Management of Medullary Thyroid Cancer.
Abstract Medullary thyroid cancer (MTC) is rare but aggressive. It can be cured only if intrathyroid at diagnosis. MTC can be sporadic (75%) or familial (25%) and the 2 forms are distinguished by RET mutations analysis. Calcitonin is the specific serum marker; its doubling time is the most important prognostic factor for survival and progression; 30% of MTC patients have distant metastases at diagnosis and, when progressing, systemic therapy with vandetanib or cabozantinib should be considered. Before starting this treatment, the possibility of using a local treatment should be evaluated to delay systemic therapy....
Source: The Medical Clinics of North America - February 6, 2019 Category: General Medicine Authors: Viola D, Elisei R Tags: Endocrinol Metab Clin North Am Source Type: research

Genetics of Eating Disorders: What the Clinician Needs to Know.
Abstract Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) are heritable conditions that are influenced by both genetic and environmental factors. Recent genome-wide association studies (GWAS) of AN have identified specific genetic loci implicated in AN, and genetic correlations have implicated both psychiatric and metabolic factors in its origin. No GWAS have been performed for BN or BED. Genetic counseling is an important tool and can aid families and patients in understanding risk for these illnesses. PMID: 30704640 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Bulik CM, Blake L, Austin J Tags: Psychiatr Clin North Am Source Type: research

Diagnosis in Neurologic Disease.
Abstract The diagnosis of neurologic disease is relevant to the non-neurologist because neurologic symptoms are a common reason patients present to their health care provider and most of these patients are never referred to a neurologist. The diagnosis of a neurologic disease is a rewarding endeavor because it requires intellectual rigor, skill, and is of paramount importance to patient care. A tailored history and examination lead to localization and differential diagnosis. Diagnostic testing often involves neuroimaging and serum testing and also may involve lumbar puncture, electroencephalogram, nerve conduction...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Milligan TA Tags: Med Clin North Am Source Type: research

Examination of the Patient with Dizziness or Imbalance.
Abstract Dizziness and imbalance are common and challenging chief complaints carrying high morbidity, due to their association with falls, injuries, and loss of quality of life. The physical examination represents an opportunity to collect objective clinical data that facilitate an understanding of symptoms that might otherwise be enigmatic and ineffable. This review focuses on the examination techniques used routinely by physicians who provide specialized care for patients with dizziness and imbalance. PMID: 30704676 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Whitman GT Tags: Med Clin North Am Source Type: research

Gait Disorders and Falls in the Elderly.
Abstract Gait disorders in the elderly may be based on a neurologic deficit at multiples levels, or may be secondary to nonneurologic causes. The physiology and pathophysiology of gait problems are reviewed and bedside examination and investigative tools are discussed. The reader will have an excellent working knowledge of the subject and will know how to diagnose and treat gait disorders and falls. PMID: 30704677 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Ronthal M Tags: Med Clin North Am Source Type: research

Migraine and Tension-Type Headache: Diagnosis and Treatment.
Abstract Migraine and tension-type headache are highly prevalent. Migraine is associated with significant work- and family-related disability. Migraine is underdiagnosed; it reasonable to err on the side of migraine when choosing between primary headaches. Barriers to appropriate treatment of migraine include lack of access to providers, misdiagnosis, and acute and preventive therapies not being prescribed. Acute, rescue, and preventive treatment options are extensive, and new classes of treatments are either available or in development. This review addresses diagnostic challenges including recognizing migraine wi...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Burch R Tags: Med Clin North Am Source Type: research

Nonmigraine Headache and Facial Pain.
Abstract The vast majority of headache patients encountered in the outpatient general medicine setting will be diagnosed with a primary headache disorder, mostly migraine or tension-type headache. Other less common primary headaches and secondary headaches, related to or caused by another condition, are the topic of this article. Nonmigraine primary headaches include trigeminal autonomic cephalalgias, primarily cluster headache; facial pain, primarily trigeminal neuralgia; and miscellaneous headache syndromes, such as hemicrania continua and new daily persistent headache. Selected secondary headaches related to va...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Vgontzas A, Rizzoli PB Tags: Med Clin North Am Source Type: research

Concussion Evaluation and Management.
Abstract Concussion is a public health crisis affecting vulnerable populations including youth athletes. As awareness increases, more patients with acute concussion are seeking medical evaluations. Internists are frontline medical providers and thus should be able to identify, diagnose, manage, and know when to refer patients with concussion. Management of concussion includes rapid removal from play, symptomatic treatment, and return to learn/play recommendations. Inappropriate management may lead to recurrent concussions, prolonged recovery, and potential long-term consequences. Understanding the key features of ...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Jackson WT, Starling AJ Tags: Med Clin North Am Source Type: research

The Alzheimer's Disease Clinical Spectrum: Diagnosis and Management.
Abstract Alzheimer's disease (AD) care requires timely diagnosis and multidisciplinary management. Evaluation involves structured patient and caregiver history and symptom-function reviews, examination, and testing (laboratory and neuroimaging) to delineate impairment level, determine the cognitive-behavioral syndrome, and diagnose cause. Clinical biomarkers are available to aid high confidence in etiologic diagnosis. Management uses psychoeducation, shared goal setting, and patient-caregiver dyad decision making. When combined, pharmacologic and nonpharmacologic therapies mitigate symptoms and reduce clinical pro...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Atri A Tags: Med Clin North Am Source Type: research

Cerebrovascular Disease: Primary and Secondary Stroke Prevention.
Abstract Despite advances in earlier diagnosis and available aggressive treatments for vascular risk factors, stroke remains a leading cause of death and long-term disability worldwide. Disparities exist in stroke risk, rates of stroke, and treatment. Stroke is a heterogeneous disease with multiple additive risk factors and causes. Primary prevention of stroke focusing on risk factor modification plays an important role in reducing the burden of stroke in an aging population. Secondary prevention of recurrent strokes relies on the workup and a tailored treatment targeted at the mechanisms responsible for the incid...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Caprio FZ, Sorond FA Tags: Med Clin North Am Source Type: research

Seizures and Epilepsy.
Abstract Epilepsy affects 65 million people worldwide, and is a leading neurologic cause of loss of quality-adjusted life years. The diagnosis of seizures and epilepsy often depends on a careful history, and is supported with electroencephalogram and imaging. First-line treatment of epilepsy includes medical management. Antiepileptic drugs must be chosen with the patient's particular comorbidities in mind. Drug-resistant epilepsy cases should be referred to an epilepsy specialist and may be evaluated for additional medications, epilepsy surgery, neurostimulation, or dietary therapy. When caring for women, provider...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Johnson EL Tags: Med Clin North Am Source Type: research

Multiple Sclerosis and Autoimmune Neurology of the Central Nervous System.
Abstract Autoimmune disorders of the central nervous system are common and often affect people in the most productive years of their lives. Among primary autoimmune diseases of the central nervous system, multiple sclerosis is most prevalent in the United States. Many other autoantibody-mediated neurologic syndromes have been identified within the past 2 to 3 decades, including neuromyelitis optica and anti-N-methyl-D aspartate receptor encephalitis. Finally, the central nervous system can also be affected by systemic autoimmune diseases such as sarcoidosis. Many of these diseases are treatable when detected early...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Galetta KM, Bhattacharyya S Tags: Med Clin North Am Source Type: research

Parkinson's Disease.
Abstract The diagnosis of Parkinson disease (PD) is based on the presence of bradykinesia and either resting tremor or rigidity and there should be no features from the history or examination to suggest an alternative cause of parkinsonism. In addition to the motor manifestations of PD, there is a long list of nonmotor symptoms, several of which occur before motor signs and are considered "prodromal" PD. These are classified as neuropsychiatric, autonomic, sleep, and sensory. There are many medical options for the treatment of PD but levodopa remains the mainstay. Deep brain stimulation and other advance...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Reich SG, Savitt JM Tags: Med Clin North Am Source Type: research

Essential Tremor.
Abstract Essential tremor is one of the most common movement disorders. It is characterized by a bilateral action tremor of the upper limbs. It may be accompanied by tremor of the head, voice, or lower limbs. Essential tremor is often present for years or decades before presentation and it progresses insidiously. It is often familial and transiently responsive to alcohol. For patients requiring treatment, the two first-line medications are propranolol and primidone, which are synergistic. Patients with disabling essential tremor that cannot be managed medically are candidates for either deep brain stimulation or f...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Reich SG Tags: Med Clin North Am Source Type: research

Entrapment Neuropathies of the Upper Extremity.
Abstract Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities. PMID: 30704687 [...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Doughty CT, Bowley MP Tags: Med Clin North Am Source Type: research

Entrapment Neuropathies of the Lower Extremity.
Abstract Entrapment neuropathies in the lower limbs are a common neurologic problem and may present in any medical setting. Accurate identification and management of these nerve palsies can prevent pain, sensory loss, incoordination, and muscle weakness that may significantly affect a patient's functional mobility. In this article, the authors focus on the cause, signs and symptoms, diagnosis, and treatment of select entrapment neuropathies of the lower extremity, including palsies of the common peroneal, lateral femoral cutaneous, femoral, and posterior tibial nerves. PMID: 30704688 [PubMed - in process] (So...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Bowley MP, Doughty CT Tags: Med Clin North Am Source Type: research

Peripheral Neuropathy.
This article provides a diagnostic framework for neuropathies and summarizes treatment options. PMID: 30704689 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Barrell K, Smith AG Tags: Med Clin North Am Source Type: research

Dads and Moms.
PMID: 30704690 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Ashar BH Tags: Med Clin North Am Source Type: research

The Importance of Neurology for the Non-Neurologist.
PMID: 30704691 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Milligan TA Tags: Med Clin North Am Source Type: research

Spine Oncology: Imaging and Intervention.
Abstract Osseous metastases are the most common spine tumor and increasingly prevalent as advances in cancer treatments allow patients to live longer with their disease. Evidence-based algorithms derive the majority of their data from imaging studies and reports; the radiologist should understand the most current treatments and report in the language of the treatment team for efficient and effective communication and patient care. Advanced imaging techniques such as diffusion-weighted imaging and dynamic contrast-enhanced MRI are increasingly used for diagnosis and problem solving. Radiologists have a growing role...
Source: The Medical Clinics of North America - February 3, 2019 Category: General Medicine Authors: Gibbs WN, Nael K, Doshi AH, Tanenbaum LN Tags: Radiol Clin North Am Source Type: research

Leadership Driving Safety and Quality.
Abstract Leaders in health care play a large role in successful achievement of quality and safety goals through an overt commitment to both quality and safety, fostering a culture of quality improvement and clear and consistent communication of goals and plans. Specific training for frontline providers, managers, and staff is critical in developing skilled leaders with a quality and safety orientation. Many models exist for organizational leadership development, and exemplars of quality and safety leadership have openly shared the keys to their successes for others to raise the bar. PMID: 30262167 [PubMed - i...
Source: The Medical Clinics of North America - December 28, 2018 Category: General Medicine Authors: McKean EL, Snyderman CH Tags: Otolaryngol Clin North Am Source Type: research

Reprocessing Standards for Medical Devices and Equipment in Otolaryngology: Safe Practices for Scopes, Speculums, and Single-Use Devices.
This article details best practices in reprocessing reusable and single-use devices in otolaryngology, with particular attention to flexible fiberoptic endoscopes/nasophyarngoscopes, nasal speculums, and other clinic and operating room instruments. High-risk devices require sterilization, whereas lower risk devices may be reprocessed using various disinfection procedures. Reprocessing practices have implications for adequacy, efficiency, and cost. Nuanced understanding of procedures and their rationale ensures delivery of safe, ethical, and quality patient care. PMID: 30262168 [PubMed - indexed for MEDLINE] (Source: T...
Source: The Medical Clinics of North America - December 28, 2018 Category: General Medicine Authors: Chang CWD, Brenner MJ, Shuman EK, Kokoska MS Tags: Otolaryngol Clin North Am Source Type: research

Multidisciplinary Tracheostomy Care: How Collaboratives Drive Quality Improvement.
Abstract There have been reports of successful quality-improvement initiatives surrounding tracheostomy care for more than a decade, but widespread adoption of best practices has not been universal. Five key drivers have been found to improve the quality of care for tracheostomy patients: multidisciplinary synchronous ward rounds, standardization of care protocols, appropriate interdisciplinary education and staff allocation, patient and family involvement, and use of data to drive improvement. The Global Tracheostomy Collaborative is a quality-improvement collaborative dedicated to improving the care of tracheost...
Source: The Medical Clinics of North America - December 28, 2018 Category: General Medicine Authors: Bedwell JR, Pandian V, Roberson DW, McGrath BA, Cameron TS, Brenner MJ Tags: Otolaryngol Clin North Am Source Type: research

MR Imaging of the Urinary Bladder: Added Value of PET-MR Imaging.
Abstract MR imaging has been increasingly getting attention for the evaluation of bladder cancer. Recent studies have been promising for the staging performance of MR imaging in the bladder cancer, although its specific role has not been established yet. Additionally, the use of hybrid imaging combining PET with MR imaging could have the potential to increase its accuracy, although more research studies are needed. PMID: 30466905 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 25, 2018 Category: General Medicine Authors: Altun E Tags: Magn Reson Imaging Clin N Am Source Type: research

MR Imaging of the Penis and Urethra.
Abstract MR imaging has been increasingly used as a problem-solving adjunct after an initial ultrasound examination for a variety of penile disorders, and is the best cross-sectional imaging modality for the assessment of urethra and periurethral disease. Critical advantages of MR imaging for penile and urethra imaging include high soft tissue contrast resolution providing detailed anatomic evaluation, which is important for the demonstration and assessment of critical structures such as tunica albuginea or walls of the urethra, larger field of view for better evaluation of extent of disease, and demonstration of ...
Source: The Medical Clinics of North America - November 25, 2018 Category: General Medicine Authors: Altun E Tags: Magn Reson Imaging Clin N Am Source Type: research

Update on Genitourinary MR Imaging.
PMID: 30466916 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 25, 2018 Category: General Medicine Authors: Altun E Tags: Magn Reson Imaging Clin N Am Source Type: research

Chronic Kidney Disease and Dietary Measures to Improve Outcomes.
Abstract Chronic kidney disease is an ongoing deterioration of renal function that often progresses to end-stage renal disease. Management goals in children include slowing disease progression, prevention and treatment of complications, and optimizing growth, development, and quality of life. Nutritional management is critically important to achieve these goals. Control of blood pressure, proteinuria, and metabolic acidosis with dietary and pharmacologic measures may slow progression of chronic kidney disease. Although significant progress in management has been made, further research is required to resolve many o...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Akchurin OM Tags: Pediatr Clin North Am Source Type: research

Infections of the Ear.
This article is geared toward the emergency physician, urgent care provider, and primary care provider who will likely be the initial evaluating and treating provider to assist them in determining what treatment modalities can be managed in a clinic and what needs to be referred for admission or specialty consultation. PMID: 30454772 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Szmuilowicz J, Young R Tags: Emerg Med Clin North Am Source Type: research

Tracheostomy Emergencies.
Abstract Tracheostomy is a common procedure for long-term airway management. Although the overall complication rate is greater than 50%, the incidence of serious complications is low. These serious complications can, however, lead to significant morbidity and mortality and it is incumbent on the emergency provider to be prepared to deal with such tracheostomy-related emergencies. The greatest life threats to the tracheostomy patient are decannulation, obstruction, and hemorrhage. Other important but lower-acuity complications include tracheoesophageal fistula formation, tracheal stenosis, infection, and tracheocut...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Bontempo LJ, Manning SL Tags: Emerg Med Clin North Am Source Type: research

Peripheral Vertigo.
This article summarizes the systematic assessment of the dizzy patient who presents with peripheral vertigo. It demonstrates the steps and tests necessary using the Triage-Timing-Trigger-Test (Triage + TiTraTe) method to accurately diagnose the underlying most probable cause while ruling out life-threatening causes. Using video support and just-in-time infographics, it demonstrates the Dix-Hallpike, Semont, Epley, and HINTS maneuvers. PMID: 30454774 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Omron R Tags: Emerg Med Clin North Am Source Type: research

Foreign Bodies of the Ear, Nose and Throat.
Abstract Foreign bodies to the ear, nose, and throat often can be managed in the emergency department, particularly if the patient offers a history consistent with foreign body and is calm and compliant with the examination and removal attempts. Tips for success include analgesia, adequate visualization, immobilization of the patient's head, dexterity and experience level of the provider, and minimizing attempts at removal. It is critical to recognize the risks involved with certain retained objects (button batteries or sharp objects) and when to call a consultant to help facilitate safe, successful removal of obj...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Oyama LC Tags: Emerg Med Clin North Am Source Type: research

Traumatic Injuries of the Ear, Nose and Throat.
This article reviews the presentation, diagnosis, and management of common traumatic injuries of the ear, nose, and throat, including laryngeal trauma, auricular and septal hematomas, and tympanic membrane rupture. PMID: 30454776 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Henry M, Hern HG Tags: Emerg Med Clin North Am Source Type: research

The Diagnosis and Management of Facial Bone Fractures.
Abstract Appropriate medical care for a patient with a facial fracture can not only optimize aesthetic outcomes but also prevent the potential morbidity and mortality of delayed treatment. In this article, we focus on the clinical presentations, physical examination findings, diagnostic imaging, consultations, and follow-up that patients with facial fractures need related to their emergency department management. Specifically, we address the nuances of evaluating frontal, orbital, nasal, maxillofacial, and mandibular fractures. PMID: 30454777 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Chukwulebe S, Hogrefe C Tags: Emerg Med Clin North Am Source Type: research

Epistaxis.
Abstract Most anterior epistaxis originates primarily from the Kiesselbach plexus, whereas posterior epistaxis is less common and originates from branches of the sphenopalatine artery. Risk factors include local trauma, foreign body insertion, substance abuse, neoplasms, inherited bleeding diatheses, or acquired coagulopathies. Assessment of airway, breathing, and circulation precedes identification of bleeding source, pain control, and achieving hemostasis. Management options include topical vasoconstrictors, direct pressure, cautery, tranexamic acid, nasal tampons, Foley catheters, or surgical intervention. Spec...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Krulewitz NA, Fix ML Tags: Emerg Med Clin North Am Source Type: research

Sinusitis Update.
Abstract Rhinosinusitis affects many pediatric patients as well as 1 in 6 adults in any given year, resulting in ambulatory care, pediatric, and emergency department visits. Uncomplicated rhinosinusitis requires no imaging or testing and does not require antibiotic treatment. Using strict clinical diagnostic criteria may minimize unnecessary antibiotics. When indicated, amoxicillin with or without clavulanate for 5 to 10 days remains the first-line antibiotic, despite increasing incidence of staphylococcal sinusitis in the post-pneumococcal conjugate vaccine era. Emergency providers also need to recognize aty...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Wyler B, Mallon WK Tags: Emerg Med Clin North Am Source Type: research

Infections of the Oropharynx.
This article reviews the presentation, diagnosis, and management of common and "can't miss" infections of the oropharynx, including streptococcal pharyngitis, infectious mononucleosis, peritonsillar abscess, retropharyngeal abscess, and epiglottitis. PMID: 30454781 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Klein MR Tags: Emerg Med Clin North Am Source Type: research

Dental Emergencies.
Abstract Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures. PMID: 30454782 [PubM...
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Hammel JM, Fischel J Tags: Emerg Med Clin North Am Source Type: research

Infections of the Neck.
This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities. PMID: 30454783 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Li RM, Kiemeney M Tags: Emerg Med Clin North Am Source Type: research

Ears, Nose, and Throat Emergencies.
PMID: 30454784 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Mattu A Tags: Emerg Med Clin North Am Source Type: research

Ear, Nose, and Throat Emergencies.
PMID: 30454785 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Authors: Bontempo LJ, Shoenberger J Tags: Emerg Med Clin North Am Source Type: research

Erratum.
Authors: PMID: 30454786 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 21, 2018 Category: General Medicine Tags: Emerg Med Clin North Am Source Type: research

Workforce Trends in Rheumatology.
Abstract The United States is facing a rheumatology provider shortage over the next decade, which will negatively affect care for patients with rheumatic disease across the nation if this deficit is not thoughtfully addressed. The increasing numbers of retiring rheumatology specialists, women entering the workforce, and rheumatology graduates seeking part-time employment were identified as the most significant factors driving the projected decline in supply of providers. The major factors driving the projected increase in demand include an aging and growing population and improved treatment options, both of which ...
Source: The Medical Clinics of North America - November 20, 2018 Category: General Medicine Authors: Kilian A, Upton LA, Battafarano DF, Monrad SU Tags: Rheum Dis Clin North Am Source Type: research

Radiotherapy for Skin Cancers of the Face, Head, and Neck.
Abstract Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed. PMID: 30420066 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 14, 2018 Category: General Medicine Authors: Mierzwa ML Tags: Facial Plast Surg Clin North Am Source Type: research

Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction.
This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction. PMID: 30420069 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 14, 2018 Category: General Medicine Authors: VanKoevering KK, Zopf DA, Hollister SJ Tags: Facial Plast Surg Clin North Am Source Type: research

Management of Early-Stage Melanoma.
Abstract Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treat...
Source: The Medical Clinics of North America - November 14, 2018 Category: General Medicine Authors: Quintanilla-Dieck MJ, Bichakjian CK Tags: Facial Plast Surg Clin North Am Source Type: research

State-of-the-Art in Skin Cancer Surgery.
PMID: 30420077 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - November 14, 2018 Category: General Medicine Authors: Moyer JS Tags: Facial Plast Surg Clin North Am Source Type: research

Improving Care in Pediatric Inflammatory Bowel Disease.
This article describes a brief history of health care QI, identifies gaps and challenges in delivery of quality pediatric IBD care, highlights several IBD QI initiatives, and concludes with future directions for improving pediatric IBD outcomes. PMID: 30337040 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - October 21, 2018 Category: General Medicine Authors: Egberg MD, Kappelman MD, Gulati AS Tags: Gastroenterol Clin North Am Source Type: research

Infective Endocarditis.
Abstract Infective endocarditis (IE) is an uncommon infection of cardiac valves associated with bacteremia. It increasingly affects elderly patients with chronic disease and artificial cardiac devices. The presentation, however, remains subtle and varied, with nonspecific symptoms ranging from those resembling a mild viral infection to septic shock and multiorgan failure. IE carries potential to cause significant morbidity and mortality through its impact on cardiac function and from embolic complications. Blood cultures prior to antibiotics and obtaining prompt echocardiography are key diagnostic steps, followed ...
Source: The Medical Clinics of North America - October 11, 2018 Category: General Medicine Authors: Yang E, Frazee BW Tags: Emerg Med Clin North Am Source Type: research

Community-Acquired Pneumonia.
Abstract Community-acquired pneumonia is one of the most common infections seen in emergency department patients. There is a wide spectrum of disease severity and viral pathogens are common. After a careful history and physical examination, chest radiographs may be the only diagnostic test required. The first step in management is risk stratification, using a validated clinical decision rule and serum lactate, followed by early antibiotics and fluid resuscitation when indicated. Antibiotics should be selected with attention to risk factors for multidrug-resistant respiratory pathogens. Broad use of pneumococcal va...
Source: The Medical Clinics of North America - October 11, 2018 Category: General Medicine Authors: Rider AC, Frazee BW Tags: Emerg Med Clin North Am Source Type: research

The Emergency Department Diagnosis and Management of Urinary Tract Infection.
Abstract Urinary tract infection (UTI) is a common infection seen in the emergency department. The spectrum of UTI includes simple versus complicated infection and lower versus upper UTI. No one history or examination finding is definitive for diagnosis. Testing often includes urinalysis and/or urine dipstick, and several pitfalls may occur in interpretation. Urine cultures should be obtained in complicated or upper UTIs but not simple and lower tract UTIs, unless a patient is pregnant. Imaging often is not required. Most patients with simple cystitis and pyelonephritis are treated as outpatients. A variety of pot...
Source: The Medical Clinics of North America - October 11, 2018 Category: General Medicine Authors: Long B, Koyfman A Tags: Emerg Med Clin North Am Source Type: research