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When Less Is More: How To Improve The Quality Of Primary Care

On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt:

“A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.

After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.

So what should family doctors not be doing? The Top 5 list for them goes like this:

1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems.
2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better.
3. No annual electrocardiograms for low-risk patients without cardiac symptoms.
4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.
5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.”

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Drug Resistant Bacteria Found In Half Of US Meat And Chicken

Drug-resistant strains of Staphylococcus aureus were found in nearly half of meat and poultry samples, and were likely from the animal themselves, a study reported.

Meat Department by Anthony Albright via Flickr and Creative CommonsResearchers collected and analyzed 136 samples of 80 brands of beef, chicken, pork and turkey from 26 retail grocery stores in Los Angeles, Chicago, Washington, D.C., Fort Lauderdale, Fla., and Flagstaff, Ariz. Among the samples, 47% were contaminated with S. aureus, and 52% of the strains were resistant to at least three classes of antibiotics–and some to nine antibiotics.

Translational Genomics Research Institute, a non-profit research organization, conducted the study and published results in Clinical Infectious Diseases.

DNA testing suggested that the food animals themselves were the major source of contamination. Read more »

*This blog post was originally published at ACP Internist*

Antibiotics Losing The Battle Against Drug-Resistant Bacteria

The single most important medicine ever discovered is the antibiotic.  Prior to 1930, humans died at early ages of simple infections and even childbirth was a major killer of women because of infection.   The mortality rate from simple staph aureus was as high as 80%,  but between 1944 and 1972 the human life expectancy jumped by 8 years because of antibiotics.   By 1950 the golden age of antibiotics was already looking tarnished as organisms became resistant to the drugs.  Now many medical advances that we take for granted, including cancer treatment, surgery, transplantation and neonatal care are endangered by increasing antibiotic resistance and a decline in new medications to combat the super germs.

Drug resistance is both a public health and global security threat. Resistance has emerged for all known antibiotics in use.  For most antibiotics, resistant genes have created super bugs that require more combinations of antibiotics  to treat and there are certain infections that we cannot effectively treat.   Read more »

*This blog post was originally published at EverythingHealth*

Asymptomatic Strep Throat: Should We Treat It?

Occasionally, I see patients who have received throat swabs for strep that have come back positive… even if they have no signs or symptoms of pharyngitis.

In this situation, there are 2 main actions a physician may take (I am biased towards one):

1) Prescribe antibiotics until throat cultures are normal
2) Do nothing

Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for??? Read more »

*This blog post was originally published at Fauquier ENT Blog*

Ear Infections: To Treat Or Not To Treat?

Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27 percent of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis.

In the 1980s, that consensus began to change. We realized that as many as 80 percent of uncomplicated ear infections resolve without treatment in three days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause side effects. A new strategy of watchful waiting was developed.

Current Medical Guidelines

In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) collaborated to issue evidence-based guidelines based on a review of the published evidence. Something was lost in the transmission: The guidelines have been over-simplified and misrepresented, so it’s useful to look at what they actually said. There were six parts:

1. Criteria were specified for accurate diagnosis.

  • History of acute onset of signs and symptoms
  • Presence of middle ear effusion (ear drum bulging, lack of mobility, air-fluid level)
  • Signs and symptoms of middle ear inflammation: Either red ear drum or ear pain interfering with normal activity or sleep

They stressed that AOM must be distinguished from otitis media with effusion (OME). OME is more common, occurs with the common cold, can be a precursor or a consequence of AOM, and is not an indication for antibiotic treatment. Read more »

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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