December 2010

Back to school

Drug and Disease Updates
Clinical Editorial: Clinician, Heal Thyself
Weighing Obesity: Epocrates Physician Survey Results
FDA MedWatch Safety Alerts
Clinical Question of the Month
Coming Soon: Epocrates EHR™
Save Time with Epocrates CME on Your iPhone®
Feature Focus: BMI Tool
What's This Disease?

During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 38.8% are obese and 5.7% are extremely obese of U.S. adults 20 years of age and older.

Keep reading to discover how Epocrates can help you and your patients …

Clinical Editorial

Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Clinician, Heal Thyself

Have you experienced the awkwardness of counseling a patient about lifestyle changes, when you yourself are in need of the identical advice? One afternoon post-call during residency, I remember nearly falling asleep during clinic, as I lectured a patient on the importance of a good night’s rest. On another occasion, I had a challenging end-of-life conversation with the family of a terminally ill patient, wherein we discussed her poor quality of life. Unlike her peers, the patient had no social life, interacting only minimally with hospital staff. She was unable to tolerate hospital food; her sleep was routinely interrupted. She spent most of her life inside the walls of a hospital.  A few hours after these words left my mouth, it dawned on me: The same applies to me.

They say that doctors make the worst patients. Many clinicians I know fit into one of two camps. They are either hypochondriacal about their own health, using their medical knowledge to attribute the worst possible meaning to their smallest symptom, or they consider themselves immune to illness in general. One physician, of the latter camp, confessed, “I realized that when I became a doctor, it was as if I had made a silent pact:  If I take care of sick people, then I won’t get sick myself.” I wish it were true. It seems particularly tragic when a clinician ends up suffering from a condition in their very own specialty – a urologist with a rare bladder tumor, a pulmonologist with a perplexing lung disease, or an obstetrician with a complication of labor.

Studies show that patients respond to clinician advice, and it stands to reason that in an ideal world, we would model health-promoting behaviors ourselves. Fortunately, perfection is not required for clinicians to make a difference. In my thirties, my personal physician sternly encouraged me to slim down, despite the fact that she had a few obvious pounds to shed herself. I took her advice to heart. A year later, my efforts ended up inspiring her to become more fit.

We can do more than ladle out advice, we can follow it. Exercise, nutrition, and preventive care benefit clinicians, too. Taking our own advice might offer us a longer and better life, as well as deepen our understanding of the patients under our care.

Drug and Disease
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Weighing Obesity: Epocrates Physician Survey Results
Epocrates Research Team

Chart: Percentage of patients who are obese

We invited 350 physicians to offer their clinical perspective on managing obesity in modern practice. According to the CDC, self-reported obesity prevalence in the US was 26.7% last year, and no state had met the Healthy People 2010 objective of an adult obesity rate under 15%. The experience of Epocrates physicians surveyed was bleaker:  on average, 40% of their patients were obese.  Over 35% of physicians estimated that more than half of their patients suffer from obesity. Diabetes, hypertension, and dyslipidemia topped the list of co-morbidities seen in this population.

Chart: Top co-morbitities seen in obese patients

Which factors motivate patients to make lifestyle improvements directed at obesity? Sudden events impacting health topped the list. The majority of physicians considered diet plus exercise to be unrealistic or ineffective. Physicians surveyed recommended bariatric surgery to 12% of patients and anti-obesity drugs to 13%. A large majority cited the need for anti-obesity drugs with improved risk-benefit profiles.  However, most felt that anti-obesity drugs are unlikely to provide a lasting solution, since they do not address the causative factors underlying obesity.

Chart: Motivating factors causing obese patients to address obesity

If you would like to participate in the Epocrates Honors® survey community, join now and be compensated for participating in research studies.

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FDA Medwatch Safety Alerts

Prescription drugs: Propoxyphene: Withdrawal - Cardiac Toxicity, Fentanyl Transdermal System: Recall – Potential for Faster Release, Heparin Sodium (B. Braun) - Trace Contaminant, Methotrexate Injection - Glass Particulates

OTC products: undeclared drug ingredients in Vigor-25, Duro Extend Capsules for Men 

Medical devices: Micromedics Surgical Sealant Dispensers, Nasal Septal Buttons, Otological Ventilation Tubes, Needleless Pre-filled Glass Syringes, VITEK 2 Gram Negative Susceptibility Cards Containing Piperacillin/Tazobactam: Recall, Triton Pole Mount Infusion Pump (WalkMed): Recall, Sigma Spectrum Infusion Pump: Class 1 Recall, Hospira Symbiq 1- and 2-Channel Infusers: Class I Recall, Octopus Nuvo Tissue Stabilizer: Class I Recall   

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Clinical Question of the month

Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

How does Epocrates deal with drugs that are withdrawn from the market, such as Meridia and Darvocet? Do you recommend specific alternatives for patients on those medications?

When a brand name product is withdrawn from the market as a result of FDA request, we make the note "Withdrawn from US Market" in the Dosing sections of the Epocrates Rx monograph. Though rare, if specific recommendations are given by the FDA or manufacturer about managing patients on these drugs, such as ongoing monitoring or how to convert to other therapies, we also include this information. Even if no specific alternatives have been named, you can easily find other medications that may be appropriate for your patient by selecting the Formulary field at the top of the Epocrates monograph for the withdrawn drug. You will then be given the opportunity to navigate to another drug in the same class or for the same indication.


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Coming Soon: Epocrates EHR™

Available in Spring 2011, Epocrates EHR has an intuitive interface that enables you to work the way you like and was designed with input from our vast network of doctors. It includes user-friendly features that enhance your workday without adding to it, and our outstanding support and training are always just a click away.

Over ten years ago, Epocrates changed the way doctors approached patient care. Now, the trusted leader in mobile point-of-care tools is bringing that same innovation and quality to a new EHR system.

Please visit ehr.epocrates.com to learn more.

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Save Time With Epocrates CME On Your iPhone®

Epocrates CME is a convenient new way to do CME, for credits or just to learn something new. You can now access this FREE resource on your iPhone/iPod touch and online. Please note that an Internet connection is required to view and complete activities.

Unique features of Epocrates CME include the ability to schedule activities, set your own goals, and measure your performance.

Download the Free iPhone App Now >
Access Epocrates CME Online >

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BMI Tool

The BMI Tool is an in-depth weight management tool developed to assist clinicians in the diagnosis and treatment of obesity. The tool features a BMI calculator that quickly gives accurate results in a few seconds.

This FREE tool also displays indications for pharmacotherapy and bariatric surgery, weight loss guidelines, a Basal Energy Expenditure Calculator using the Harris-Benedict Equation, and other useful information.

Download it to your iPhone OS device >
Download it to your Palm or Windows Mobile device >

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Acanthosis nigricans Test your knowledge!
Can you identify the disease in this image?


Find this image and many others in Epocrates® Essentials for iPhone® and BlackBerry®, Epocrates Essentials® Deluxe for iPhone and BlackBerry.
Log in to Epocrates Online for continually updated drug information and disease content and images.

Mobile Updates

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We always love to hear from our members about Epocrates products or any other topic at youropinion@epocrates.com. We occasionally select reader comments to feature in future newsletters. All readers featured in the newsletter will receive a free one-year subscription to the premium product of their choice.

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