May 2015

The days of patients requesting stacks of paper medical records being sent to a new healthcare professional are largely over in many places. How the information is transmitted and who gets to see that information is now a topic of discussion in the community.

Having one of the oldest electronic health record systems in the country the state of Indiana has been at the forefront of the field for close to 30 years. Using those records and networks in the state a group from the Regenstrief Institute looked at how patients might want to control who can see their records.

A 17-year-old Filipino female in the southern San Joaquin Valley of California presented with a 3 week history of progressive dyspnea on exertion and orthopnea accompanied by fever, chills, pleuritic chest pain, weight loss, and general debilitation.

This was a systematic review and meta-analysis examining the accuracy of rapid antigen diagnostic tests (RADTs) for group A strep (GAS) pharyngitis in children and adults as well as differences between studies already performed.

You see a 48-year-old white man for his annual examination. . The patient is overweight with a body mass index (BMI) of 32. A screening chemistry panel is normal except for an aspartate aminotransferase (AST, formerly SGOT) level of 85 U/L (normal 15-50 U/L) and an alanine aminotransferase (ALT, formerly SGPT) level of 98 U/L (normal 5-50 U/L). He says you are the first doctor he has seen in more than 10 years and does not recall the last time he had a blood test.

Although commercial support for continuing medical education has been on the decline since 2008, it nevertheless continues to be a major revenue source for CME providers and a cause for potential concern.

A 25-year-old man with no prior cardiac history presents for evaluation of presyncope. He reports he was shaving when he felt chest pain, shortness of breath and palpitations. He felt dizzy and diaphoretic. Symptoms resolved after 15 minutes.

Obesity contributes to significant morbidity and mortality among primary care patients. This paper summarizes options for pharmacological management of obesity. Medications approved for obesity are Phenteremine/Topiramate, Orlistat, Lorcaserin, Naltrexone/Bupropion, Liraglutide.

The IBIS-I randomized control trial included women of ages 35-70 from 37 health centers in eight countries from April, 1992, until March, 2001 that were deemed to be at increased risk of developing breast cancer (by virtue of family history of breast cancer or abnormal benign breast disease), and randomized to treatment with oral tamoxifen or placebo for 5 years.

This was a prospective multinational birth cohort study to determine if the age of first gluten introduction was associated with increased risk for celiac disease in genetically predisposed (high risk) children.

This 25-year-old African-American man has had this papular rash for the last 2 years following a short haircut. Initially he had pustules, itching and inflammation but currently only has itching papules that are slowly enlarging. Triamcinolone 0.1% ointment has helped the itching. Past history and remainder of physical examination is noncontributory.

This is an observational cohort study of Medicare beneficiaries of patients undergoing cataract surgery in the year 2011. Using multivariate analysis, the authors determined the relationship between preoperative testing and patient characteristics, health systems' characteristics, surgical setting, surgical care team, and the occurrence of a preoperative office visit.

Last month's Pain Perspectives focused on the benefits of psychotherapy in depressed patients with chronic pain. However, quality psychotherapy is not always available, and not all patients are open to it. This month, I will be looking at rational pharmacotherapy for the primary care physician in treating the depression that is generally an aspect of chronic pain syndromes.