Archive for April 2010

What’s Behind Today’s Primary Care Crisis: You Don’t Know the Half of It

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.In today’s issue of the New England Journal of Medicine, internist Rich Baron chronicles the work of his 5-person Philadelphia office practice during the 2008 calendar year. Rather than “Why am I not losing weight?”, Rich’s study aims to answer the question, “Why does my work day feel so bad?” The answer: an enormous amount of metaphorical snacking between meals. In the NEJM study, Rich (who is a dear friend – we served together on the ABIM board for several years) found that each of the physicians in his practice conducted 18 patient visits per day (a total of 16,640 visits over the year for…

Dengue fever in travelers returning from Haiti

The CDC has released a health advisory for physicians to be aware of the risk of Dengue fever in travelers returning from Haiti, where Dengue is endemic. The disease is transmitted by mosquitoes, is characterized by high fevers and systemic symptoms, and can usually be managed with conservative symptomatic treatment. Typical incubation period is 3-14 days. More information is available on the CDC website (CDC). Suspected cases can be confirmed by sending a blood sample to selected state health departments or the CDC (CDC form)

30 day outcomes of elective cardioversion

In this retrospective analysis of 400 patients with new onset Afib who underwent cardioversion, it was successful in restoring sinus rhythm in 96% of patients (within 3 attempts). No patients experienced stroke, thromboembolic event, or died within 30 days. Almost all the patients had a CHADS2 score of 1 and were generally healthy. In this subgroup of healthy patients with low CHADS2 score, elective cardioversion is safe and effective in restoring sinus rhythm (abstract).

Early cholecystectomy for gallstone pancreatitis

Timing of cholecystectomy in patients with gallstone pancreatitis remains controversial. In this small trial, 50 patients with mild pancreatitis (Ranson score 3 or less) were randomized to early cholecystectomy (within 48 hours) or late cholecystectomy (after resolution of pain and improvement in labs). Those in the early group had significantly shorter LOS (mean 3.5 vs 5.8 days) with no difference need for open procedure or peri-operative complications. Early cholecystectomy in patients with mild gallstone pancreatitis may shorten hospital LOS without increasing complications (abstract)

PPI-clopidogrel saga continues

In this retrospective analysis of a large database, researchers found that patients recently discharged after an MI or stent on PPI-clopidogrel had a 93% higher risk of re-hospitalization for MI (and 64% higher risk for re-hospitalization for MI or stent) than patients on clopidogrel without a PPI. This association was found despite type of PPI (omeprazole or pantoprazole). The current warning on PPI labeling, to avoid concomitant use with clopidogreal when able, is probably warranted, until the controversy can be resolved (abstract)