Pulse Newsletter Epocrates
May 2012
Education

In a richly technology-saturated world, integrating information technology seamlessly into patient encounters poses a fresh challenge: How does mobile technology support a new style of bedside manner that still keeps the focus squarely on the patient? Read on to hear how Dr. Claudio Palma accessed the right information in the moment to reassure his patient.

 
In This Issue
Drug & Disease Updates
Clinical Editorial: Finding Answers in the Moment
DocAlert Editor’s Pick: Patient Stories
FDA MedWatch Alerts
DocAlert Editor’s Pick: Simple Advice Motivates Patients to Exercise
Act by June 30, 2012, to Avoid Medicare’s 2013 eRx Payment Adjustment
Extraordinary Moments With Epocrates: What’s Your Story?
Epocrates 1-1-1 Donation Program
Android Tips and Tutorials
Do You Have the Latest Version of
Epocrates?
Mobile Resource Center: Atrial Fibrillation
Epocrates CME Highlights
What's This Disease?

Plus, our Medical Information editors highlight two popular DocAlert messages: Patient Stories offers advice from a humanities professor who encourages an attitude of humility as we let patients tell us their stories; Simple Advice Motivates Patients to Exercise reminds us that patients are listening – clinician advice about lifestyle changes really does make a meaningful difference. We also want to hear your extraordinary patient care stories.

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Clinical Editorial

Finding Answers in the Moment
Anne Meneghetti, MD
Director, Clinical Communications

When a patient is right in front of you, it’s great to be able to find answers without breaking the flow of the visit. This is especially true when a patient is acutely suffering. Dr. Claudio Palma shared the following story with us, wherein he discovered that a patient’s acute pain flare was related to a drug-drug interaction between an opioid and an antibiotic.

Watch Dr. Palma’s video on YouTube

Little more than a decade ago, mobile technology did not support instant answers like this one. In the past, many clinicians were not comfortable accessing information in front of patients. Now, clinicians tell us they get positive feedback from patients when they briefly use technology during visits. Getting instant answers via phone or tablet makes it that much easier to stay in the moment with patients.



DocAlert Editor’s Pick

Patient Stories
By Anju Goel, MD, MPH

As medicine becomes increasingly driven by technology and testing, medical educators struggle with physicians on basic bedside skills, such as active listening, to enhance effective communication with patients.

Med Humanities 2011;37:68-72 [Free full-text PDF]

Johanna Shapiro

Illness narratives: reliability, authenticity and the empathic witness

[EXCERPTS]

Several scholarly trends, such as narrative medicine, patient-centered and relationship-centered care, have long advocated for the value of the patient's voice in the practice of medicine. From the clinical perspective, while diagnostic technologies are widely regarded as objective and replicable, patient stories can change in both content and emphasis from one telling to the next, and therefore may be seen as problematic, especially when they are resistant or oppositional narratives. While acknowledging the not inconsiderable pitfalls awaiting the interpreter of illness narratives, I argue that ultimately, physicians and scholars should approach patient stories with an attitude of narrative humility, despite inevitable limits on reliability and authenticity. An old folk proverb asks, ‘What is truer than the truth?’ The answer? ‘A good story’.

Copyright © 2012 by the BMJ Publishing Group Ltd & Institute of Medical Ethics. All rights reserved.

 
  update Update (sync) your Epocrates app once a week to ensure that you have the most current clinical information.
UPDATES AT A GLANCE
Updated Diseases and Conditions
Animal bites
Evaluation of acute headache in adults
Evaluation of vaginal discharge
Anterior cruciate ligament injury
Croup
Hemochromatosis
Hypertrophic cardiomyopathy
Guillain-Barre syndrome
Celiac disease
Optic neuritis

New Drug Monographs
Alyacen 1/35
(norethindrone/ethinyl estradiol)
Alyacen 7/7/7
(norethindrone/ethinyl estradiol)
Exparel
(bupivacaine liposomal)
fluvastatin
(first-time generic for Lescol)
Hecoria
(tacrolimus)
irbesartan
(first-time generic for Avapro)
irbesartan/
hydrochlorothiazide

(first-time generic for Avalide)
Marlissa
(levonorgestrel/ethinyl estradiol)
modafinil
(first-time generic for Provigil)
Myorisan
(isotretinoin)
Omontys
(peginesatide)
Picato
(ingenol mebutate topical)
Preparation H Cooling Gel
(phenylephrine/witch hazel topical)
Preparation H Cream Maximum Strength Pain Relief
(phenylephrine/pramoxine/
glycerin/petrolatum rectal)
Preparation H Ointment
(phenylephrine/mineral oil/petrolatum rectal)
Preparation H Suppository
(phenylephrine/cocoa butter rectal)
quetiapine
(first-time generic for Seroquel)
Subsys
(fentanyl transmucosal)
Suprenza
(phentermine hydrochloride)
Voraxaze
(glucarpidase)

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FDA MedWatch Safety Alerts

Prescription drugs: Birth Control Pills Containing Drospirenone: Products may be associated with a higher risk for blood clots. Celexa (citalopram hydrobromide): Revised recommendations, potential risk of abnormal heart rhythms. Brilliant Blue G Compounded by Franck's: Recall of unapproved drug - ongoing investigation of fungal endophthalmitis cases. Altuzan (bevacizumab): Counterfeit product - contains no active ingredient. Argatroban Injection 50 mg/50 mL (1 mg/mL): Recall - potential for visible particulates. American Regent Injectable Products: Recall - visible particulates in products.

Medical devices: Thoratec Corporation, HeartMate II Left Ventricular Assist System (LVAS): Recall - outflow graft may kink or deform.


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DocAlert Editor’s Pick

Simple Advice Motivates Patients to Exercise
Monique Yohanan, MD, MPH

Recent findings on promoting physical activity highlight the importance of the clinician-patient interaction. In primary care settings where exercise was encouraged in face-to-face or phone discussions, the number needed to treat for previously sedentary adults to meet recommended activity levels at 1 year was 12. Simple discussions between clinicians and patients about lifestyle changes have the potential to make a significant impact.

BMJ 2012;344:e1389 [Free full-text PDF]

Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials

Orrow G, et al

[EXCERPTS]

In 13 trials presenting self reported physical activity, we saw small to medium positive intervention effects at 12 months. The number needed to treat with an intervention for one additional sedentary adult to meet internationally recommended levels of activity at 12 months was 12 (7 to 33). Promotion of physical activity to sedentary adults recruited in primary care significantly increases physical activity levels at 12 months, as measured by self report.

© 2012 BMJ Publishing Group Ltd

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Act by June 30, 2012, to Avoid Medicare’s 2013 eRx Payment Adjustment

The Centers for Medicare & Medicaid Services Electronic Prescribing (eRx) program applies payment adjustments to encourage electronic prescribing. For eligible professionals who do not become successful e-prescribers, Medicare Part B Physician Fee Schedule professional services payments are reduced by 1% in 2012, 1.5% in 2013, and 2% in 2014.

How can you avoid the 2013 payment adjustment?

• Become an e-prescriber by June 30, 2012. Individual professionals need to report at least 10 eRx events via claims. Small group practice reporting option participants need 625 eRx events via claims; large group practice reporting option participants need 2,500 eRx events via claims.

• Submit a Significant Hardship Exemption by June 30, 2012. Individuals and groups may be exempted if e-prescribing would result in a significant hardship, for example, if they:

• are unable to e-prescribe due to local, state, or federal law or regulation
• prescribe fewer than 100 prescriptions in a 6-month reporting period (1/1/12 - 6/30/12)
• practice in rural areas without sufficient high-speed Internet or without sufficient pharmacies available for e-prescribing.

More information and resources are available from CMS online.

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Extraordinary Moments With Epocrates: What’s Your Story?

Over a million healthcare professionals like yourself work to deliver above-and-beyond patient care with Epocrates.

Every day, the work you do profoundly improves the lives of others. From the physician who discovered a drug interaction between an opioid and an antibiotic, to the paramedic who identified an overdose of tricyclic anti-depressants taken by a young adult—we want to hear your stories.

Tell My Story

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Epocrates 1-1-1 Donation Program

Thank you for your support of the Epocrates
1-1-1 Donation Program and voting for our 2012 finalists. We are happy to announce Volunteers in Medicine Clinic (Stuart, Florida) was selected to receive our premium support package including subscriptions to Epocrates Essentials and mobile devices for its volunteers.



Epocrates has saved me countless hours of time which I can now devote to patient care. Thank you for all your years of assisting in the care of needy patients.

     - Dr. Voss, Medical Director, Volunteers in Medicine Clinic




The 2013 application is now open at www.epocrates.com/who/donate. Is there a medical non-profit organization you contribute to or admire? Recommend our program to an organization you know or apply today.


Apply or Recommend
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Android Tips and Tutorials

The latest version of Epocrates brings you new icons, customizable home screens, transferability to the SD card, & support for OS 4.0 (Ice Cream Sandwich).

Don’t have Epocrates v 1.925? Update now.

Need help getting oriented? Watch brief demo videos within the Epocrates app by selecting “Help”, then “Tips”. Or, visit our Tips and Tutorials page.

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Do You Have the Latest Version of Epocrates?

Epocrates version 4.2 is available to you, with improved functionality within drug monographs, DocAlert messages, MELD calculator, and clinical content updates.

Update Now
iphone tips
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Mobile Resource Center: Atrial Fibrillation

iphone tips

The Atrial Fibrillation mRC offers free access to timely medical news and scientific abstracts selected by Douglas P. Zipes, MD, distinguished professor at Indiana University School of Medicine in Indianapolis, Indiana.

Learn More
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Epocrates CME Highlights

Take a CME activity online or on your iPhone with Epocrates CME. It’s a convenient way to do CME, for credits or just to learn something new. Try one of the activities below:

An Evidence-based Approach to the Diagnosis and Treatment of COPD: Improving Patient Care

Harold Visit 1: A 56-year old African American man with type 1 diabetes and leg pain

Marisol Visit 1: Disparities in Care of Type 2 Diabetes in Hispanics

iphone tips
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