokers the cessation tools they need. (November 2006)
COPD is high on mortality, low on public recognition
Campaign urges those at risk to get checked and asks physicians to be more vigilant about screening. (October 2006)
COPD
Easily preventable, chronic obstructive pulmonary disease remains the country's fourth largest killer. (January-February 2006)
Smoking cessation: the golden rule of COPD
There is no disease-modifying intervention in COPD except smoking cessation, says one noted pulmonologist. (Web exclusive)
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Mental health
Tearing down walls between mind, body health
Pending bills seek to end inequity of insurance coverage for mental, physical illnesses (September 2007)
Dementia
Evidence-based recommendations about care (June 2007)
Separating anxiety disorders from mimics and masks
Antidepressants may help, but these patients often need additional medications and therapy to help them cope. (May 2007)
Tips for recognizing and managing adult ADHD
Experts say awareness in primary care is key to proper diagnosis and treatment. (September 2006)
Doctors face new challenges of PTSD
As combat veterans seek care, internists need to know how to screen and treat. (July-August 2006)
Special focus: depression
New feature takes a look at this insidious disease. (January-February 2005)
SSRIs: Too much—or too little—of a good thing?
Experts say a "one-dose-fits-all" approach does not work with antidepressants. (March 2004)
ACP: Mental health benefits need parity with other health insurance. (March 2004)
Tips to treat the psychological fallout of trauma
When treating patients who have endured a traumatic event, physicians must heal them both physically and psychologically (June 2002)
Clinical depression: more than just residency blues
Getting past old stigmas is the key to recognizing symptoms—and helping vulnerable residents (December 2000)
Exploring the link between depression and suicide
Learn to recognize the risk factors that causes some depressed patients to become suicidal (June 1999)
A new take on treating depression
Depression presents differently in a primary care setting than in psychiatric one (July/August 1996)
How to better diagnose and treat anxiety disorders
Learn to distinguish the cause of a patient's cluster of symptoms (May 1995)
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Nephrology
A new risk for patients with chronic kidney disease
Mark A. Perazella, FACP, explains why a common MRI agent is suspected in nephrogenic systemic fibrosis. (May 2007)
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Obesity
Gastroenterologists face consequences of obesity epidemic (January 2008)
Assessing BMI, waist size vital to preventing worsening obesity (January 2008)
National Trends: Obesity (January 2008)
Diets, drugs or surgery? The skinny on weight loss
As an obesity expert and researcher whose average patient weighs about 325 pounds, Dr. Fujioka has counseled many people on the best ways to lose weight. (June 2007)
Obesity
Easy to diagnose, but a challenge to cure. (July-August 2005)
Weight loss drugs: Give your patients facts, not lectures
Addressing the pros and cons of medications may be the best way to get patients on track for lifestyle changes. (June 2005)
New ACP guidelines target obesity management
Physicians should make referrals, study the drugs, and for some, consider surgery. (April 2005)
Nature and nurture: twin culprits in obesity epidemic
Counsel patients early, before they become severely obese. (June 2004)
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Pain management
How to care for patients suffering from chronic pain
For chronic nonmalignant pain, you need to meet the challenges of prescribing opioids and building trust. (June 2006)
Migraine
More prevalent than asthma or diabetes, migraine is the most common headache disorder found in a medical setting. (June 2005)
Pain Management for the Internist
Assessment, Treatment, Follow-Up (December 2004)
Avoiding trouble when using opiates to treat patient pain
Overcome fears about sanctions for overprescribing painkillers and patient addiction to better ease your patients' pain. (June 2003)
COX-2s get a boost for treating osteoarthritis pain
New guidelines urging the use of more aggressive drug therapies are raising serious questions (November 2002)
Drug therapies to treat—and prevent—migraines
Physicians can now offer migraine patients a multi-tiered regimen of drugs to bring needed relief (July-August 2002)
Managing the fifth vital sign: your patients' pain
By learning to use drugs and other therapies wisely, residents can bring hurting patients needed relief (April 2001)
How to discern drug-seekers from patients really in pain
Physicians don't want to fall victim to substance abusers faking pain symptoms (May 1998)
Dealing with pain management
Patients know more about their pain than their physicians do (May 1997)
Separating fact from fiction in treating low back pain
Physicians need to follow a systematic and rational early approach to treating back pain (May 1995)
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Patient safety practices
Making drug labels say what they mean
With drug in hand, patients wonder: Does red mean danger? How much is plenty? (April 2007)
FDA speeds device response. (December 2006)
Trial registration can cure dangerous publication bias. (December 2006)
National series highlights efforts to ‘remake medicine’
Reducing catheter-associated infections with business principles. (October 2006)
Getting patients right drugs at right time no easy task
With reconciliation a top source of medical errors, hospitals are under pressure to improve their programs. (October 2006)
Tips to avoid key drug interactions and side effects
Warfarin, SSRIs, statins top the list of drugs that can cause problems, especially for the chronically ill or elderly. (June 2006)
Low health literacy leads to mistakes, poorer outcomes
Literacy problems are associated with chronic illness and poorer health. (June 2006)
Imaging hand-offs: tips to help prevent medication errors
Many errors listed in a recent USP report were linked to patient hand-offs and communication lapses. (April 2006)
Tips for heading off harmful drug interactions
The list of drugs that can trigger interactions includes antibiotics and statins. (September 2005)
New advisory on antipsychotics may limit care options
If the drugs' risks now outweigh their benefits, where do physicians and patients go for help? (July-August 2005)
Letters
Readers discuss clinical research, drug safety reporting, and access to health care. (July-August 2005)
When data go AWOL: filling the clinical gaps
Clinical information often goes AWOL
A first-of-its-kind study found that patient information often goes missing. (May 2005)
Letters
Readers discuss drug safety, physician titles, sleep disorders. (May 2005)
To improve patient safety, try treating problem physicians
A patient safety expert paints a pervasive picture of problem physicians. (July-August 2004)
Seven simple steps to prevent outpatient drug errors
Statistics show that nearly half of all drug errors are the result of problems in the prescribing process. (June 2003)
Don't forget to tap a major safety resource: your patients
Tips to educate patients to do more to ensure their own safety. (June 2003)
Navigating the handoff from hospital to community care
Improving the transition period when patients go from hospital to community care (Annual Session News 2003)
Pre-op evaluations: emerging evidence for four areas
A look at patient safety practices that can make an enormous difference in patient morbidity and mortality (November 2002)
Strategies to tackle outpatient errors
Tracking test results, referrals and even no-shows can help keep you out of trouble (June 2002)
What we can do to prevent errors and improve patient safety
Improving system—and our own practice habits—can reduce medical errors (June 2001)
Letters: patient safety
In their study of medical errors, IOM researchers deliberately designed their study to target high-risk admissions (February 2000)
Why we need a systems approach to prevent deadly medical errors
While most errors can be prevented, we won't find a real solution until the culture of medicine changes (November 1999)
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Pulmonary medicine
Diagnosing Pulmonary Embolism
Evidence-based recommendations about care (January 2008)
Strategies to overcome "steroid phobia"
Tailored dosages and combination therapies can help minimize troubling side effects of inhaled corticosteroids. (May 2004)
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Referrals
When should you refer asthma patients for an allergy consult?
While there are no clear cut answers, there are some clues that difficult-to-manage asthma patients could benefit from a subspecialist referral. (June 2004)
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Revitalization
Doctor-patient relationship is the key to revitalization. (June 2004)
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Screening tests
General internists are performing 50% fewer procedures than they did 18 years ago. (May 2007)
Next weapon in war on AIDS: universal HIV screening
Aggressive testing may slow transmission but some say resources would be better spent elsewhere. (December 2006)
Sorting through the latest breast imaging alternatives
A breast imaging expert weighs in on MRIs, ultrasound, PET scanning and digital mammography. (October 2006)
Is an access crisis on the horizon in mammography?
A convergence of problems has some talking about looming access problems. (October 2003)
Getting breast cancer diagnoses right: help from an insurer
One medical liability insurer in Massachusetts has worked to cut failure-to-diagnose claims against its physicians by more than 50%.(Web Only)
New Pap guidelines reduce screening but raise concerns about compliance
Some worry that the call for less frequent Pap tests will reduce patient compliance with regular screening (April 2003)
Colonoscopy screening gains momentum, but problems remain
Obstacles include mediocre reimbursements and a shortage of gastroenterologists to do the procedure (September 2002)
CT scans: new screening tool or risky fad?
Physicians are trying to decide whether the procedures are merely the latest consumer health craze or the dawn of a new age of diagnostic imaging (February 2002)
When should you test your patients for breast cancer genes?
Many women want the test, but the results often raise difficult questions (December 2001)
A new solution to confusing Pap smear reports
Revised terminology on lab reports aims to clarify which patients need follow-up care (November 2001)
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Sleep Disorders
Sleep disorder rise is wake-up call for internists (November/December 2007)
Putting chronic fatigue syndrome's myths to bed
A new campaign aims to raise awareness of a condition that many say doesn't exist. (May 2007)
Insomnia
When patients complain of insomnia, the challenge for physicians stems from the complexity of diagnosis and the need to tailor treatments to individuals. (July-August 2006)
Letters
Readers discuss drug safety, physician titles, sleep disorders. (May 2005)
How to detect common sleep disorders
A growing body of evidence links troubled sleep to diabetes and hypertension. (March 2005)
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Stroke rehabilitation
Waking up the brain after stroke. (July-August 2007)
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Titration
Try more meds for depression. (December 2006)
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Miscellaneous
The MKSAP challenge
A 53-year-old man with a recent inferior myocardial infarction, hpertension and type 2 diabetes needs to lower his LDL cholesterol. (July-August 2006)
Low back pain
Acute episodes of low back pain should prompt a discussion of weight control and exercise. (June 2006)
The MKSAP Challenge
A 58-year-old man with a history of congestive heart failure develops psoriatic arthritis. (May 2006)
The MKSAP Challenge
A 64-year-old man with severe chronic obstructive pulmonary disease with mild hypercapnia and persistent dyspnea on minimal exertion is evaluated. (April 2006)
The FDA takes action on inhalable insulin, ranolazine and more. (March 2006)
The MKSAP Challenge
A 55-year-old-man is hospitalized because of a four-week history of problems, including progress left-sided weakness. (March 2006)
Internists play key role in DVT prevention
Experts urge wider prophylaxis but leave doctors to work out clinical details. (March 2006)
The MKSAP Challenge
A 44-year-old woman with type 2 diabetes mellitus and hyperlipidemia is evaluated because of, among other issues, intermittent right upper quadrant discomfort. (January-February 2006)
The MKSAP Challenge
A 45-year-old man is evaluated in the emergency department for nausea and severe dizziness. (December 2005)
Medically managing your pregnant patient
Internists need to play a bigger role to safeguard the health of moms and babies. (November 2005)
Hospitals adopt new protocols for stroke care
Advances in treatment and communication aim to improve stroke outcomes. (November 2005)
The MKSAP Challenge
A 36-year-old woman is admitted to the intensive care unit with Guillain-Barre syndrome. (November 2005)
Letters
Readers discuss orthopedists and internists, MKSAP, and the rising costs of physician services. (October 2005)
Tips for heading off harmful drug interactions
The list of drugs that can trigger interactions includes antibiotics and statins. (September 2005)
The MKSAP Challenge
A 37-year-old man is evaluated in the office for a first episode of syncope. (September 2005)
Not all sports injuries need specialist care
More internists are learning how to tackle musculoskeletal complaints in-house. (July-August 2005)
Deciphering the telltale signs of osteoarthritis
Physicians need to distinguish this common condition from other joint disorders. (July-August 2005)
Letters
Readers discuss clinical research, drug safety reporting, and access to health care. (July-August 2005)
The MKSAP Challenge
A 40-year-old woman, treated five years ago for breast cancer, is evaluated for pain in her back, a nagging cough and fatigue. (July-August 2005)
'I feel dizzy' doesn't have to mean a long workup
For most patients with dizziness, a thorough history should provide the diagnosis. (June 2005)
Fear factor: DVT and the hospitalized medical patient
Lowering the "threshold for suspicion" is a good way to improve patients' odds of avoiding a fatal embolism. (June 2005)
The MKSAP Challenge
A 39-year-old executive had a generalized tonic-clonic seizure one week ago, and returns for an office visit. (June 2005)
The MKSAP Challenge
Two years after undergoing mitral valve replacement, a 48-year-old man has a cerebrovascular accident. (May 2005)
Is there a crisis looming in clinical research?
New pressures are thinning the numbers of clinical researchers at academic centers. (May 2005)
Prescribing DME? Tips to help keep your patients safe
Experts urge physicians to take a team approach to find out what equipment patients may need at home. (April 2005)
The MKSAP Challenge
A 63-year-old woman with a 30-year history of rheumatoid arthritis is evaluated prior to an elective hip arthroplasty. (April 2005)
March is DVT Awareness Month. (March 2005)
The MKSAP Challenge
A new, 52-year-old male patient requests an annual exam and a serum prostate-specific antigen measurement. (March 2005)
Internists wanted for complex adolescent care
A growing number of childhood disease survivors need to transition from pediatric care. (December 2004)
The MKSAP Challenge
A 43-year-old man is evaluated because he falls asleep while working at his computer during the day. (December 2004)
The MSKAP Challenge
An elderly woman has had a headache for eight days and blurring and double vision have begun. (November 2004)
The MKSAP Challenge
A 30-year-old, HIV-infected man has a one-week history of increasing headaches, fever and other symptoms. (October 2004)
The MKSAP Challenge
A 67-year-old man is evaluated because of a two-day history of fever and diminished consciousness. (September 2004)
The MKSAP Challenge
A 20-year-old college student is experiencing a rapid pounding in her chest and neck and recently the episodes have been longer and more frequent. (July-August 2004)
The MKSAP Challenge
A 55-year-old woman with mild hypertension would like to avoid taking medication and asks what else she can do to lower her blood pressure. (June 2004)
The MKSAP Challenge
A 56-year old postmenopausal woman is brought to the emergency department because of severe substernal burning pain and progressive dyspnea. (April 2004)
The MKSAP Challenge
A 36-year old man with a long history of heavy alcohol use presents within 24 hours of his last drink. (March 2004)
The MKSAP Challenge
A 62-year old woman is evaluated because of abnormal results on a chest X-ray. (January-February 2004)
The MKSAP Challenge
A 77-year old man is found to have asymptomatic atrial fibrillation on a routine examination. (December 2003)
Strategies to treat unexplained symptoms
Somatizing patients can be a source of professional satisfaction-not frustration. (November 2003)
Drug therapies to nip allergies in the bud
Sneezing can lead to wheezing. Here's how to keep rhinitis from becoming asthma. (June 2003)
Chemical agents that every physician should recognize
While the media have focused on bioterrorism, chemicals pose a more immediate threat. (May 2003)
Help for treating mild traumatic brain injuries (February 2003)
When it comes to chronic kidney disease, new guidelines call for a bolder approach
Experts are urging primary care physicians to do more to detect and treat kidney disease (October 2002)
The role of drugs in treating obesity
While many physicians have been scared away from prescribing anti-obesity medications, weight loss experts say it is time to take another look (February 2002)
The placebo effect: more than sugar pills
Despite a debate over research, placebo proponents point to real results in patient care (January 2002)
New thyroid therapies raise management questions
A look at existing therapies and when to time treatments (May 1995)
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