Engaging Stakeholders and Patient Partners.
This article focuses on the mechanisms, challenges, and benefits of patient and stakeholder engagement, with strategies for improvement. The 3 stages of clinical research and key iterative steps to create a reciprocal relationship are presented. Despite recent advances in stakeholder engagement, additional investigation and improved reporting of methods will facilitate strong reciprocal relationships between researchers and stakeholders. PMID: 30213411 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - September 15, 2018 Category: General Medicine Authors: Hacker KE, Smith AB Tags: Surg Oncol Clin N Am Source Type: research

Regionalization and Its Alternatives.
This article begins by introducing the historical background surrounding the volume-outcomes relationship literature, particularly in complex cancer surgery. The state of evidence surrounding mortality, as well as other outcomes, in relation to both hospital and surgeon procedure volume is synthesized. Where it is understood, the level of adoption of regionalization of various complex surgeries in the United States is also presented. Various controversies are weighed and discussed. Finally, various models of regionalization and proposed alternatives to regionalization from the peer-reviewed literature are presented. P...
Source: The Medical Clinics of North America - September 15, 2018 Category: General Medicine Authors: Lumpkin S, Stitzenberg K Tags: Surg Oncol Clin N Am Source Type: research

Platelet-Rich Plasma for Skin Rejuvenation and Tissue Fill.
Abstract Platelet preparations, including platelet-rich plasma and platelet-rich fibrin matrix, have been used to improve wound healing, recovery time, and cosmetic outcomes for facial rejuvenation. Bioactive growth factors released from platelets are the putative agents in producing a reparative tissue reaction in the treated area. Different methods of processing the patients' blood will yield different types of platelet preparations with different components and properties, and it is important to understand these differences and their potential implications. More robust studies are necessary to better understand...
Source: The Medical Clinics of North America - September 15, 2018 Category: General Medicine Authors: Lin J, Sclafani AP Tags: Facial Plast Surg Clin North Am Source Type: research

Waldenstr öm Macroglobulinemia: Lessons Learned from Basic and Clinical Research.
Waldenström Macroglobulinemia: Lessons Learned from Basic and Clinical Research. Hematol Oncol Clin North Am. 2018 Oct;32(5):xiii-xiv Authors: Castillo JJ, Kastritis E, Treon SP PMID: 30190026 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - September 8, 2018 Category: General Medicine Authors: Castillo JJ, Kastritis E, Treon SP Tags: Hematol Oncol Clin North Am Source Type: research

Endemic Mycoses in Solid Organ Transplant Recipients.
Abstract The endemic mycoses are a group of thermally dimorphic fungal pathogens occupying a specific geographic range. In North America, the chief endemic mycoses are histoplasmosis, coccidioidomycosis, and blastomycosis. Endemic fungi can cause serious infections in solid organ transplant recipients from primary infection, reactivation of latent disease, or donor-derived infection. PMID: 30146029 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 29, 2018 Category: General Medicine Authors: Nel JS, Bartelt LA, van Duin D, Lachiewicz AM Tags: Infect Dis Clin North Am Source Type: research

Antimicrobial Stewardship Programs: Principles and Practice.
Abstract Antimicrobial stewardship involves optimizing antibiotic use while using cost-effective interventions to minimize antibiotic resistance and control Clostridium difficile. An effective hospital-wide antimicrobial stewardship program (ASP) should be led by an infectious disease (ID) physician. The ASP team needs full and ongoing financial support for the ASP from the hospital administration. The ID clinician leader should have special expertise in various aspects of antimicrobial therapy, that is, pharmacokinetics, resistance, pharmacoeconomics, and C difficile. The ASP ID team leader and ID-trained clinica...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Cunha CB Tags: Med Clin North Am Source Type: research

Antimicrobial Stewardship and Antimicrobial Resistance.
Abstract Antimicrobial stewardship programs aim to reduce costs, optimize therapeutic outcomes, and reduce antimicrobial resistance. Reductions of antimicrobial resistance are the most elusive because emergence and spread of resistant bacteria involves antimicrobial selective pressure and lapses in infection control techniques. The relationship between antimicrobial usage and resistance is not always direct. The understanding of which techniques are most effective is limited because many studies are descriptive or quasiexperimental. Recent meta-analyses or systematic reviews of stewardship programs offer encourage...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Rice LB Tags: Med Clin North Am Source Type: research

Antimicrobial Resistance: An Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach.
Abstract Antimicrobial resistance (AR) is one of the most serious public health threats today, which has been accelerated by the overuse and misuse of antimicrobials in humans and animals plus inadequate infection prevention. Numerous studies have shown a relationship between antimicrobial use and resistance. Antimicrobial stewardship (AS) programs have been shown to improve patient outcomes, reduce antimicrobial adverse events, and decrease AR. AS programs, when implemented alongside infection control measures, especially hand-hygiene interventions, were more effective than implementation of AS alone. Targeted co...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Septimus EJ Tags: Med Clin North Am Source Type: research

Antibiotic Stewardship: Strategies to Minimize Antibiotic Resistance While Maximizing Antibiotic Effectiveness.
Abstract Empiric therapy of the septic patient in the hospital is challenging. Antibiotic stewardship is concerned with optimizing antibiotic use and minimizing resistance. Clinicians should avoid overcovering and overtreating colonizing organisms in respiratory secretions and urinary catheters. Empiric therapy should take into account the prevalence of multidrug-resistant organisms in the hospital setting. The most effective resistance prevention strategies is to preferentially select a low resistance potential antibiotic, which should be administered in the highest possible dose without toxicity for the shortest...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Cunha CB, Opal SM Tags: Med Clin North Am Source Type: research

Creative Collaborations in Antimicrobial Stewardship: Using the Centers for Disease Control and Prevention's Core Elements as Your Guide.
Abstract Antimicrobial stewardship program (ASP) success and growth rely on recurring collaborations with partners within the health care system, such as administration, clinical services, infection prevention, pharmacy, the medical school, and microbiology. These collaborations present valuable opportunities for development of hospital policies, institutional guidelines, and educational curriculum. External opportunities for collaboration may be less frequent but equally valuable. These collaborations are facilitated by health system partnerships with national quality organizations, neighboring ASPs, and the Depa...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Nori P, Guo Y, Ostrowsky B Tags: Med Clin North Am Source Type: research

Role of Education in Antimicrobial Stewardship.
Abstract The ability to treat infectious diseases with antimicrobials is an essential component of medical management. Antimicrobial therapy is based on the characteristics of the patient, drug, microorganisms causing the infection, and colonizing flora. Prudent antibiotic use is the only option to delay the emergence of resistance. Training in infectious diseases and knowledge of the principles of responsible antibiotic prescribing and uses must be improved. To change practice, health care professionals should be educated at all levels of their training. PMID: 30126576 [PubMed - in process] (Source: The Medi...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Gyssens IC Tags: Med Clin North Am Source Type: research

The Role of the Hospital Epidemiologist in Antibiotic Stewardship.
Abstract Antibiotic stewardship programs (ASPs) play a crucial role in controlling the emergence of resistant organisms, reducing rates of Clostridium difficile infections and associated hospital length of stay, promoting judicious use of antibiotics, and minimizing associated adverse events. There is a significant overlap between the goals of infection control programs and ASPs, and both programs can benefit from a synergistic relationship. Hospital epidemiologists can support these programs by providing leadership support, sharing surveillance data, bridging gaps between ASPs and departments such as microbiology...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Abbas S, Stevens MP Tags: Med Clin North Am Source Type: research

Role of the Clinical Microbiology Laboratory in Antimicrobial Stewardship.
llo A Abstract For adequate antimicrobial stewardship, microbiology needs to move from the laboratory to become physically and verbally amenable to the caregivers of an institution. Herein, we describe the contributions of our microbiology department to the antimicrobial stewardship program of a large teaching hospital as 10 main points ranging from the selection of patients deemed likely to benefit from a fast track approach, to their clinical samples, or the rapid reporting of results via a microbiology hotline, to rapid searches for pathogens and susceptibility testing. These points should serve as guidelines f...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Bouza E, Muñoz P, Burillo A Tags: Med Clin North Am Source Type: research

Current and Future Opportunities for Rapid Diagnostics in Antimicrobial Stewardship.
Abstract Rapid diagnostic testing has improved clinical care of patients with infectious syndromes when combined with antimicrobial stewardship. The authors review the current data on antimicrobial stewardship and rapid diagnostic testing in bloodstream, respiratory tract, and gastrointestinal tract infections. Evidence for the potential benefit of rapid tests in bloodstream infections seems strong, respiratory tract infections mixed, and gastrointestinal tract infections still evolving. The authors also review future directions in rapid diagnostic testing and suggest areas of focus for antimicrobial stewardship e...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Timbrook TT, Spivak ES, Hanson KE Tags: Med Clin North Am Source Type: research

Antimicrobial Stewardship in Community Hospitals.
Abstract Antibiotic stewardship programs are needed in all health care facilities, regardless of size and location. Community hospitals that have fewer resources may have different priorities and require different strategies when defining antibiotic stewardship program components and implementing interventions. By following the Centers for Disease Control and Prevention Core Elements and using the strategies suggested in this article, readers should be able to design, develop, participate in, or improve antibiotic stewardship programs within community hospitals. PMID: 30126580 [PubMed - in process] (Source: T...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Buckel WR, Veillette JJ, Vento TJ, Stenehjem E Tags: Med Clin North Am Source Type: research

Role of the Pharmacist in Antimicrobial Stewardship.
Abstract The goals of antimicrobial stewardship are to optimize antimicrobial use to improve patient outcomes and minimize adverse consequences. A successful antimicrobial stewardship program is one that is multidisciplinary. Pharmacists are core members of antimicrobial stewardship and undertake multiple roles to accomplish the goals of the program. As antimicrobial stewardship continues to expand across the patient care continuum, pharmacists will serve a vital role in preserving the armamentarium of antimicrobials and improving quality of patient care. PMID: 30126581 [PubMed - in process] (Source: The Medi...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Parente DM, Morton J Tags: Med Clin North Am Source Type: research

The Pharmacoeconomic Aspects of Antibiotic Stewardship Programs.
Abstract Optimal antimicrobial therapy must take into account the key factors in antibiotic selection, that is, spectrum, tissue penetration, resistance potential, safety profile, and relative cost-effectiveness. The least expensive drug is usually accompanied by other concerns, such as high resistance potential, poor side effect profile, pharmacokinetic properties that limit penetration into target tissue (site of infection), and/or suboptimal activity against the presumed/known pathogen. It is false economy to preferentially select the least expensive antibiotics solely because of its acquisition cost. Therapeut...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Cunha CB Tags: Med Clin North Am Source Type: research

Antibiotic Stewardship Program Perspective: Oral Antibiotic Therapy for Common Infectious Diseases.
Abstract Traditionally, initial antibiotic therapy was administered intravenously (IV). Over the past 3 decades, there has been increased understanding, appreciation, and application of pharmacokinetic (PK) and pharmacodynamic (PD) principles in antibiotic therapy. The utilization of PK/PD parameters as applied to antimicrobial therapy has led to optimizing dosage regimens as well as increased awareness and experience with oral versus antibiotic therapy. When an oral antibiotic, given at the same dose as its IV formulation, results in the same serum/tissue levels, then oral antibiotics should be used whenever poss...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Cunha CB Tags: Med Clin North Am Source Type: research

Role of Technology in Antimicrobial Stewardship.
Abstract Because of the increasing plague of antimicrobial resistance and antibiotic misuse, antimicrobial stewardship programs (ASPs) are now a mandatory entity in all US hospitals. ASPs can use technological advances, such as the electronic medical record and clinical decision support systems, to impact a larger patient population with more efficiency. Additionally, through the use of mobile applications and social media, ASPs can highlight and propagate educational information regarding antimicrobial utilization to patients and providers in a widespread and timely manner. In this article, the authors describe h...
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Bremmer DN, Trienski TL, Walsh TL, Moffa MA Tags: Med Clin North Am Source Type: research

Metrics of Antimicrobial Stewardship Programs.
This article reviews the various antimicrobial stewardship metrics that have been described in the literature, evidence to support these metrics, controversies surrounding metrics, and areas in which future research is necessary. PMID: 30126585 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Brotherton AL Tags: Med Clin North Am Source Type: research

Make Antibiotics Great Again.
PMID: 30126586 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Ashar BH Tags: Med Clin North Am Source Type: research

An Overview of Antimicrobial Stewardship Programs: Imperatives, Interventions, and Innovations.
PMID: 30126587 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - August 23, 2018 Category: General Medicine Authors: Cunha CB Tags: Med Clin North Am Source Type: research

Gastric Carcinoids.
Abstract Gastric carcinoids, formally named gastric neuroendocrine neoplasms (NENs), are derived from enterochromaffin-like cells of the stomach and are increasingly diagnosed. A majority are designated as type I (related to autoimmune gastritis) and type II (related to gastrinoma) neoplasms that develop secondary to gastrin hypersecretion. Types I and II gastric carcinoids are mostly small-sized (1-2 cm), multiple, low-malignancy potential lesions mainly confined to the gastric mucosa/submucosa. These lesions have an indolent course and low metastatic potential. In contrast, type III gastric carcinoids are s...
Source: The Medical Clinics of North America - August 15, 2018 Category: General Medicine Authors: Grozinsky-Glasberg S, Alexandraki KI, Angelousi A, Chatzellis E, Sougioultzis S, Kaltsas G Tags: Endocrinol Metab Clin North Am Source Type: research

Pharmacologic Treatment of Perinatal Depression.
Abstract This review provides information about medications used to treat perinatal depression, including guidance around when to use certain medications and when to consult a mental health provider. For each group of medications, including selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, mirtazapine, bupropion, lithium, atypical antipsychotics, and lamotrigine, the risks and benefits of treatment during pregnancy and lactation are reviewed, and unique qualities of each medication. A treatment algorithm is included and a description of the Food and Drug Administration's approa...
Source: The Medical Clinics of North America - August 12, 2018 Category: General Medicine Authors: Kimmel MC, Cox E, Schiller C, Gettes E, Meltzer-Brody S Tags: Obstet Gynecol Clin North Am Source Type: research

Psychosocial Aspects of Fertility and Assisted Reproductive Technology.
Abstract Psychosocial aspects of fertility, infertility, and assisted reproductive technology (ART) can significantly impact patients' sense of self-identity and personal agency, mental well-being, sexual and marital relationships, reproductive efficiency, compliance with treatment, and pregnancy outcomes. Research is needed to understand how stress, anxiety, depression, mood disorders, and psychotropic medications impact fertility and infertility treatment. The psychosocial implications of ART on our society include a shift toward older maternal age at conception, the complexities of third-party reproduction, and...
Source: The Medical Clinics of North America - August 12, 2018 Category: General Medicine Authors: Stanhiser J, Steiner AZ Tags: Obstet Gynecol Clin North Am Source Type: research

The Latest Cancer Agents and Their Complications.
This article provides the emergency physician with a brief introduction and overview of immunotherapy drugs and their complications. PMID: 30037436 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Dubbs SB Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Infectious Disease Emergencies in Patients with Cancer.
Abstract Patients with cancer can be immunocompromised because of their underlying malignancy as well as the medical therapies with which they are treated. Infections frequently present atypically and can be challenging to diagnose. The spectrum of infectious diseases encountered in patients receiving chemotherapy, hematopoietic stem cell transplant, and immunotherapy is broad depending on the depth of immunosuppression. Early recognition of infectious processes followed by appropriate diagnostic testing, imaging, and empiric antibiotic therapy in the emergency department are critical to providing optimal care and...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Charshafian S, Liang SY Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Tumor Lysis Syndrome.
Abstract Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency, characterized by a constellation of hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. The spectrum ranges from patients who are asymptomatic to those who go into cardiac arrest and die. Prompt recognition and initiation of treatment by emergency physicians are key, especially in the early stages of the syndrome. This case-based review presents an overview of the key points in pathophysiology, diagnosis, and management of TLS that are key to emergency physicians. PMID: 30037438 [PubMed - in process] (Source: The Medi...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Dubbs SB Tags: Emerg Med Clin North Am Source Type: research

Pediatric Oncologic Emergencies.
Abstract Pediatric patients with cancer, although rarely, do present to emergency departments for first-time diagnosis, as well as for complications of treatment. The presenting symptoms can be vague, so emergency physicians must maintain a high index of suspicion and be aware of guidelines to help direct appropriate care after an initial diagnosis. It is also necessary to know the complications of treatment. Although these patients often seek care in the institution where they receive treatment, many live far from these locations and may present to any emergency department in extremis. PMID: 30037439 [PubMed...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Stephanos K, Picard L Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Central Nervous System Emergencies.
Abstract Neurologic complications are unfortunately common in oncology patients, with many presenting to the emergency department for diagnosis and management. This case-based review provides a brief overview of the key points in pathophysiology, diagnosis, and management of 2 oncologic central nervous system emergencies: malignant spinal cord compression and intracranial mass. PMID: 30037440 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Dubbs SB, Honasoge AP Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Hypercalcemia.
Abstract Hypercalcemia is commonly encountered in the clinical setting and requires identification by the clinician to avoid disastrous patient outcomes. The 2 most common causes are malignancy and hyperparathyroidism. The underlying cause for hypercalcemia may be readily known at presentation or may require further investigation. After identification, acuity of treatment will depend on severity of calcium level and symptoms. In the emergency setting, intravenous hydration with isotonic fluids is the treatment mainstay. Other commonly used medications to further decrease calcium include bisphosphates, calcitonin, ...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Carrick AI, Costner HB Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Pericardial Effusion and Tamponade.
Abstract One of the most common causes of pericardial effusion in the Western world is malignancy. Emergency physicians must maintain vigilance in suspecting pericardial effusion and tamponade in patients with known or suspected malignancy who present with tachycardia, dyspnea, and hypotension. Diagnosis can be expedited by key physical examination, electrocardiogram, and sonographic findings. Unstable or crashing patients with tamponade must undergo emergent pericardiocentesis for removal of fluid and pressure to restore cardiac output. PMID: 30037442 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Honasoge AP, Dubbs SB Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Sickle Cell Disease.
Abstract Emergency providers are likely to encounter sickle cell disease-related emergencies. The pathophysiology of emergent complaints are usually related to either an acute anemia or a vasoocclusive crisis. Differentiating between the two is the first step in the workup. Anemic crises must then be differentiated by the source. Vasoocclusive crises must be appropriately treated with aggressive pain management, gentle hydration, and other appropriate adjuncts. Early recognition and treatment are key in providing excellent emergency care to those with sickle cell disease. PMID: 30037443 [PubMed - in process] ...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Porter M Tags: Emerg Med Clin North Am Source Type: research

Anticoagulation Reversal.
This article reviews strategies to address bleeding complications occurring secondary to warfarin, low-molecular-weight heparin, and direct oral anticoagulant therapy. PMID: 30037445 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Simon EM, Streitz MJ, Sessions DJ, Kaide CG Tags: Emerg Med Clin North Am Source Type: research

Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome.
Abstract Emergency providers are likely to encounter patients with acute and chronic leukemias. In some cases, the first presentation to the emergency department may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and consulting a hematologist can be life saving. Presenting symptoms are caused by complications of bone marrow infiltration and hyperleukocytosis with white blood cell counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurologic symptoms owing to hyperleukocytosis and subsequent leukostasis. Treat...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Emerson G, Kaide CG Tags: Emerg Med Clin North Am Source Type: research

Emergency Medicine Evaluation and Management of Anemia.
Abstract Anemia is a common condition and is diagnosed on laboratory assessment. It is defined by abnormally low hemoglobin concentration or decreased red blood cells. Several classification systems exist. Laboratory markers provide important information. Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology. Iron is an alternative treatment for patients with microcytic anemia owing to iron deficiency. Hyperbaric oxygen is an option for alternative re...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Long B, Koyfman A Tags: Emerg Med Clin North Am Source Type: research

The Cancer Emergency Department-The Ohio State University James Cancer Center Experience.
Abstract In 2015, The James Cancer Hospital's Emergency Department (ED) opened at The Ohio State University Wexner Medical Center's ED. Careful planning was undertaken to assure that the needs of patients with cancer would be addressed. Strong relationships between experts in hematology, oncology, and emergency medicine were built to maximize the positive impact. Ongoing reevaluation of operational needs facilitates optimal patient flow, resource use, and opportunities to build and develop new resources. The results are evident in improved patient satisfaction in the cancer ED and a much smoother flow of patients ...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Delatore LR Tags: Emerg Med Clin North Am Source Type: research

The Oncologic Emergency Medicine Fellowship.
Abstract The United States cancer population is growing and is projected to grow further. The current cancer population has a high rate of emergency department admission. Further training about oncologic emergencies may be needed and would ideally strive to care for the whole patient, including sequelae of the malignancy, progressive disease, symptom control, adverse effects of treatment, and palliative care. The James Cancer Hospital at The Ohio State University Wexner Medical Center and The University of Texas MD Anderson Cancer Center fellowship training programs in oncologic emergency medicine are described. ...
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Purcell MG, El Majzoub I Tags: Emerg Med Clin North Am Source Type: research

Hematologic and Oncologic Emergencies.
PMID: 30037450 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Mattu A Tags: Emerg Med Clin North Am Source Type: research

The Heme-Onc Tidal Wave: Are You Prepared?
PMID: 30037451 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - July 26, 2018 Category: General Medicine Authors: Kaide CG, Dubbs SB Tags: Emerg Med Clin North Am Source Type: research

New Insights into Clonal Mast Cell Disorders Including Mastocytosis.
Abstract Mastocytosis is a heterogeneous group of neoplasms that involve the clonal expansion of mast cells into one or more organ systems, which typically involves the skin and hematopoietic systems. Systemic mastocytosis consists of a multifocal infiltration of mast cells into various noncutaneous tissue sites, especially the bone marrow. Diagnosis requires tissue confirmation, and algorithms have been developed to assist clinicians in this process. The current classification system focuses on delineating prognostic categories. Therapeutic approaches include symptomatic management, prevention of complications, a...
Source: The Medical Clinics of North America - July 17, 2018 Category: General Medicine Authors: Volertas S, Schuler CF, Akin C Tags: Immunol Allergy Clin North Am Source Type: research

Age-Related Deficits in Taste and Smell.
Abstract Disturbances in both the ability to smell and to taste are common in older persons. Such disturbances influence nutrition, safety, quality of life, and psychological and physical health. The anatomic and physiologic causes of age-related disturbances are multiple and interacting, and depend on genetic and environmental factors. Frank losses of function, distortions, and hallucinations are common. Most distortions resolve over time, although this can take months or even years. Olfactory dysfunction occurs during the earliest stages of several neurologic disorders, most notably Alzheimer's disease and Parki...
Source: The Medical Clinics of North America - July 14, 2018 Category: General Medicine Authors: Doty RL Tags: Otolaryngol Clin North Am Source Type: research

Addressing Unhealthy Substance Use in Primary Care.
Abstract Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Pace CA, Uebelacker LA Tags: Med Clin North Am Source Type: research

Inpatient Addiction Consult Service: Expertise for Hospitalized Patients with Complex Addiction Problems.
Abstract Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Weinstein ZM, Wakeman SE, Nolan S Tags: Med Clin North Am Source Type: research

Addressing Adolescents' and Young Adults' Substance Use Disorders.
Abstract Adolescents and young adults (AYAs) have unique needs and important biopsychosocial differences when compared with older adults who use substances. As their brains continue to develop, youth are especially susceptible to the reinforcing effects of substances in the context of a still-developing capacity for executive control and decision making. In this article, the authors highlight key differences in the neurobiologic, epidemiologic, and relational aspects of substance use found in AYA. They also discuss how best to engage with youth who use substances and how prevention and intervention can be adapted ...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Chadi N, Bagley SM, Hadland SE Tags: Med Clin North Am Source Type: research

Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists.
Abstract Drawing from existing opioid prescribing guidelines, this article describes how medical providers can reduce the risk of overdose. Through primary prevention, providers can prevent initial exposure and associated risks by educating patients, using risk stratification, minimizing opioid dose and duration, and avoiding coprescribing with sedatives. Secondary prevention efforts include monitoring patients with urine toxicology and prescription monitoring programs, and screening for opioid use disorders. Tertiary prevention includes treating opioid use disorders and providing naloxone to prevent overdose deat...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Peglow SL, Binswanger IA Tags: Med Clin North Am Source Type: research

Office-Based Addiction Treatment in Primary Care: Approaches That Work.
Abstract Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with sub...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Edelman EJ, Oldfield BJ, Tetrault JM Tags: Med Clin North Am Source Type: research

Pharmacotherapy for Alcohol Use Disorder.
Abstract Alcohol use disorder is a common, destructive, and undertreated disease. As understanding of alcohol use disorder has evolved, so has our ability to manage patients with pharmacotherapeutic agents in addition to nondrug therapy, including various counseling strategies. Providers now have a myriad of medications, both approved and not approved by the US Food and Drug Administration, to choose from and can personalize care based on treatment goals, comorbidities, drug interactions, and drug availability. This review explores these treatment options and offers the prescriber practical advice regarding when e...
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Holt SR, Tobin DG Tags: Med Clin North Am Source Type: research

When and How to Treat Possible Cannabis Use Disorder.
This article reviews the current state of knowledge regarding effective treatments for cannabis use disorder. PMID: 29933822 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Lévesque A, Le Foll B Tags: Med Clin North Am Source Type: research

Nontraditional Alcohol and Opioid Agonist Treatment Interventions.
This article reviews the available evidence of these treatment modalities. PMID: 29933823 [PubMed - in process] (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - June 26, 2018 Category: General Medicine Authors: Fairgrieve C, Fairbairn N, Samet JH, Nolan S Tags: Med Clin North Am Source Type: research