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Sir William Osler, the first ever Physician-in-Chief of the new Johns Hopkins Hospital in 1889, is famously quoted as saying, "Soap and water and common sense are the best disinfectants." He then went on to establish the medical residency, among other contributions, radically reforming education models for future physicians.
We have much to be thankful for in the name of progress in medicine, as Dr. Jacob Varghese highlights in this month's Clinical Editorial. Keep reading to learn about the release of our smart new design for iOS, a request for donations of basic medical equipment for a rural clinic in India, the latest safety alerts from the FDA, an extension of gratitude towards the handy Electronic Preventive Services Selector (ePSS) app, a Pill ID infographic, and more.
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On Gratitude
Jacob Varghese, M.D., FAAFP
As we approach the year's end, I want to take time to reflect on all that we have to be thankful for. I am always amazed that Americans are willing to roll up our sleeves when the going gets tough and extend generosity to the less fortunate, especially in the face of disasters and calamity, even to total strangers. I am thankful for the freedoms and liberties we have, especially as we hear of the political unrest around the world.
As a practicing physician, I am thankful for the numerous advantages of our medical system. Having been the Medical Director of a Health Center for uninsured patients, and having traveled overseas to provide medical outreach in several third world countries, I have had the opportunity to see healthcare from a broadened perspective. The opportunity to travel, and the rich experiences therein, have helped me cultivate a deeper appreciation for all that we have available to us.
As clinicians, we have access to a myriad of resources within a world class medical system that includes top doctors, researchers, and the latest and safest drugs. We have an array of diagnostic tools and tests that help us diagnose diseases earlier, and cutting edge therapies to treat more appropriately. At our fingertips, we have mobile resources like Epocrates that aid us during the patient encounter, equipping us to be more thorough, accurate, better clinicians.
One final thanks, to those who made all of the above possible. I am in awe of how far medicine has come since I started medical school. That's only 15 years ago; just imagine where we will be in another 15 years.
Generosity: Global
Clinicians in underserved areas often rely on their own terrific physical exams skills. Yet, simple medical equipment can help medical teams take patient care to the next level. Dr. Meneghetti, our Director of Clinical Communications, volunteers from time to time at a new rural clinic in western India. The clinic is in need of new or gently used medical equipment, including stethoscopes, oto/ophthalmoscopes, reflex hammers, tuning forks, and a sphygmomanometer. If you have extras to donate, or know where these could be found at a reasonable cost, let us know. Donations are tax-deductible.
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Prescription drugs: Interaction Between SSRI/SNRI <=> Zyvox (linezolid): FDA has received reports of serious CNS reactions when Zyvox is given to patients taking a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI). Similar reports are cited between SSRI/SNRI <=> Methylene Blue. Orap (pimozide): The drug is metabolized by CYP 2D6; concomitant use with paroxetine or other strong CYP 2D6 inhibitors is contraindicated. Individuals with genetic variations resulting in poor CYP 2D6 metabolism (5 - 10% of the population) exhibit higher pimozide concentrations; alternative dosing strategies are recommended in such patients. Risperdal (risperidone) tablets, oral solution, Risperdal M-Tab orally disintegrating tablets, Risperdal Consta injection: Atypical antipsychotics have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk (hyperglycemia, dyslipidemia, weight gain). While all drugs in the class have been shown to produce metabolic changes, each drug has its own specific risk profile. Chantix (varenicline): Monitor patients for neuropsychiatric symptoms. Sprycel (dasatinib): May increase the risk of pulmonary arterial hypertension. Procardia (nifedipine) 10 mg capsules: Procardia capsules should not be used for control of essential hypertension. Although not approved for this purpose, Procardia and other immediate-release nifedipine capsules have been used for long-term essential hypertension control; no properly controlled studies have been conducted to define appropriate dosing for such treatment.
OTC products: Nostrilla Nasal Decongestant: Bacterial contamination with Burkholderia cepacia; Uprizing 2.0: Contains an undeclared drug ingredient, superdrol, a synthetic steroid
Medical devices: CooperVision Avaira Toric Soft Contact Lenses: Unintended residue on lenses.
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Epocrates v4.0 for iOS is Here
Epocrates v4.0 for iOS is ready for you, with its icon-centric customizable Epocrates homepage, quicker access to drug & disease resources, our extensive medical App Directory, and more.
To update:
1. Tap the App Store icon
2. Tap the Updates tab
3. Scroll down to Epocrates and tap it
4. Tap the [Update] button
5. Follow the on-screen instructions |
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App Appreciation
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates
Am I supposed to be screening asymptomatic patients for hypothyroidism, PAD, or vitamin D deficiency? Who needs aspirin for prevention? Didn't I read something about screening asymptomatic women for chlamydia? Keeping up with the latest recommendations on health screenings and other preventive services is no mean feat. I am deeply grateful to the US Agency for Healthcare Research & Quality (AHRQ) for creating the handy Electronic Preventive Services Selector (ePSS) app. Enter age, gender, tobacco and sexual activity status' and behold the evidence-based recommendations.
Tab through the display for guidance graded according to the evidence:
| A. |
High certainty that the net benefit is substantial for these recommended services. If you are a diagnostic/ therapeutic nihilist like myself, you may be tempted to stop here. But read on. |
| B. |
Moderate. Included are recommended services with high certainty that the net benefit is moderate, as well as services with moderate certainty that the benefit is moderate-to-substantial. |
| C. |
Uncertain. The US Preventive Services Task Force (USPSTF) recommends against routinely providing these services; yet there may be valid reasons to offer them to selected individuals. |
| D. |
Discourage use of these services, as there is moderate or high certainty that they have no benefit - or that harms outweigh benefits. |
| I. |
Insufficient evidence to assess the balance of benefits and harms. |
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Recommended screening tests, counseling services, and preventive drugs (aspirin, vitamins, etc.) are included – one notable absence is immunizations. If you like the succinct style of Epocrates clinical references, you will appreciate the short, clear results displayed in ePSS. More information is available through drilling down, including detailed rationales and resource links. More good news: The app is available free on iPhone/iPod touch, Android, BlackBerry, Palm OS/webOS, and Windows Mobile devices. You can also use it directly online or via a web widget. Do you have a patient portal for your practice? The app also comes in a friendly consumer-speak version: consider linking to it or installing the consumer widget on your site.
If you are choosing an EHR, do yourself a big favor and find one that has ePSS-like decision-support built right in. You'll be grateful for the health maintenance reminders tailored to individual patients. Clinicians are human, too. While you are checking out this terrific app, take a moment to enter your own data to see which preventive services are recommended for you. |
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DocAlert: Editor's Pick
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates
We received several emailed thank-you notes from readers who enjoyed this DocAlert Message on mobile devices, so we decided to share it with our Pulse readers as well. Can you guess the syndrome and next tests to order? View the free full-text article for answers.
BMJ 2011; 342:d2977 doi: 10.1136/bmj.d2977
Picture Quiz
A woman with episodic headaches, sweating, and palpitations
Angus Jones, Matthew Bull, Bijay Vaidya
[Excerpts]
Link to free full-text BMJ article PDF
A 39 year old woman was referred to the headache clinic with a 10 year history of episodic headaches, sweating, and palpitations. The symptoms had intensified over the past one to two years. Since then she has been experiencing three to four episodes a day, mostly at night, of severe headache, chest tightness, sweating, palpitations, and "churning stomach." Her mother had been diagnosed with metastatic cancer of unknown source in her early 60s.
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| Fig 1 Coronal 123I-MIBG SPECT fusion scan |
Fig 2 Coronal Coronal T2 weighted magnetic resonance image of the abdomen showing a large cystic right adrenal mass and a much smaller left adrenal mass (arrows) |
On examination, her blood pressure was 100/80 mm Hg, with no postural drop; pulse was 86 beats/min and regular. She had a palpable left thyroid nodule but no associated lymphadenopathy, and other systemic examinations were unremarkable. Thyroid function tests were normal; 24 hour urinary catecholamines performed twice showed markedly raised noradrenaline and adrenaline.
© 2011 BMJ Publishing Group Ltd.
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ERRATUM
The dosing calculator in Epocrates v4.0 for mobile Apple iOS devices displays an incorrect result when the dose amount units are set to mcg/kg or g/kg. Correction of this issue is expected to be available mid-November.
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Log in to Epocrates Online for continually updated drug information and disease content and images.
Update (sync) your device regularly to download free clinical content and news, including new drugs and DocAlert messages. |
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Thanks to those who sent us a note about what they are grateful for. We used the feedback to create the Wordle you see at the top. We always love to hear from our members about Epocrates products or any other topic at youropinion@epocrates.com. |
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Copyright © 2011 Epocrates, Inc. All Rights
Reserved. Epocrates, iChart and DocAlert are trademarks of Epocrates,
Inc. in the United States and other countries. All other trademarks
referenced are the property of their respective owners.
Epocrates, Inc., 1100 Park Place, Suite 300, San Mateo, CA 94403 www.epocrates.com |
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