Jeannette Y. Wick, RPh, MBA, FASCP

A low-dose adrenocorticotropic hormone (ACTH) stimulation test is more sensitive in patients with cases of mild hypoadrenalism, and the high-dose test often misses secondary hypoadrenalism due to pituitary or hypothalamic dysfunction. Endocrinologists still debate test result interpretation for the low-dose test, however.

Dietary trans fatty acids have had their heyday and are fading from the American food landscape. Once ubiquitous in margarine, snack food, packaged baked goods, and fried fast food, they have been associated with adverse effects on lipid profiles, metabolic function, insulin resistance, inflammation, and cardiac and general health.

In previous studies, regular breakfast consumption has been correlated with lower BMI and improved cardiometabolic risk profile. Furthermore, evidence suggests that low-energy density, high-fiber, and high-carbohydrate foods may be more satiating when compared to their alternatives.

Epidemiological studies have provided conflicting evidence regarding the impact of dietary cholesterol and egg consumption on heart disease risk in patients with type 2 diabetes mellitus (T2DM). Also controversial is the idea that dietary cholesterol may contribute to the very development of T2DM by altering glucose metabolism. Given the significant influence of diet on diabetes management, the lack of conclusive evidence on this subject emphasizes the need for further study.

The Paleolithic (grain-free) diet is gathering steam among dieters and health conscious individuals alike. Proponents consume only items that, hypothetically, cavemen would have had access to. They claim that modern man can't metabolize comparatively new types of food, and our reliance on processed foods has increased rates of obesity, heart disease, and diabetes.

The summer 2015 issue of the Journal of Surgical Orthopedic Advances discusses a question that continues to vex surgeons and patients alike: when can patients who have arthroscopic rotator cuff repair drive again and what are the patient's perceptions? To date, no clear guideline has been developed for driving safety and maneuverability during post-operative recovery.

Insurers, regulators and statisticians have long contended that where patients undergo weight loss surgery can be as important as who performs it. A skilled, experienced bariatric surgeon will only perform optimally and patients will only receive ideal post-op care if the center in which he or she works is well-equipped.

A recent study looked at whether metabolic syndrome confers a greater cancer risk than the sum of its individual components and component associations, and whether it is a useful predictor for future cancer risk.

What if obesity isn't necessarily a result of an imbalance in energy consumed compared to energy expended, but a much more complicated problem related to gut microbiota (among other things)?

Are surgeons less likely to embrace evidence-based medicine and use cutting-edge research methods to conduct high-quality randomized, controlled trials than their medical colleagues?

Small case study shows limited positive benefits in 2 children with Wolf-Hirschhorn syndrome who were treated with growth hormone.

A meta-analysis of peer-reviewed articles published after 2000 that looked at the economic consequences of type 2 diabetes mellitus treatment intensification produced several interesting findings.

Danish researchers conducted a meta-analysis that looked at possible associations between coffee intake and obesity, metabolic syndrome, and type 2 diabetes. They reported finding only a low risk of these conditions in coffee drinkers, but no genetic variance to explain the relationships.

With the global boom in type 2 diabetes mellitus, many patients have greatest access to and are well-cared for by their primary care practitioners (PCPs). For those with basic, predictable, garden-variety diabetes, PCPs are perfectly capable of helping them. It's unclear when referral to a specialist for consultation or chronic management is most sensible.

A recent review article summarized the socioeconomic consequences of Klinefelter syndrome, which is the most frequent chromosomal aberration in humans and is associated with hypogonadism and neurocognitive deficits.

Prosthetic joint infection (PJI) occurs after approximately 2% of primary hip or knee replacements and in up to 6% of revisions surgeries, and cost more than $50,000 per episode. A recent review found that many surgeons have altered their approaches to PJI management based on recent clinical findings.

Besides being the most common cause of chronic liver disease in industrialized nations, non-alcoholic fatty liver disease has serious hepatic consequences. It is expected to be the most frequent indication for liver transplantation by 2030.

GLP-1 receptor antagonists have been associated with thyroid cancer in rodents, and in fact carry a boxed warning about the potential for cancer in humans. This leads many clinicians to ask if they should be concerned about using these drugs in patients who have or develop specific types of thyroid cancer

Historically, surgical times were tracked to help operating suite managers schedule operating rooms. For the last 25 years or so, quality managers have watched surgical times with respect to patient outcomes. They've come to a growing realization that faster is not always better and slower may not represent careful, deliberate technique.

China's type 2 diabetes mellitus (T2DM) epidemic continues to be a pervasive, costly health care issue, with proportions surpassed only by epidemic here in the US. The majority of T2DM treatment guidelines recommend metformin as the first-line anti-hyperglycemic agent for diabetes management due to its relative safety, tolerability, and cost-effectiveness.

The American Diabetes Association published its revised Standards of Medical Care in Diabetes in April 2015. The American Association of Clinical Endocrinologists (AACE) also issued an updated guideline in April 2015.

As P4P strategies gain popularity, the need for accurate assessment tools becomes more and more apparent-many physicians support PCP but believe that current measures are inaccurate. A common problem is that physicians appear to be penalized if they treat the elderly or patients who have reduced access to care or drug treatment.

Studies show that nutrient-dense yogurt may benefit individuals with lactose intolerance, constipation and diarrheal diseases, hypertension, cardiovascular diseases, diabetes, and certain types of cancer.

When patients are initially diagnosed with type 2 diabetes, clinicians usually recommend several lifestyle changes, including weight loss. Few studies have looked at weight changes in patients with type 2 diabetes around initial diagnosis, although it's clear that it is more difficult for patients with diabetes to lose weight than it is for others.

Chronic itch (itch last 6 weeks or longer) is a clinical challenge, and is associated with a number of dermatologic, systemic, neuropathic, and psychogenic causes. Transmission of the itch sensation is similar to that of pain, but distinct in several ways. Scientists have found itch-specific neuronal pathways that when activated, cause considerable discomfort for patients. Current available treatments, however, are still more trial-and-error than evidence-based.

Hair loss, whether it's partial or complete, is troubling to many people. By age 50, 35 to 50 percent of American men have significant hair loss, and hair thinning and loss increases with age. Many people associate hair loss with premature aging, making pharmaceuticals that arrest hair loss quite popular. However, they are not without certain side effects.

What factors make a plastic surgeon successful? That was the research question asked by a team of researchers, and answered by an analysis of a survey sent to members of the American Association of Plastic Surgeons. The results, published in Plastic and Reconstructive Surgery Global Open, provide insight that could help select the best candidates for careers in plastic surgery.

Across the United States, especially within the Veterans Affairs healthcare system, heart failure (HF) is reported to cause hospitalization, disability, and death.

Although stroke is the second leading cause of death globally, in China, it is the most frequent cause of death. Some trials and meta-analyses have found that folic acid supplementation has no effect on cardiovascular events in general, but it may reduce stroke risk.

In a perspectives piece published in the April 2015 issue of JAMA Internal Medicine, physicians from Montefiore Medical Center in New York City underscored the importance of removing language barriers.