Articles related to PRACTICE PEARLS

Uncover vital insights about supplemental oxygen use, demystify misconceptions, and learn best practices for managing respiratory diseases. Good day, physicians. Let’s talk about the controversial issue of supplemental oxygen use, frequently discussed by patients, clinicians, advocacy groups, and even politicians. In this summary, we’ll untangle misconceptions and illuminate best practices. To start with, the body’s oxygen utilization depends on three things: lung function, heart efficiency, and muscle oxygen use. These factors can improve with exercise, but worsen with inactivity. Remember, exercise matters. Why does oxygen matter? For patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), or pulmonary hypertension (PH), impaired oxygenation can lead to hypoxemia and hypoxia. Hence, supplemental oxygen becomes a necessity. How do we assess oxygen levels? Two tests can be employed: arterial blood gas (ABG) or pulse oximetry. Normal partial pressure of oxygen, as per ABG, is around 75-100 mmHg, and a drop below 60 necessitates supplemental oxygen. Oxygen saturation, measurable via either test, should ideally be 95% or above, and values dropping to 90 or below indicate the need for supplemental oxygen. Now, let’s dispel some myths. Shortness of breath doesn’t always equate to hypoxia. A patient can experience breathlessness even with normal oxygen […]

In a recent talk at the Internal Medicine Meeting 2023, hospitalist Heather Nye emphasized the need to update the “Ten Commandments for Effective Consultations” originally outlined by Lee Goldman and colleagues in 1983. Dr. Nye provided new insights for performing and requesting consults in the 21st century. Some key points she highlighted included the importance of going the extra mile to determine the patient’s condition, establishing urgency, providing clear and written recommendations, documenting all interactions, and following up on recommendations and actions taken. Dr. Nye stressed the significance of clear communication in consult relationships. For hospitalists requesting consults from subspecialists, she advised following the commandments outlined and overcoming reluctance in seeking clarification and follow-up. It was emphasized that hospitalists should manage consultants effectively, ensuring they follow up on recommended studies and document their recommendations in the patient’s chart. Additionally, hospitalists should be proactive in obtaining contact information and communicate with consultants even after they sign off, especially during patient discharge discussions. Overall, Dr. Nye emphasized that effective communication, documentation, and follow-up are essential in providing optimal patient care and ensuring collaboration between hospitalists and subspecialists.

An essential component of successfully enhancing transplant outcomes is early viral infection prevention. Clinically severe viral infections have been successfully avoided in hematopoietic cell transplant patients with prophylactic and preventive therapy with antiviral medications. Through a better understanding of the biology and risk factors, the introduction of novel antiviral agents, and developments in immunotherapy, significant progress has been made in the past few decades in preventing viral infections. There is solid proof that herpes simplex virus, varicella-zoster virus, and CMV infection and illness can be prevented. There is a dearth of information on how to effectively prevent infections with human herpesvirus 6, Epstein-Barr virus, adenovirus, and BK virus.

From side effect to mechanism of action to patient acceptance to managing insurance hurdles, this collection of expert points from the February Endocrine Society meeting is a helpful synopsis of need-to-know items for PCPs.

Among non-adherent glaucoma patients surveyed in a cross-sectional study, the most prominent barries to adherence are forgetfulness, poor self-efficacy, beliefs/skepticism about glaucoma, poor knowledge of glaucoma, beliefs/skepticism about medication, difficulty with medication schedule, difficulty with drop administration, life stress, side effects of medication, cost, and mistrust of physician. Here are some pointers from three optometrists on how to deal with these and other issues.

Discovery of erythroplakia in a patient’s mouth is more serious than finding leukoplakia. Approximately half of erythroplakic lesions represent invasive carcinomas. Review the differential diagnosis and management in this review article.