Hope you are all well. This is what came up during this week.
- nCoV nover Corona Virus Update from WHO conference
- Deltoid vaccination technique reminder: avoid the upper 1/3rd bec of risk of shoulder dysfunction.
- Are children who present with abdominal pain at risk of CAP (Chronic Abdominal Pain) in later life?
- How many disabled people are there in the world?
- How efficient are Family Medicine Doctors (aka GPs) in the UK’s NHS (National Health Service)?
- 52000 shortage of Family Doctors in the US by 2025!
- Asymptomatic carotid stenosis : To operate or not?
- Electronic Health Records
- More talk and less electronic communication helps you become happy – study Annals of Medicine (May 2013)
- Can we use Spironolactone in resistant acne vulgaris? (Useful paper Mar 2012)
nCoV nover Corona Virus Update from WHO conference
Incubation period 2.5 to 14 days. Some patients present with diarrhea. There is a short presentation (attached to email) from the WHO conference on the nCoV and something called MERS-CoV (Middle East Respiratory Syndrome Coronavirus (MERS CoV)). In short: 44 cases, 22 deaths, Age range 24-94 (note no children yet), 79% male, no treatment apart from supportive care, no clear case definition yet, all have respiratory disease mild to severe pneumonia. Latest case 63y man, Qaseem Saudi Arabia, with co-morbidities – unrelated to Eastern province cases.
Deltoid vaccination technique reminder: avoid the upper 1/3rd bec of risk of shoulder dysfunction.
Nice article on Medscape http://www.medscape.com/viewarticle/782615_print . I have copied a picture from the medscape article as it a nice visual reminder of the anatomy of the region. Good one to share with nursing colleagues who do most of our vaccines (please see article for picture).
Are children who present with abdominal pain at risk of CAP (Chronic Abdominal Pain) in later life?
- RT @Medscape: Children who present to primary care with abdominal pain have a high risk of developing chronic abdominal pain (CAP) http://t… May 24, 2013
How many disabled people are there in the world?
- RT @WHO: Dr Chan: Over 1b people, about 15% of the world population, experience some form of disability http://t.co/7ME9DG8XLD #WHA66 May 23, 2013
How efficient are Family Medicine Doctors (aka GPs) in the UK’s NHS (National Health Service)?
- RT @rvautrey: GPs see 1 million patients daily, deliver 90% of #NHS activity for only 9% of budget = workload saturation & GPs under pressu… May 23, 2013
- RT @rcgp: One whole day’s care in #generalpractice costs one tenth of a day in hospital – RCGP calls for more investment in GP May 23, 2013
- RT @rcgp: Only 9% of #NHS budget spent on General Practice in 2011/12 yet GPs see 1mill+ patients daily & 90 activity happens in GP May 23, 2013
52000 shortage of Family Doctors in the US by 2025!
- RT @aafp: A renewed focus on #familymedicine, prompted by the desire for a long-term relationship with her patients http://t.co/8SjRqEUNRi … May 23, 2013
Asymptomatic carotid stenosis : To operate or not?
- RT @Medscape: Asymptomatic carotid stenosis: new reviews concludes medical therapy is the best option. http://t.co/62PbPo4MxU May 23, 2013
Electronic Health Records
- RT @Medscape: Note-entering scribes and in-box screeners reduce EHR stress for physicians, says study http://t.co/uLR9bPLClR May 22, 2013
- RT @Medscape: Does this study signal a physician backlash against EHRs? http://t.co/uLR9bPLClR May 22, 2013
More talk and less electronic communication helps you become happy – study Annals of Medicine (May 2013)
We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.
Can we use Spironolactone in resistant acne vulgaris?
I had this question in mind and had a look on Pubmed for something relevant and came across a nice review article. The conclusion from the paper is quoted below and it has a very useful Table 5 that summarises questions to ask before commencing Spironoloactone:
“Although there have been considerable advances in acne therapy, treatment failure can occur especially in adult female patients. Overall, spironolactone as a monotherapy or in combination with other agents is well tolerated if properly dosed and adjusted and has been shown to be beneficial for women with AV, especially in those exhibiting the hormonal pattern clinically. Although not first line, some women may benefit, including in cases where an endocrine disorder is suspected and oral isotretinoin therapy is not desired. Use of spironolactone for women with AV is not limited to those who exhibit hyperandrogenism clinically, as spironolactone can be used in women with normal circulating androgen levels. Spironolactone is usually reserved for recalcitrant cases of AV in adult women that are resistant to conventional treatment. Importantly, spironolactone may be used in conjunction with an OC to enhance therapeutic benefit for AV, to achieve birth control in women of childbearing potential, and to decrease menstrual-related side effects. There are also sufficient data to suggest that short- and long-term use with spironolactone is deemed safe overall, provided certain contraindications and risk-factor exclusions are identified before starting treatment. More studies are needed to confirm these results. Concerns regarding breast cancer and hyperkalemia should not intimidate the clinician from using spironolactone for AV when it is clearly needed in young, healthy individuals, provided specific exclusions are identified up front. In conclusion, data from medical literature, clinical experience over many years support that, overall, spironolactone is a safe and efficacious therapy for adult women with AV in many clinical circumstances. Table 5 provides a practical checklist for the clinician when considering the use of spironolactone, with emphasis on treatment of AV in women. Spironolactone should be considered as a major agent in the armamentarium for treatment of adult women with AV. Its use, either as monotherapy or in rational combination with other agents, can provide many patients legitimate hope of achieving reasonable improvement that is usually sustained with continued use, with complete or near-complete control of their acne flares observed in many adult women with AV.”
Kim, Grace K., and James Q. Del Rosso. “Oral spironolactone in post-teenage female patients with acne vulgaris: practical considerations for the clinician based on current data and clinical experience.” The Journal of clinical and aesthetic dermatology 5.3 (2012): 37.