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Showing posts from June, 2009

The Basic Geriatric Respiratory Examination CME/CE

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From MedscapeCME Family Medicine Mark E. Williams, MD CME/CE Released: 06/09/2009; Valid for credit through 06/09/2010 The objective of the pulmonary assessment of a geriatric patient is to check for the following: Quality of respiratory efficiency; Gas exchange; and Presence of disease. Assessing Respiration Efficiency Of note, if the patient is bedfast, complete evaluation of respiratory efficiency is often less than optimal because chest expansion is not always symmetric and percussion notes may be less resonant. Respiratory Rate Although a patient's respiratory rate is often recorded in his or her chart (most often as 20 breaths per minute), cultivate the discipline to obtain it yourself. Count the respirations for a minute and observe the pattern and degree of respiratory effort. Note that moving the diaphragm without moving any air does not count as a breath. Normal respiratory rates for older patients are12 to 18 breaths

HIV Serosorting in Men Who Have Sex With Men: Is It Safe?

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From JAIDS: Journal of Acquired Immune Deficiency Syndromes Matthew R. Golden, MD, MPH; Joanne Stekler, MD, MPH; James P. Hughes, PhD; Robert W. Wood, MD Authors and Disclosures Published: 01/12/2009 Abstract and Introduction Abstract Background: Serosorting is the practice of preferentially having sex with partners of concordant HIV status or of selectively using condoms with HIV-discordant partners. Methods: We evaluated the epidemiology of serosorting among men who have sex with men (MSM) seen in a sexually transmitted disease clinic, Seattle, WA, 2001-2007, and defined the percentage of visits during which MSM tested HIV positive based on whether they reported nonconcordant unprotected anal intercourse (UAI), UAI only with partners thought to be HIV negative (serosorters), no UAI, or no anal intercourse. Results: Men reported serosorting during 3295 (26%) of 12,449 visits. From 2001 to 2007, the proportion of visits during which men reported serosorting incr

The Good Patient

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  From Academic Medicine Evan J. Zucker MD Authors and Disclosures Published: 06/11/2009 Before medical school, I had taken it for granted that doctors treated all patients equally. My experience caring for a patient on my third-year surgical rotation taught me otherwise. My patient was a young man, just a few years older than myself. He was a good kid-from the suburbs, a law school student, with two devoted parents. He was tall with an athletic build, dark blond hair, light brown eyes, the kind of guy nurses doted over, someone whose path I might have crossed in other circumstances. He was otherwise healthy, but he had a problem. Some vague fatigue, a hematocrit in the low 20s, and then the CT, which revealed a massive gastric sarcoma. I was there for his debulking surgery; the morale in the OR was high that day. Nurses played Guess how much the tumor weighs as the surgeon scooped out the bowling-ball-sized cancer in record time. And what an interesting case! A brother with Wilms tum

Chronic Kidney Disease ( CKD ) Overview

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CKD as an Underrecognized Threat to Patient Safety Jeffrey C. Fink, MD; Jeanine Brown, MS; Van Doren Hsu, PharmD; Stephen L. Seliger, MD; Loreen Walker, BS; Min Zhan, PhD Chronic kidney disease (CKD) is common, but underrecognized, in patients in the health care system, where improving patient safety is a high priority. Poor disease recognition and several other features of CKD make it a high-risk condition for adverse safety events. In this review, we discuss the unique attributes of CKD that make it a high-risk condition for patient safety mishaps. We point out that adverse safety events in this disease have the potential to contribute to disease progression; namely, accelerated loss of kidney function and increased incidence of end-stage renal disease. We also propose a framework in which to consider patient safety in CKD, highlighting the need for disease-specific safety indicators that reflect unsafe practices in the treatment of this disease. Finally, we discuss the hypo