MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Cleveland Clinic Journal of Medicine' source. Fri, 19 Mar 2010 15:40:45 +0100 http://www.medworm.com/index.php?rid=3328827&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F207%3Frss%3D1 Outbreaks continue to be reported in communities with a high number of unvaccinated people. Most cases are linked to international travel. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328827 Wed, 03 Mar 2010 16:31:25 +0100 3328827 http://www.medworm.com/index.php?rid=3328826&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F205%3Frss%3D1 A healthy 47-year-old woman presents with a 3-day history of widespread asymptomatic lesions in the extremities, fever, arthralgias, and mild abdominal pain. What is the diagnosis? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328826 Wed, 03 Mar 2010 16:31:25 +0100 3328826 http://www.medworm.com/index.php?rid=3328825&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F195%3Frss%3D1 Not all asymptomatic people with a mildly elevated liver enzyme value need an extensive evaluation, which can be costly, anxiety-provoking, and risky. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328825 Wed, 03 Mar 2010 16:31:25 +0100 3328825 http://www.medworm.com/index.php?rid=3328824&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F191%3Frss%3D1 The incidence of venous thromboembolism in people taking rosuvastatin (Crestor) 20 mg/day was about half that in people taking placebo. This was a relatively healthy population, and the incidence in both groups was low. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328824 Wed, 03 Mar 2010 16:31:25 +0100 3328824 http://www.medworm.com/index.php?rid=3328823&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F178%3Frss%3D1 It is time to strongly reconsider the current aggressive approach to revascularization of stenotic renal arteries and to take a more coordinated, critical approach. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328823 Wed, 03 Mar 2010 16:31:25 +0100 3328823 http://www.medworm.com/index.php?rid=3328822&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F164%3Frss%3D1 The three randomized trials of stenting vs medical therapy published so far are so seriously flawed that it is impossible to make treatment decisions based on their results. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328822 Wed, 03 Mar 2010 16:31:25 +0100 3328822 http://www.medworm.com/index.php?rid=3328821&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F160-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328821 Wed, 03 Mar 2010 16:31:25 +0100 3328821 http://www.medworm.com/index.php?rid=3328820&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F160%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328820 Wed, 03 Mar 2010 16:31:25 +0100 3328820 http://www.medworm.com/index.php?rid=3328819&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F155%3Frss%3D1 A recent multicenter trial indicated that empirically prescribing a proton pump inhibitor does not help control asthma symptoms and that current guidelines need to be reevaluated. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328819 Wed, 03 Mar 2010 16:31:25 +0100 3328819 http://www.medworm.com/index.php?rid=3328818&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F3%2F151%3Frss%3D1 Outbreaks of measles are seemingly on the rise, mainly because of lower vaccination rates, which are in part due to the unfounded fear that the vaccine causes autism. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328818 Wed, 03 Mar 2010 16:31:25 +0100 3328818 http://www.medworm.com/index.php?rid=3328866&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS53%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328866 Mon, 01 Mar 2010 17:31:57 +0100 3328866 http://www.medworm.com/index.php?rid=3328865&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS52%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328865 Mon, 01 Mar 2010 17:31:57 +0100 3328865 http://www.medworm.com/index.php?rid=3328864&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS51%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328864 Mon, 01 Mar 2010 17:31:57 +0100 3328864 http://www.medworm.com/index.php?rid=3328863&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS49%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328863 Mon, 01 Mar 2010 17:31:57 +0100 3328863 http://www.medworm.com/index.php?rid=3328862&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS48%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328862 Mon, 01 Mar 2010 17:31:57 +0100 3328862 http://www.medworm.com/index.php?rid=3328861&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS47%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328861 Mon, 01 Mar 2010 17:31:57 +0100 3328861 http://www.medworm.com/index.php?rid=3328860&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS46%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328860 Mon, 01 Mar 2010 17:31:57 +0100 3328860 http://www.medworm.com/index.php?rid=3328859&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS45%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328859 Mon, 01 Mar 2010 17:31:57 +0100 3328859 http://www.medworm.com/index.php?rid=3328858&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS44%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328858 Mon, 01 Mar 2010 17:31:57 +0100 3328858 http://www.medworm.com/index.php?rid=3328857&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS43%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328857 Mon, 01 Mar 2010 17:31:57 +0100 3328857 http://www.medworm.com/index.php?rid=3328856&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS41%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328856 Mon, 01 Mar 2010 17:31:57 +0100 3328856 http://www.medworm.com/index.php?rid=3328855&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS40%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328855 Mon, 01 Mar 2010 17:31:57 +0100 3328855 http://www.medworm.com/index.php?rid=3328854&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS39%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328854 Mon, 01 Mar 2010 17:31:57 +0100 3328854 http://www.medworm.com/index.php?rid=3328853&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS38%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328853 Mon, 01 Mar 2010 17:31:57 +0100 3328853 http://www.medworm.com/index.php?rid=3328852&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS37%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328852 Mon, 01 Mar 2010 17:31:57 +0100 3328852 http://www.medworm.com/index.php?rid=3328851&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS35%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328851 Mon, 01 Mar 2010 17:31:57 +0100 3328851 http://www.medworm.com/index.php?rid=3328850&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS34%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328850 Mon, 01 Mar 2010 17:31:56 +0100 3328850 http://www.medworm.com/index.php?rid=3328849&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS32%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328849 Mon, 01 Mar 2010 17:31:56 +0100 3328849 http://www.medworm.com/index.php?rid=3328848&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS31%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328848 Mon, 01 Mar 2010 17:31:56 +0100 3328848 http://www.medworm.com/index.php?rid=3328847&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS30%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328847 Mon, 01 Mar 2010 17:31:56 +0100 3328847 http://www.medworm.com/index.php?rid=3328846&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS29%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328846 Mon, 01 Mar 2010 17:31:56 +0100 3328846 http://www.medworm.com/index.php?rid=3328845&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS28%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328845 Mon, 01 Mar 2010 17:31:56 +0100 3328845 http://www.medworm.com/index.php?rid=3328844&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS26%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328844 Mon, 01 Mar 2010 17:31:56 +0100 3328844 http://www.medworm.com/index.php?rid=3328843&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS25%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328843 Mon, 01 Mar 2010 17:31:56 +0100 3328843 http://www.medworm.com/index.php?rid=3328842&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS24%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328842 Mon, 01 Mar 2010 17:31:56 +0100 3328842 http://www.medworm.com/index.php?rid=3328841&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS23%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328841 Mon, 01 Mar 2010 17:31:56 +0100 3328841 http://www.medworm.com/index.php?rid=3328840&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS21%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328840 Mon, 01 Mar 2010 17:31:56 +0100 3328840 http://www.medworm.com/index.php?rid=3328839&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS19%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328839 Mon, 01 Mar 2010 17:31:56 +0100 3328839 http://www.medworm.com/index.php?rid=3328838&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS18%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328838 Mon, 01 Mar 2010 17:31:56 +0100 3328838 http://www.medworm.com/index.php?rid=3328837&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS17%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328837 Mon, 01 Mar 2010 17:31:56 +0100 3328837 http://www.medworm.com/index.php?rid=3328836&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS16%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328836 Mon, 01 Mar 2010 17:31:56 +0100 3328836 http://www.medworm.com/index.php?rid=3328835&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS15%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328835 Mon, 01 Mar 2010 17:31:56 +0100 3328835 http://www.medworm.com/index.php?rid=3328834&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS14%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328834 Mon, 01 Mar 2010 17:31:56 +0100 3328834 http://www.medworm.com/index.php?rid=3328833&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS13%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328833 Mon, 01 Mar 2010 17:31:56 +0100 3328833 http://www.medworm.com/index.php?rid=3328832&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS11%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328832 Mon, 01 Mar 2010 17:31:56 +0100 3328832 http://www.medworm.com/index.php?rid=3328831&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS9%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328831 Mon, 01 Mar 2010 17:31:56 +0100 3328831 http://www.medworm.com/index.php?rid=3328830&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS8%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328830 Mon, 01 Mar 2010 17:31:56 +0100 3328830 http://www.medworm.com/index.php?rid=3328829&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS4%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328829 Mon, 01 Mar 2010 17:31:56 +0100 3328829 http://www.medworm.com/index.php?rid=3328828&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FElectronic_Suppl_1%2FeS1%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328828 Mon, 01 Mar 2010 17:31:56 +0100 3328828 http://www.medworm.com/index.php?rid=3328872&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS27%3Frss%3D1 Radiation therapy is recommended as an adjuvant to resection for intermediate- and high-grade soft-tissue sarcomas; its role in bone sarcomas is largely limited to select patients with Ewing sarcoma. Despite the integral role of radiation therapy in soft-tissue sarcoma management, its optimal timing—preoperative versus postoperative—is uncertain, with each timing scenario having advantages and disadvantages. Preparation for radiation therapy involves a detailed planning session to optimize and standardize patient positioning and determine the target volume. Side effects of radiation therapy may include skin changes, delayed wound healing and other wound complications, fatigue, reduced range of motion of the affected limb, pain, and bone fractures. (Source: Cleveland Clinic Jour... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328872 Tue, 23 Feb 2010 17:01:32 +0100 3328872 http://www.medworm.com/index.php?rid=3328871&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS23%3Frss%3D1 For patients with bone sarcomas, chemotherapy has a proven role in the primary therapy of osteogenic sarcoma and Ewing sarcoma but no role for chondrosarcoma. Chemotherapy’s role is currently more limited for patients with soft-tissue sarcomas, as it is generally used to palliate metastatic disease in most subtypes of soft-tissue sarcoma and remains largely investigational in the treatment of operable disease. The chemotherapy regimens for musculoskeletal sarcomas often carry significant potential toxicities, so the efficacy of less intensive and less toxic regimens is a focus of ongoing research. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328871 Tue, 23 Feb 2010 17:01:32 +0100 3328871 http://www.medworm.com/index.php?rid=3328870&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS18%3Frss%3D1 The defects left by resection of bone and soft-tissue sarcomas often require reconstructive surgery to provide adequate wound coverage, preserve limb function, and optimize cosmetic results. Immediate reconstruction should always be considered after resection with a negative margin, and should be attempted whenever possible. The choice of reconstructive method and tissue flap depends on multiple factors, including body site, donor site morbidity, functional requirements, size of the vascular pedicle, and aesthetics. Preoperative planning before the resection should anticipate the defect size and resulting functional and cosmetic deficits; the success of such planning depends on a collaborative approach between the teams performing the primary resection and the reconstruction. Vigilant post... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328870 Tue, 23 Feb 2010 17:01:32 +0100 3328870 http://www.medworm.com/index.php?rid=3328869&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS13%3Frss%3D1 Patients with soft-tissue sarcomas generally present with a mass that is increasing in size; the presence or absence of pain is not typically predictive of malignancy. While magnetic resonance imaging (MRI) can identify a few soft-tissue lesion types as benign, diagnosis of most lesions requires a careful biopsy, preferably performed by or in consultation with the surgeon who would do an eventual resection. If biopsy confirms a diagnosis of sarcoma, MRI-guided surgical resection with a wide margin is the mainstay of treatment. Neoadjuvant radiation therapy and chemotherapy have not been of proven benefit in well-controlled studies but are frequently used as adjuncts. Resections with wide margins are generally associated with a low (< 10%) risk of recurrence. (Source: Cleveland Clinic Jo... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328869 Tue, 23 Feb 2010 17:01:32 +0100 3328869 http://www.medworm.com/index.php?rid=3328868&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS8%3Frss%3D1 Outcomes for patients with bone sarcomas have improved dramatically over the past 40 years, and most bone sarcomas today are treated with surgery and chemotherapy. The most common clinical findings in patients with bone sarcomas are pain and an enlarging bone mass, although pain is not generally a good indicator of malignancy. In general, any patient with a bone mass with indeterminate imaging findings should be referred to an orthopedic oncologist. Bone sarcomas are diagnosed after a biopsy, which is best performed by the surgeon who will be doing the curative resection. Postresection reconstruction of the affected limb is generally done with an allograft-prosthetic composite or a modular metallic prosthetic joint replacement device. Post-therapy follow-up at frequent and regular interval... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328868 Tue, 23 Feb 2010 17:01:32 +0100 3328868 http://www.medworm.com/index.php?rid=3328867&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2FSuppl_1%2FS2%3Frss%3D1 The clinical presentation of bone and soft-tissue sarcomas is varied. Constitutional symptoms are rare, and although bone sarcomas tend to be painful while soft-tissue sarcomas usually are not, there are exceptions to this general rule. A high index of suspicion is required for any unexplained mass with indeterminate imaging findings. Choosing the right imaging modality is critical to the diagnosis and management of patients with suspected sarcoma, and referring clinicians have a multitude of imaging options. After discovery of a malignant-appearing bone lesion by radiography, further imaging is obtained for better characterization of the lesion (typically with magnetic resonance imaging [MRI]) and for staging (typically with computed tomography of the chest). In contrast, radiographs are ... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3328867 Tue, 23 Feb 2010 17:01:32 +0100 3328867 http://www.medworm.com/index.php?rid=3229240&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F131%3Frss%3D1 Acute upper gastrointestinal (GI) bleeding is common and potentially life-threatening and needs a prompt assessment and aggressive medical management. All patients need to undergo endoscopy to diagnose, assess, and possibly treat any underlying lesion. In addition, patients found to have bleeding ulcers should receive a proton pump inhibitor, the dosage and duration of treatment depending on the endoscopic findings and clinical factors. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229240 Tue, 02 Feb 2010 04:01:38 +0100 3229240 http://www.medworm.com/index.php?rid=3229239&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F123%3Frss%3D1 In hospitalized medical patients, randomized trials have established that anticoagulant prophylaxis has an acceptable benefit-to-risk ratio: ie, it lowers the incidence of clinically silent and symptomatic venous thromboembolism (VTE), including fatal pulmonary embolism, more than it raises the risks of bleeding and other complications. However, no similar trials have been done in long-term care residents. More research is needed to ascertain which long-term care residents would benefit most from VTE prophylaxis. In the absence of evidence-based guidelines, we advocate a selective approach. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229239 Tue, 02 Feb 2010 04:01:38 +0100 3229239 http://www.medworm.com/index.php?rid=3229238&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F117%3Frss%3D1 A 40-year-old man who works as a roofer has begun to experience episodes of generalized weakness, perioral numbness, and diffuse paresthesias. What is the cause? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229238 Tue, 02 Feb 2010 04:01:38 +0100 3229238 http://www.medworm.com/index.php?rid=3229237&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F113%3Frss%3D1 The US Food and Drug Administration has issued a warning that omeprazole (Prilosec) reduces the antiplatelet activity of clopidogrel (Plavix) by about 50%. However, the warning is based largely on ex vivo data. Preliminary results from a randomized clinical trial revealed no effect on cardiovascular outcomes when omeprazole was given with clopidogrel. We recommend that physicians continue to prescribe a proton pump inhibitor for patients receiving dual antiplatelet therapy who are at risk of gastrointestinal bleeding or have an indication for use of a proton pump inhibitor. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229237 Tue, 02 Feb 2010 04:01:38 +0100 3229237 http://www.medworm.com/index.php?rid=3229236&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F101%3Frss%3D1 Non-ST-elevation myocardial infarction (MI) and unstable angina represent the majority of acute coronary syndromes. Recent studies have helped clarify treatment strategies. Drug-eluting stents have reduced the problem of restenosis, but questions remain about the length of time patients need dual antiplatelet therapy. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229236 Tue, 02 Feb 2010 04:01:38 +0100 3229236 http://www.medworm.com/index.php?rid=3229235&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F96%3Frss%3D1 A plain chest radiograph reveals multiple calcified cysts in the upper abdomen of a man who has been on dialysis for 15 years. What is the most plausible diagnosis? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229235 Tue, 02 Feb 2010 04:01:38 +0100 3229235 http://www.medworm.com/index.php?rid=3229234&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F90%3Frss%3D1 An obese woman with long-standing uncontrolled type 2 diabetes mellitus presents with indurated thickening of the skin on her back. What is the diagnosis? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229234 Tue, 02 Feb 2010 04:01:38 +0100 3229234 http://www.medworm.com/index.php?rid=3229233&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F76%3Frss%3D1 Despite the new US recommendations, we continue to recommend yearly mammograms for most women, starting at age 40. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229233 Tue, 02 Feb 2010 04:01:38 +0100 3229233 http://www.medworm.com/index.php?rid=3229232&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F75%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229232 Tue, 02 Feb 2010 04:01:38 +0100 3229232 http://www.medworm.com/index.php?rid=3229231&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F74%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229231 Tue, 02 Feb 2010 04:01:38 +0100 3229231 http://www.medworm.com/index.php?rid=3229230&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F2%2F71%3Frss%3D1 Starting this month, readers can earn CME credit on a per-article basis. Each article that bears the CME logo is a separate CME test, each worth 1 credit. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3229230 Tue, 02 Feb 2010 04:01:38 +0100 3229230 http://www.medworm.com/index.php?rid=3140323&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F60%3Frss%3D1 Yes. Obesity hypoventilation syndrome is often undiagnosed and greatly increases perioperative risk. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140323 Mon, 04 Jan 2010 15:32:20 +0100 3140323 http://www.medworm.com/index.php?rid=3140322&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F51%3Frss%3D1 What we know about the mechanisms of food allergies and eosinophilic esophagitis, how to diagnose them, and how to treat them. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140322 Mon, 04 Jan 2010 15:32:20 +0100 3140322 http://www.medworm.com/index.php?rid=3140321&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F45%3Frss%3D1 Her body mass index is 18.7, and she has lost 20 lb despite a good appetite. What is the cause? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140321 Mon, 04 Jan 2010 15:32:20 +0100 3140321 http://www.medworm.com/index.php?rid=3140320&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F37%3Frss%3D1 The myelodysplastic syndromes are clonal bone marrow disorders that lead to underproduction of normal blood cells. Primary care physicians tend to be the first to identify the problem. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140320 Mon, 04 Jan 2010 15:32:20 +0100 3140320 http://www.medworm.com/index.php?rid=3140319&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F34%3Frss%3D1 A 64-year-old man presents with a 10-day history of painful vesicles and erosions on the dorsa of the hands that appeared after sun exposure. What is the diagnosis? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140319 Mon, 04 Jan 2010 15:32:20 +0100 3140319 http://www.medworm.com/index.php?rid=3140318&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F19%3Frss%3D1 Often, patients overdose because they take more than one acetaminophen product and are unaware that both products contain the drug. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140318 Mon, 04 Jan 2010 15:32:19 +0100 3140318 http://www.medworm.com/index.php?rid=3140317&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F12%3Frss%3D1 Should we abandon this popular procedure? Or are there considerations that may mitigate the negative findings of these two trials? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140317 Mon, 04 Jan 2010 15:32:19 +0100 3140317 http://www.medworm.com/index.php?rid=3140316&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F8%3Frss%3D1 Two recent trials call into question the efficacy of vertebroplasty for treating osteoporotic vertebral compression fractures and are leading many of us to question our assumptions about vertebroplasty. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140316 Mon, 04 Jan 2010 15:32:19 +0100 3140316 http://www.medworm.com/index.php?rid=3140315&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F77%2F1%2F7%3Frss%3D1 Sometimes, the results of clinical trials do not immediately affect what physicians do because the results do not jibe with experience. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140315 Mon, 04 Jan 2010 15:32:19 +0100 3140315 http://www.medworm.com/index.php?rid=3046311&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F724%3Frss%3D1 Some patients need higher-than-expected doses of warfarin to reach their target INR. The cause can be acquired (poor compliance, drug interactions) or hereditary. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046311 Tue, 01 Dec 2009 21:00:07 +0100 3046311 http://www.medworm.com/index.php?rid=3046310&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F715%3Frss%3D1 When a patient with chronic kidney disease suffers a fragility fracture, a key question is whether the patient has osteoporosis or, instead, renal osteodystrophy. Bone densitometry does not help in this distinction. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046310 Tue, 01 Dec 2009 21:00:07 +0100 3046310 http://www.medworm.com/index.php?rid=3046309&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F707%3Frss%3D1 Prasugrel (Effient) is faster and more consistent in its effects, but patients at high bleeding risk should still receive clopidogrel (Plavix). (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046309 Tue, 01 Dec 2009 21:00:07 +0100 3046309 http://www.medworm.com/index.php?rid=3046308&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F697%3Frss%3D1 Evidence-based guidelines on managing acute pancreatitis are available, but many physicians are not following them. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046308 Tue, 01 Dec 2009 21:00:07 +0100 3046308 http://www.medworm.com/index.php?rid=3046307&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F693%3Frss%3D1 No. Dual renin-angiotensin system blockade has never been shown to reduce the rates of morbidity or death from any cause. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046307 Tue, 01 Dec 2009 21:00:07 +0100 3046307 http://www.medworm.com/index.php?rid=3046306&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F684%3Frss%3D1 The patient with chronic renal disease who has a fracture remains a unique management challenge. Opinions on treatment abound, but without adequate evidence to back them up. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046306 Tue, 01 Dec 2009 21:00:07 +0100 3046306 http://www.medworm.com/index.php?rid=3046305&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F12%2F683%3Frss%3D1 Low bone density is not a one-size-fits-all disorder. We need to carefully consider the diagnostic and therapeutic options before assuming that low bone density is osteoporosis. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046305 Tue, 01 Dec 2009 21:00:07 +0100 3046305 http://www.medworm.com/index.php?rid=3140329&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS39%3Frss%3D1 Despite advances in diagnosis and treatment, type 2 diabetes mellitus (T2DM), overweight/obesity, cardiovascular disease, and their sequelae are major public health burdens worldwide. The understanding of the pathophysiology of T2DM has traditionally emphasized decreased insulin secretion and increased insulin resistance, but evolving concepts now include the role of incretin hormones in disease progression. A comprehensive approach to managing patients with T2DM requires targeting both the fundamental defects of the disease and its comorbidities, including the sequelae of nonoptimal control of blood glucose, blood pressure, body weight, and lipids. Newer antidiabetes agents, such as the glucagon-like peptide–1 (GLP-1) receptor agonists and the dipeptidyl peptidase–4 (DPP-4) in... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140329 Tue, 01 Dec 2009 20:12:23 +0100 3140329 http://www.medworm.com/index.php?rid=3140328&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS28%3Frss%3D1 Type 2 diabetes mellitus (T2DM) is intrinsically connected to overweight and obesity. It is a complex metabolic disorder that predisposes patients to, and is associated with, cardiovascular disease. In addition to the triumvirate of core defects associated with T2DM (involvement of the pancreatic beta cell, the muscle, and the liver), other mechanisms including hyperglucagonemia, accelerated gastric emptying, and incretin deficiency/resistance are also involved. This has led to the development of incretinbased therapies, such as glucagon-like peptide–1 (GLP-1) receptor agonists and dipeptidyl peptidase–4 (DPP-4) inhibitors. These newer therapies have beneficial effects on glycosylated hemoglobin A1c (HbA1c) levels, weight, and pancreatic beta-cell function. (Source: Cleveland C... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140328 Tue, 01 Dec 2009 20:12:23 +0100 3140328 http://www.medworm.com/index.php?rid=3140327&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS20%3Frss%3D1 Lifestyle modifications in conjunction with antidiabetes medications can produce near-normal blood glucose concentrations in patients with type 2 diabetes mellitus (T2DM). Because these patients have increased cardiovascular morbidity and mortality, treatment strategies should also address the cardiovascular aspects of the disease, including blood pressure, lipids, and body weight. Since the prevalence of these abnormalities is increasingly secondary to poor diet and sedentary lifestyles and because most patients with T2DM are overweight/obese, clinicians are encouraged to help patients reduce body weight while correcting hyperglycemia by selecting treatment options that improve both parameters. The glucose-lowering properties of insulin and sulfonylureas are well known but they are also a... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140327 Tue, 01 Dec 2009 20:12:23 +0100 3140327 http://www.medworm.com/index.php?rid=3140326&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS12%3Frss%3D1 Nutrient intake stimulates the secretion of the gastrointestinal incretin hormones, glucagon-like peptide–1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which exert glucose-dependent insulinotropic effects and assist pancreatic insulin and glucagon in maintaining glucose homeostasis. GLP-1 also suppresses glucose-dependent glucagon secretion, slows gastric emptying, increases satiety, and reduces food intake. An impaired incretin system, characterized by decreased responsiveness to GIP and markedly reduced GLP-1 concentration, occurs in individuals with type 2 diabetes mellitus (T2DM). The administration of GLP-1 improves glycemic control, but GLP-1 is rapidly degraded by the enzyme dipeptidyl peptidase–4 (DPP-4). Exenatide, a DPP-4–resistant exendin-4 ... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140326 Tue, 01 Dec 2009 20:12:23 +0100 3140326 http://www.medworm.com/index.php?rid=3140325&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS4%3Frss%3D1 The current epidemics of excessive weight and type 2 diabetes mellitus (T2DM) cause significant morbidity and mortality. T2DM frequently coexists with excess weight as well as hypertension and dyslipidemia, placing a significant percentage of the population at an elevated risk of cardiovascular disease. Maintaining effective glycemic control is linked with a diminished risk of developing microvascular complications, and recent studies have shown it may also reduce overall macro vascular complications. Reduction of associated risk factors, including those related to excessive weight, high blood pressure, and dyslipidemia, are also necessary to meaningfully decrease cardiovascular risk. Agents that can improve glycemia with weight neutrality or weight loss could offer additional benefit to o... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140325 Tue, 01 Dec 2009 20:12:23 +0100 3140325 http://www.medworm.com/index.php?rid=3140324&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_5%2FS2%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3140324 Tue, 01 Dec 2009 20:12:23 +0100 3140324 http://www.medworm.com/index.php?rid=2952476&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F663%3Frss%3D1 Many patients need the combination of aspirin and clopidogrel (Plavix) or prasugrel (Effient) to reduce their risk of cardiovascular events, as shown in recent trials. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952476 Mon, 02 Nov 2009 16:03:33 +0100 2952476 http://www.medworm.com/index.php?rid=2952475&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F657%3Frss%3D1 Several new devices provide more information than does traditional sphygmomanometry about the patient’s true hypertensive status, blood pressure control, and risk of end-organ damage. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952475 Mon, 02 Nov 2009 16:03:33 +0100 2952475 http://www.medworm.com/index.php?rid=2952474&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F649%3Frss%3D1 Both uremia and dialysis can complicate glycemic control by affecting the secretion, clearance, and peripheral tissue activity of insulin. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952474 Mon, 02 Nov 2009 16:03:33 +0100 2952474 http://www.medworm.com/index.php?rid=2952473&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F641%3Frss%3D1 Rather than merely wait for bowel sounds to return after patients undergo surgery, we can try to get the gut working again sooner. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952473 Mon, 02 Nov 2009 16:03:33 +0100 2952473 http://www.medworm.com/index.php?rid=2952472&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F639%3Frss%3D1 A 60-year-old man presents with worsening shortness of breath and productive cough. Flexible bronchoscopy reveals the surprising cause. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952472 Mon, 02 Nov 2009 16:03:33 +0100 2952472 http://www.medworm.com/index.php?rid=2952471&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F635%3Frss%3D1 After undergoing induction chemotherapy for acute myeloid leukemia, he developed fever, lung infiltrates, and severe neutropenia. What is the most likely cause? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952471 Mon, 02 Nov 2009 16:03:33 +0100 2952471 http://www.medworm.com/index.php?rid=2952470&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F630-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952470 Mon, 02 Nov 2009 16:03:33 +0100 2952470 http://www.medworm.com/index.php?rid=2952469&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F630%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952469 Mon, 02 Nov 2009 16:03:33 +0100 2952469 http://www.medworm.com/index.php?rid=2952468&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F629-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952468 Mon, 02 Nov 2009 16:03:33 +0100 2952468 http://www.medworm.com/index.php?rid=2952467&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F629%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952467 Mon, 02 Nov 2009 16:03:33 +0100 2952467 http://www.medworm.com/index.php?rid=2952466&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F11%2F625%3Frss%3D1 Despite the many ways to introduce inaccuracies in low-tech cuff measurements of blood pressure, the benefits of treating high blood pressure diagnosed this way can be great. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2952466 Mon, 02 Nov 2009 16:03:33 +0100 2952466 http://www.medworm.com/index.php?rid=3046331&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS126%3Frss%3D1 An extensive medication history, including the use of nonprescription agents and herbal products, is the foundation of effective perioperative medication management. Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, the potential for drug interactions with anesthesia, and the patient’s short-term quality of life. In general, medications with withdrawal potential should be continued perioperatively, nonessential medications that increase surgical risk should be discontinued before surgery, and clinical judgment should be exercised in other cases. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046331 Fri, 30 Oct 2009 22:16:38 +0100 3046331 http://www.medworm.com/index.php?rid=3046330&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS119%3Frss%3D1 Medical malpractice lawsuits are commonly brought against surgeons, anesthesiologists, and internists involved in perioperative care. They can be enormously expensive as well as damaging to a doctor’s career. While physicians cannot eliminate the risk of lawsuits, they can help protect themselves by providing competent and compassionate care, practicing good communication with patients (and their families when possible), and documenting patient communications and justifications for any medical decisions that could be challenged. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046330 Fri, 30 Oct 2009 22:16:38 +0100 3046330 http://www.medworm.com/index.php?rid=3046329&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS112%3Frss%3D1 Perioperative anemia is associated with excess morbidity and mortality. Transfusion of allogeneic blood has been a longstanding strategy for managing perioperative anemia, but the blood supply is insufficient to meet transfusion needs, and complications such as infection, renal injury, and acute lung injury are fairly common. Further, data suggest that mortality and length of stay are worsened with liberal use of transfusion. Medical alternatives to transfusion include iron supplementation and erythropoiesis-stimulating agents (ESAs). Though ESAs reduce the need for perioperative blood transfusion compared with placebo, they are associated with an increased risk of thrombotic events in surgical patients. Cleveland Clinic has been developing a blood management program aimed at reducing allo... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046329 Fri, 30 Oct 2009 22:16:38 +0100 3046329 http://www.medworm.com/index.php?rid=3046328&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS104%3Frss%3D1 Three directors of dedicated preoperative assessment clinics share their experience in setting up and running their programs. Standardizing and centralizing all or part of the preoperative evaluation process—obtaining patient records; the history and physical examination; the surgical, anesthesiology, and nursing assessments; ordering tests; and documentation and billing—increases efficiency. The savings achieved from minimizing redundancy, avoiding surgery delays and cancellations, and improved reimbursement coding offset the increased costs of setting up and running the clinic. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046328 Fri, 30 Oct 2009 22:16:38 +0100 3046328 http://www.medworm.com/index.php?rid=3046327&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS98%3Frss%3D1 Obstructive sleep apnea (OSA) is associated with increased risks of cardiovascular disease and stroke and with elevated rates of postoperative complications (including cardiac ischemia and respiratory failure) in surgical patients. Additionally, the prevalence of OSA is higher in surgical patients than in the general population. Screening for OSA prior to surgery is recommended to identify patients at risk for postoperative complications. The presence of moderate or severe OSA calls for modified strategies of perioperative anesthesia, pain management, and postoperative monitoring to reduce the chance of OSA-associated complications. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046327 Fri, 30 Oct 2009 22:16:38 +0100 3046327 http://www.medworm.com/index.php?rid=3046326&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS93%3Frss%3D1 In surgical patients with underlying chronic liver disease, surgical outcomes correlate with hepatocellular function. The risk of surgery in such patients should be assessed preoperatively using the Child-Pugh or Model for End-Stage Liver Disease (MELD) severity scoring systems. Patients with severe liver disease (eg, Child-Pugh class C) should not undergo any elective surgery and should be evaluated for liver transplantation. In patients who can proceed with surgery, coagulopathy should be corrected preoperatively and careful fluid management is required intraoperatively to avoid hypotension. Renal insufficiency (as evidenced by elevated creatinine) may indicate that hepatorenal syndrome has developed and carries a poor prognosis. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046326 Fri, 30 Oct 2009 22:16:38 +0100 3046326 http://www.medworm.com/index.php?rid=3046325&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS84%3Frss%3D1 Guidelines on perioperative management of patients undergoing noncardiac surgery recommend the use of prophylactic perioperative beta-blockers in high-risk patients who are not already taking them, and their continuance in patients on chronic beta-blockade prior to surgery. These recommendations were challenged recently by results of the Perioperative Ischemic Evaluation (POISE), a large randomized trial of extended-release metoprolol succinate started immediately before noncardiac surgery in patients at high risk for atherosclerotic disease. While metoprolol significantly reduced myocardial infarctions relative to placebo in POISE, it also was associated with significant excesses of both stroke and mortality. The merits and limitations of POISE and its applicability in light of other tria... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046325 Fri, 30 Oct 2009 22:16:38 +0100 3046325 http://www.medworm.com/index.php?rid=3046324&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS79%3Frss%3D1 Vascular surgery is associated with a high risk of perioperative morbidity and mortality that is partly attributable to inflammatory stress induced by the surgical procedure. Preoperative initiation of a long-acting statin is a strategy intended to reduce the inflammatory stress response and the excess risk associated with vascular surgery. The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo III demonstrated significant reductions in perioperative myocardial ischemia and the composite end point of myocardial infarction or cardiovascular death with extended-release fluvastatin (relative to placebo) initiated 30 days prior to vascular surgery. These benefits were achieved with no increase in liver dysfunction, evidence of myopathy, or other side effects. Observational da... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046324 Fri, 30 Oct 2009 22:16:38 +0100 3046324 http://www.medworm.com/index.php?rid=3046323&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS72%3Frss%3D1 The objective is to examine issues and key evidence that should inform the decision-making process in important aspects of perioperative management. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046323 Fri, 30 Oct 2009 22:16:38 +0100 3046323 http://www.medworm.com/index.php?rid=3046322&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS66%3Frss%3D1 Postoperative gastrointestinal (GI) tract dysfunction is common and has a complex, multifactorial pathogenesis. Perioperative administration of targeted amounts of fluid to optimize ventricular filling and end-organ perfusion has consistently been shown to improve mortality and other outcomes, particularly GI tract perfusion and function. The choice of fluid loading affects postoperative recovery, with colloid showing superiority over crystalloid, and lactated Ringer’s solution proving better than normal saline. Other methods of reducing postoperative GI tract dysfunction with some proven degree of success include simple, low-cost interventions such as early initiation of oral feeding, early use of laxatives, and gum chewing. There is no evidence that prophylactic nasogastric decompr... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046322 Fri, 30 Oct 2009 22:16:38 +0100 3046322 http://www.medworm.com/index.php?rid=3046321&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS60%3Frss%3D1 Postoperative pulmonary complications are common, serious, and expensive. Important predictors of risk are advanced age, poor health as assessed by American Society of Anesthesiologists class, and surgery near the diaphragm. Effective strategies to reduce risk include postoperative lung expansion techniques, preoperative intensive inspiratory muscle training, postoperative thoracic epidural analgesia, selective rather than routine use of nasogastric tubes, and laparoscopic rather than open bariatric surgery. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046321 Fri, 30 Oct 2009 22:16:38 +0100 3046321 http://www.medworm.com/index.php?rid=3046320&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS53%3Frss%3D1 Glycemic control before, during, and after surgery reduces the risk of infectious complications; in critically ill surgical patients, intensive glycemic control may reduce mortality as well. The preoperative assessment is important in determining risk status and determining optimal management to avoid clinically significant hyper- or hypoglycemia. While patients with type 1 diabetes should receive insulin replacement at all times, regardless of nutritional status, those with type 2 diabetes may need to stop oral medications prior to surgery and might require insulin therapy to maintain blood glucose control. The glycemic target in the perioperative period needs to be clearly communicated so that proper insulin replacement, consisting of basal (long-acting), prandial (rapid-acting), and sup... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046320 Fri, 30 Oct 2009 22:16:38 +0100 3046320 http://www.medworm.com/index.php?rid=3046319&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS45%3Frss%3D1 This article reviews important principles and recent developments in perioperative VTE prophylaxis, with a focus on key recommendations and changes in the 2008 update of the American College Chest Physicians’ (ACCP) evidence-based guidelines on antithrombotic therapy. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046319 Fri, 30 Oct 2009 22:16:38 +0100 3046319 http://www.medworm.com/index.php?rid=3046318&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS37%3Frss%3D1 Perioperative management of patients on warfarin or antiplatelet therapy involves assessing and balancing individual risks for thromboembolism and bleeding. Discontinuing anticoagulant and antiplatelet therapy is usually necessary for major surgery but increases the risk of thrombotic events. Bridge therapy, the temporary perioperative substitution of low-molecular-weight heparin or unfractionated heparin in place of warfarin, is an effective means of reducing the risk of thromboembolism but may increase the risk of bleeding. The timing of warfarin withdrawal and timing of the preoperative and postoperative components of bridge therapy are critical to balancing these risks. Perioperative management of antiplatelet therapy requires special care in patients with coronary stents; the timing o... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046318 Fri, 30 Oct 2009 22:16:38 +0100 3046318 http://www.medworm.com/index.php?rid=3046317&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS32%3Frss%3D1 Anesthesiologists are the primary users of preoperative medical consultations (consults), but the information in consults is often of limited usefulness to anesthesiologists and the rest of the surgical and perioperative team. The purpose of a consult is not to "clear" a patient for surgery but rather to optimize a patient’s underlying disease states before they are compounded by the insult of surgery. Too often consults provide advice on subjects that are in the realm of expertise of the anesthesiologist—such as the type of anesthesia to administer or what intraoperative monitoring to use—and thus risk being ignored. Consults should instead provide specific data about the patient that are pertinent to the surgery, as well as guidance on preoperative and postoperative dis... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046317 Fri, 30 Oct 2009 22:16:38 +0100 3046317 http://www.medworm.com/index.php?rid=3046316&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS28%3Frss%3D1 Perioperative fluid management remains controversial. Nevertheless, its optimization is essential to reducing the risk of postoperative complications, which have been shown to profoundly affect patients’ short- and long-term outcomes. Current evidence favors a "flow-guided" approach to perioperative fluid administration, which uses variables such as stroke volume and cardiac output as the basis for guiding fluid requirements. The optimal fluid is controversial, although colloids appear to have some physiologic advantages over crystalloids. Minimally invasive technologies have emerged for intraoperative monitoring of blood flow, which may enable more precise fluid titration. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046316 Fri, 30 Oct 2009 22:16:38 +0100 3046316 http://www.medworm.com/index.php?rid=3046315&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS22%3Frss%3D1 Preoperative laboratory and electrocardiographic testing should be driven by the patient’s history and physical examination and the risk of the surgical procedure. A test is likely to be indicated only if it can correctly identify abnormalities and will change the diagnosis, the management plan, or the patient’s outcome. Needless testing is expensive, may unnecessarily delay the operation, and puts the patient at risk for unnecessary interventions. Preoperative evaluation centers can help hospitals standardize and optimize preoperative testing while fostering more consistent regulatory documentation and appropriate coding for reimbursement. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046315 Fri, 30 Oct 2009 22:16:38 +0100 3046315 http://www.medworm.com/index.php?rid=3046314&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS16%3Frss%3D1 Elderly patients pose unique challenges perioperatively. They are more likely than younger surgical patients to be mentally and physically compromised at baseline, which increases the risk of delirium and postoperative cognitive dysfunction. Postoperative cognitive risk can be predicted, however, and effective strategies exist to reduce this risk. Elderly patients are also at increased risk of a precipitous postoperative decline in physiologic reserve, which can lead to organ failure. General recommendations for the perioperative care of elderly patients include avoiding drugs that raise the risk of delirium, ensuring adequate caloric and fluid intake, getting the patient out of bed and into physical therapy as soon as possible, and early planning for discharge. An elderly patient’s ... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046314 Fri, 30 Oct 2009 22:16:38 +0100 3046314 http://www.medworm.com/index.php?rid=3046313&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS9%3Frss%3D1 The American College of Cardiology and American Heart Association updated their joint guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery in 2007. The guidelines recommend preoperative cardiac testing only when the results may influence patient management. They specify four high-risk conditions for which evaluation and preoperative treatment are needed: unstable coronary syndromes, decompensated heart failure, significant cardiac arrhythmias, and severe valvular disease. Patient-specific factors and the risk of the surgery itself are considerations in the need for an evaluation and the treatment strategy before noncardiac surgery. In most instances, coronary revascularization before noncardiac surgery has not been shown to reduce morbidity and mortality, e... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046313 Fri, 30 Oct 2009 22:16:38 +0100 3046313 http://www.medworm.com/index.php?rid=3046312&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2FSuppl_4%2FS3%3Frss%3D1 Public reporting and pay-for-performance reimbursement are two strategies designed to stimulate hospital quality improvement. Information about the quality of hospital care (including surgical volumes and staffing, process-based measures, and mortality and other outcomes) is compiled on various Web sites, giving the public means to compare providers. While public reporting has been shown to foster quality-improvement activities by hospitals, its effects on clinical outcomes are less certain. Likewise, consumers’ awareness and use of publicly available hospital and provider quality data have been low but appear to be increasing. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=3046312 Fri, 30 Oct 2009 22:16:38 +0100 3046312 http://www.medworm.com/index.php?rid=2848703&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F607%3Frss%3D1 Autoimmune pancreatitis is an idiopathic inflammatory disease that produces pancreatic masses and ductal strictures. This benign disease resembles pancreatic carcinoma both clinically and radiographically. The diagnosis of autoimmune pancreatitis is challenging to make. However, accurate and timely diagnosis may preempt the misdiagnosis of cancer and decrease the number of unnecessary pancreatic resections. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848703 Thu, 01 Oct 2009 14:02:24 +0100 2848703 http://www.medworm.com/index.php?rid=2848702&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F599%3Frss%3D1 Cutaneous changes may be the first clue that a patient has liver disease. Recognizing these signs is crucial to diagnosing liver conditions early. Here we describe the spectrum of skin manifestations that may be found in various liver diseases. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848702 Thu, 01 Oct 2009 14:02:24 +0100 2848702 http://www.medworm.com/index.php?rid=2848701&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F592%3Frss%3D1 Less-invasive interventions for upper tract urolithiasis are extracorporeal shock-wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Each has advantages and disadvantages, depending on the location, size, and composition of the stone and on the patient’s renal anatomy, body habitus, and comorbidities. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848701 Thu, 01 Oct 2009 14:02:24 +0100 2848701 http://www.medworm.com/index.php?rid=2848700&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F583%3Frss%3D1 Factors that promote stone formation include low daily urine volumes; saturation of the urine with calcium, oxalate, calcium phosphate, uric acid, or cystine; acidic urine; and bacterial infection. The author identifies the mechanisms of stone formation and outlines management aimed at preventing recurrences. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848700 Thu, 01 Oct 2009 14:02:24 +0100 2848700 http://www.medworm.com/index.php?rid=2848699&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F577%3Frss%3D1 The pandemic of a novel strain of swine-origin influenza A (H1N1) is expected to make this a difficult flu season. Fortunately, this strain is relatively mild, and the principles of prevention, diagnosis, and treatment remain the same. Physicians will have a number of complex decisions to make about when to test, when to treat, and when to simply reassure. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848699 Thu, 01 Oct 2009 14:02:24 +0100 2848699 http://www.medworm.com/index.php?rid=2848698&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F575%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848698 Thu, 01 Oct 2009 14:02:23 +0100 2848698 http://www.medworm.com/index.php?rid=2848697&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F564%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848697 Thu, 01 Oct 2009 14:02:23 +0100 2848697 http://www.medworm.com/index.php?rid=2848696&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F10%2F561%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2848696 Thu, 01 Oct 2009 14:02:23 +0100 2848696 http://www.medworm.com/index.php?rid=2754837&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F543%3Frss%3D1 More patients are asking their physicians about radiofrequency ablation. Although it has shown promising clinical results, some patients may have unrealistic expectations. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754837 Tue, 01 Sep 2009 23:00:00 +0100 2754837 http://www.medworm.com/index.php?rid=2754836&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F533%3Frss%3D1 The outcomes of clinical trials have been disappointing, and the value of beta-blockers in treating hypertensive patients who do not have compelling indications for them has been questioned. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754836 Tue, 01 Sep 2009 23:00:00 +0100 2754836 http://www.medworm.com/index.php?rid=2754835&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F525%3Frss%3D1 MRI might be indicated for workup of possible breast cancer, but not for screening except in women at high risk. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754835 Tue, 01 Sep 2009 23:00:00 +0100 2754835 http://www.medworm.com/index.php?rid=2754834&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F513%3Frss%3D1 Vaccination is the most important preventive measure. Early detection, infection control measures, prompt treatment, and preventive treatment of contacts can also help curtail an outbreak. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754834 Tue, 01 Sep 2009 23:00:00 +0100 2754834 http://www.medworm.com/index.php?rid=2754833&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F507-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754833 Tue, 01 Sep 2009 23:00:00 +0100 2754833 http://www.medworm.com/index.php?rid=2754832&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F507%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754832 Tue, 01 Sep 2009 23:00:00 +0100 2754832 http://www.medworm.com/index.php?rid=2754831&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F503%3Frss%3D1 Antiarrhythmic drugs should remain the first line of treatment until trials prove otherwise. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754831 Tue, 01 Sep 2009 23:00:00 +0100 2754831 http://www.medworm.com/index.php?rid=2754830&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F9%2F497%3Frss%3D1 Two recent trials found that a popular procedure for fixing vertebral fractures lacks efficacy. Like it or not, in the future, such evidence is going to affect whether insurers pay for care. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2754830 Tue, 01 Sep 2009 23:00:00 +0100 2754830 http://www.medworm.com/index.php?rid=2665462&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F481-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665462 Sun, 02 Aug 2009 23:00:00 +0100 2665462 http://www.medworm.com/index.php?rid=2665461&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F481%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665461 Sun, 02 Aug 2009 23:00:00 +0100 2665461 http://www.medworm.com/index.php?rid=2665460&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F479%3Frss%3D1 Intravenous urography is the gold standard for the diagnosis of medullary sponge kidney. Computed tomography and ultrasonography have limited ability to clearly show tubular ectasia. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665460 Sun, 02 Aug 2009 23:00:00 +0100 2665460 http://www.medworm.com/index.php?rid=2665459&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F476%3Frss%3D1 Measuring them can help diagnose decompensated heart failure and predict the risk of death and hospitalization, but whether it helps in chronic kidney disease is unclear. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665459 Sun, 02 Aug 2009 23:00:00 +0100 2665459 http://www.medworm.com/index.php?rid=2665458&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F467%3Frss%3D1 After menopause, women become more susceptible to periodontal disease. The problem may stem in large part from estrogen deficiency. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665458 Sun, 02 Aug 2009 23:00:00 +0100 2665458 http://www.medworm.com/index.php?rid=2665457&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F457%3Frss%3D1 To identify those at high risk of fracture, we can use the Fracture Risk Assessment Tool, or FRAX. Patients who are prescribed a drug must also be educated about how and why to take it. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665457 Sun, 02 Aug 2009 23:00:00 +0100 2665457 http://www.medworm.com/index.php?rid=2665456&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F449%3Frss%3D1 The patient acquired hepatitis B virus at birth and was never treated for it. What is his present infection status? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665456 Sun, 02 Aug 2009 23:00:00 +0100 2665456 http://www.medworm.com/index.php?rid=2665455&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F446%3Frss%3D1 Does screening have a benefit? We have new data, but do we have the answer? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665455 Sun, 02 Aug 2009 23:00:00 +0100 2665455 http://www.medworm.com/index.php?rid=2665454&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F445%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665454 Sun, 02 Aug 2009 23:00:00 +0100 2665454 http://www.medworm.com/index.php?rid=2665453&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F439%3Frss%3D1 Two large trials of screening with prostate-specific antigen measurements came to seemingly opposite conclusions. Furthermore, a large trial of selenium and vitamin E found that neither has value in preventing prostate cancer. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665453 Sun, 02 Aug 2009 23:00:00 +0100 2665453 http://www.medworm.com/index.php?rid=2665452&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F8%2F438%3Frss%3D1 Given the widening spectrum of viral hepatitis types and clinical syndromes, prompt referral to and consultation with a hepatologist are in our patients’ best interests. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2665452 Sun, 02 Aug 2009 23:00:00 +0100 2665452 http://www.medworm.com/index.php?rid=2565340&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F7%2F417%3Frss%3D1 Newer ventilators can be set to modes other than the pressure-control and volume-control modes of older machines. We review how they work and contrast their theoretical benefits and actual evidence of benefit. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2565340 Tue, 30 Jun 2009 23:00:00 +0100 2565340 http://www.medworm.com/index.php?rid=2565339&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F7%2F413%3Frss%3D1 His type 2 diabetes has been well controlled for 6 years. Now, his blood sugar levels have been rising for the past week, and he has large amounts of glucose and ketones in the urine. What has happened? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2565339 Tue, 30 Jun 2009 23:00:00 +0100 2565339 http://www.medworm.com/index.php?rid=2565338&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F7%2F410%3Frss%3D1 Six days ago, the patient had an intense headache; 4 days ago, painful herpetiform lesions appeared on his face. What is the diagnosis? (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2565338 Tue, 30 Jun 2009 23:00:00 +0100 2565338 http://www.medworm.com/index.php?rid=2565337&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F76%2F7%2F401%3Frss%3D1 Ischemic colitis is one of the diagnoses that should be considered when patients present with abdominal pain, diarrhea, and intestinal bleeding. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=2565337 Tue, 30 Jun 2009 23:00:00 +0100 2565337