Should Aging Physicians Be Required to Undergo Cognitive Testing? Three Experts Weigh In
The issue of aging physicians poses serious challenges to the medical profession, with concerns that judgment or skills might decline with age.
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Managing Migraine During Pregnancy and Lactation
A particular challenge in this population is the effective management of migraine during pregnancy and lactation while minimizing the risk for harm to the fetus.
Clinician Roundtable: Does Marijuana Affect Fertility?
Rates of marijuana use are especially high among men and women of reproductive age. How should physicians advise patients who are trying to conceive about marijuana?
Online Health Information Gathering: Changing the Physician-Patient Relationship
A 2013 Pew Research Center and Internet Life Project report found that 59% of US adults said that they turned to the Internet regarding a health problem during the past year.
Examining Post-Intensive Care Syndrome
As mortality rates associated with admission to the intensive care unit have decreased in recent decades, there has been increasing interest in the long-term negative consequences of critical care.
How to Deal With “Difficult” Patients
Clinicians can manage their emotions and behaviors to meet the challenges of working productively with sometimes abrasive and argumentative patients.
ACP Releases Policy Statement on DOI, COI Management for Clinical Guideline Development
The American College of Physicians endorses the necessity of a comprehensive process for disclosure of potential conflicts of interest to ensure the integrity of clinical guidelines and guidance statements.
Does Religion Have a Place in Medicine?
Benjamin Frush MD, a resident in internal medicine-pediatrics at Vanderbilt University Medical Center in Nashville, argues in favor of a role that physicians can play in integrating religion into their clinical practice. Rob Poole MB, FRCPsych, contends that physicians should never incorporate a religious element into clinical practice.
A Review of the Use of CBD and Other Cannabinoids in Pain Management
The therapeutic potential of cannabinoids to manage several clinical conditions, including pain, inflammation, sleep disorders, and epilepsy, is finding support through a growing body of evidence.
Chronic Pancreatitis: Challenging to Diagnose, Difficult to Treat
Chronic pancreatitis stems from a variety of pathogenic entities that result in chronic inflammation, fibrosis, and irreversible damage to the pancreas.
Headache and Trigeminal Neuralgia in Multiple Sclerosis
Researchers found that abnormal magnetic resonance imaging suggests that in patients with multiple sclerosis, headaches often precede diagnoses.
Post-ICU Syndrome: Identifying Challenges and Improving Mortality
Post-ICU syndrome includes psychological effects — depression, anxiety, and PTSD — as well as worsened physical functioning.
Reviewing the Efficacy of Dietary Supplements to Manage Chronic Musculoskeletal Pain
The use of dietary supplements to manage pain is common in individuals with musculoskeletal disorders.
On the Need for a Multidisciplinary Approach for Pediatric Pain Management
Increasing attention has focused on the use of multidisciplinary approaches that combine pharmacologic and integrative nonpharmacologic therapies for pain management.
The Link Between Misconceptions About Opioid Use Disorders and Current Policies
An estimated 20 million people in the United States meet the criteria for substance use disorder.
Improving Physician Comfort With Treating Transgender Patients
Estimates indicate that ~1.4 million people self-identify as transgender in the United States, which is double the initial estimate is made by the Williams Institute in 2011.
Using Digital Therapeutics to Treat Substance Use Disorders
The convenience and confidentiality of computer-based and mobile technologies may encourage more individuals with substance use disorders to access treatment.
Managing Migraine During Pregnancy and Lactation
A particular challenge in this population is the effective management of migraine during pregnancy and lactation while minimizing the risk for harm to the fetus.
Reviewing Off-Label Uses of Gabapentinoids
As part of current efforts to reduce unnecessary opioid consumption, clinicians have increasingly prescribed gabapentinoids for a range of pain disorders.
Managing Opioid-Induced Androgen Deficiency
The increased opioid use has been associated with a rising incidence of opioid-induced endocrinopathy, most commonly in the form of androgen deficiency.
Cannabinoids in the Treatment of RA: Current Status and Future Prospects
Researchers found data that showed in patients with rheumatoid arthritis, the delta-tetrahydrocannabinol found in medical cannabis is likely to contribute to an increase in heart rate in patients who are susceptible to atherosclerosis and cardiovascular disease. Medical cannabis was also not found to provide therapeutic effects when comparing it with a combination of cannabinoid type 1 antagonist, fatty acid amide hydrolase inhibitor, and nonpsychotropic cannabidiol.
The Complex Interplay Between Metacognition and Headache in Pediatric Patients
Researchers found data that in adults who had headaches as children, cognitive and psychomotor ability are compromised. In a Norwegian study, it was found that attention deficits were associated with migraine and nonclassifiable headache in patients aged 15 to 17 years. Metacognitive skills and anxiety, depression, motivation, academic performance, human social interactions, and stress symptoms are common headache triggers that researchers posit can be controlled and monitored by patients.
Potential Role of Arterial Hypertension in Migraine Pathogenesis
Researchers posit that the reduction in arterial baroreflex contributes to the development of arterial hypertension in migraine.
Prevention Strategies for Pediatric Migraine
Researchers found data that support intervention in chronic migraine for both the mother and child as headache frequency in children correlates with that of their mothers.
Changing the Way Chronic Pain Is Categorized
The 11th edition of the International Classification of Diseases includes chronic pain in the “Symptoms, Signs or Clinical Findings” category.
Nonmigraine Headache and Facial Pain: Overview & Expert Interview
Headache is the most commonly experienced form of pain.
Cannabinoids in the Treatment of RA: Current Status and Future Prospects
Researchers found data that showed in patients with rheumatoid arthritis, the delta-tetrahydrocannabinol found in medical cannabis is likely to contribute to an increase in heart rate in patients who are susceptible to atherosclerosis and cardiovascular disease. Medical cannabis was also not found to provide therapeutic effects when comparing it with a combination of cannabinoid type 1 antagonist, fatty acid amide hydrolase inhibitor, and nonpsychotropic cannabidiol.
Intersection of ID & OUD Epidemic: What ID Clinicians Should Know
The epidemic of opioid use disorder has led to substantial increases in new cases of HCV and HIV infection, as well as hospitalizations for other OUD-related infections.
Headache in the ED: Overview and Expert Interview
Researchers found data that showed, after consultation with an expert, optimal prevention of migraine headaches for patients who present in the emergency department includes both antiseizure medications, specifically, divalproex sodium, sodium valproate, or topiramate, and β-blockers, namely, metoprolol, propranolol, and timolol. In addition, triptans are suggested, as well as antidepressants, amitriptyline, and venlafaxine.
Physician House Calls: An Old Model With a Modern-Day Twist
Physician house calls are making a comeback, to understand why MPR interviewed three experts.
Significance and Prevalence of Headache in Multiple Sclerosis
Research study results showed that treatments for multiple sclerosis precipitated headaches and migraines.
Complementary and Integrative Treatments for Migraine: An Expert Interview
Approximately half of the 14% of Americans who have severe headache and migraine report having tried interventions such as meditation, yoga, and deep breathing exercises.
Pass Me the Psychological Scalpel: Lessons on Resilience for Doctors
As rates of physician burnout continue to climb, a diverse group of researchers weigh in on enhancing resilience and particularly emphasize enlightening educators about how resilience develops during residency.
Reconsidering Lidocaine as an Acute Treatment for Headache
Researchers found that intranasal lidocaine is effective in the treatment of acute migraine and cluster headache because of its ability to block the sphenopalatine ganglion, which is associated with facial pain from the trigeminal nerve.
Are Hospital Readmission Reduction Programs Truly Evidence Based?
When politicians attempt to make changes to health policy based on sentiments rather than on evidence-based conclusions, physicians often find themselves trying to meet unrealistic expectations.
Not so Inactive: Excipients in Medications May Trigger Adverse Reactions in Some Patients
A team of investigators from both Brigham and Women’s Hospital and the Massachusetts Institute of Technology analyzed data on thousands of inactive ingredients in approved medications to further characterize them and enhance our knowledge of their safety.
Emotionally Responsive Virtual Coach Helps Address Patient Concerns in New Simulation
Kognito, a health simulation company, is applying its simulation technology to patient education, to address a gap in patient knowledge.
Helping Patients Navigate Clinical Trials: What Physicians Can Do
Patient participation rates in clinical trials remain low, despite the overall good that clinical trials can provide to the healthcare community.
The Grey’s Anatomy Effect: When TV Warps Perception, Proactive Communication is Key
The Grey’s Anatomy effect is a term that describes the disconnect between real-life and television medicine.
Thunderclap Headache: An Overview
In an interview with Neurology Advisor, Robert Cowan, MD, FAAN explains how thunderclap headache may be the only early warning sign of vascular changes or brain injury.
ICD-10, Diagnostic Errors, and the Payment Reforms to Improve Diagnostic Accuracy
In 2015, 1 in 20 adults in the United States experienced a diagnostic error every year; yet by the beginning of 2019, nothing had been done to improve the situation.
Satisfaction of Psychological Needs and Chronic Pain in Adolescents
An estimated 25% of children and adolescents report having pain that persists for more than 3 months, with severe and disabling pain affecting 8% of this population.
Case Study: Gradually Worsening Elbow Pain
A 51-year-old woman presents to the emergency department with pain in the elbow that has gradually worsened over the past 12 hours.
Health Literacy and the Older Adult
Every day, low health literacy results in patients’ misunderstanding the instructions of their clinicians, sometimes with very serious consequences.
Navigating Effective Approaches to Migraine Treatment for the Underinsured
Approximately, 26% of participants who were underinsured or uninsured were able to navigate through consultation, diagnosis, and treatment.
HHS Task Force Issues Draft Report on Best Practices for Pain Management
In a draft report issued December 28, 2018 by the US Department of Health and Human Services-sponsored Pain Management Best Practices Inter-Agency Task Force, recommendations for a multidisciplinary approach to pain management were formulated.
AHA Issues Scientific Statement on Accurate Blood Pressure Readings
The American Heart Association has updated its scientific statement on blood pressure readings.
Physician Mental Health: The Role of Self-Compassion and Detachment
Prioritization of patients’ well-being can lead physicians to neglect their own well-being, including their mental health.
Menstruation and Migraine: Can We End the Cycle?
Researchers found that lower levels of estrogen during menstruation cause women to be more vulnerable to migraines than men.
Overcoming Aftershock: Six Ways You Can Prepare to Return to Work After a Long Absence
As with any profession, returning to work after long-term absence because of illness or injury can be daunting for healthcare providers.
Point: Dietary Supplements Can Mitigate Poor Diet, Improve Health
Although it is estimated that more than 166 million Americans use dietary supplements, many healthcare providers are unfamiliar with how these substances are regulated by the US Food and Drug Administration.
Treating Migraine in the Elderly: Navigating Polypharmacy and Comorbidities
Considering individual patient factors, effects of aging, and using online tools for drug interactions will aid in treatment of migraines in the elderly.
Medicaid Work Requirements Are Increasing the Cost of Being Sick in America
On the surface, a plan to get able-bodied individuals back to work in order to maintain their Medicaid benefits sounds reasonable — until it’s not.
Opioid-Induced Constipation: Insights Into Diagnosis and Effective Treatment
Conventional approaches to treatment of opioid-induced constipation include the use of treatment modalities that address non-opioid-related constipation as well as new medications that target the OIC mechanism of action.
Migraine and Alcohol: Encouraging a Healthy Balance of Indulgence and Vigilance
Based on the literature, investigators found no reason to tell patients with headache to abstain from alcohol.
Case Study: Shoulder Injury Following a Biking Accident
A 41-year-old man presents with a shoulder injury sustained as the result of a fall from his road bike.
In the Spotlight: How Racism Affects the Healthcare Workforce
Racism is embedded in all US institutions, including medicine — so what steps are being taken to improve the well-being of the healthcare workforce?
ACIP Updates Recommendations for US Adult Immunization Schedule
The ACIP and CDC have approved and released 2019 recommendations for the adult immunization schedule in the US.
Mobile Health Apps for Headache: An Ongoing Search for Clinical Relevancy
The main objection among clinical researchers is that commercially developed products often lack a scientific basis for their selection of features.
Protecting Your Practice From Data Breaches: An Expert Interview
To shed light on issues of cybersecurity in medical practices, MPR spoke to Michael J Sacopulos, JD, CEO of Medical Risk Institute (MRI), a firm that provides “proactive counsel” to the healthcare community to identify where liability risks originate and to reduce or remove those risks.
An Evidence-Based Road Map to Navigating the Opioid Epidemic
This rise in prescribing of prescription opioids in the last 2 decades of the 20th century occurred at a time during which medical professionals were urged to resort to prescription opioids to manage untreated and chronic noncancer pain.
Navigating Social Media Issues in Medical Practice: An Expert Interview
Issues that affect employees in all industries are compounded by a unique set of additional concerns that affect employees of medical practices.
Mentoring Women in the #MeToo Era: Expert Roundtable
Despite record numbers of women working in medicine, instances of gender discrimination and sexual harassment continue to proliferate.
Surgical, Nonsurgical Treatments for Chronic Migraine: Evidence and Relevancy
There are many procedural treatments for migraine that are effective and safe, including peripheral nerve blocks, trigger point injections, botulinum toxin injections, and sphenopalatine ganglion blocks.
Approved in Migraine, CGRP Antagonists Also Promising in Cluster Headache
Cluster headache and migraine are distinct primary headache disorders that are associated with substantial pain and disability.
Neuroimaging in Headache Disorders: When Is It Necessary?
The use of neuroimaging as a diagnostic tool remains at the discretion of the clinician, necessitating more research to improve clinical understanding of primary and secondary headaches.
Hemicrania Continua: Diagnosis and Treatment
Hemicrania continua, one of the trigeminal primary headaches, causes intense unilateral pain for ≥3 months.
Experts Offer Tips on Integrating Medical Marijuana Into Geriatric Practice
A study by the National Survey of Drug Use and Health (NSDUH) found that from 2002-2014 the proportion of adults aged 50 to 64 who reported cannabis use in the past year more than tripled from 2.9% to 9.0%. Among adults age 65 or older, there was more than a ten-fold increase (from 0.2% to 2.1%).
Migraine Treatment in the ED: Overcoming Our Penchant for Opioids
There is significant evidence that opioids are not the right treatment of choice for migraine in the emergency department.
Persistent Poststroke Headache: Finding Its Place in Stroke Aftercare
The continued observation of this delayed headache syndrome may point to a different pathophysiology from tension-type headache or acute poststroke headache.
The Unintended Consequences of the CDC Opioid Guideline According to Pain Management Specialists
The guideline formulated by the Centers for Disease Control and Prevention in an effort to curb opioid overdose-related deaths included a recommendation for steep reductions in opioid doses for patients taking high doses of the drug for chronic pain.
Striking a Balance Between Opioid Surveillance and Patient Privacy
Big data has enabled public health authorities to identify doctor-shopping patients and those who needed treatment for opioid abuse. The trade-off, however, could be patient and provider privacy.
Popular Heroin Inhalation Method Tied to Leukoencephalopathy
“Chasing the dragon” is an increasingly popular method of heroin inhalation among drug users.
The Opioid System: The Foundation for Social Risk and Reward
The opioid system is responsible for social pain and reward in the brain; therefore, understanding its underpinnings may help clinicians manage patients with depression and suicidal ideation.
Managing Comorbid Opioid and Alcohol Use Disorder
When alcohol and opioid addiction occur together, managing them concomitantly becomes challenging. Whereas some patients may not need medication for alcohol addiction, opioid abuse does require pharmacotherapy.
Perioperative Pain Management in Patients With Opioid Use Disorder
The perioperative management of pain in patients with opioid use disorders presents multiple challenges to clinicians. A recent review offered clinical guidance for various subgroups of these individuals.
The Role of Psychological Factors in Phantom Limb Pain Reviewed
Up to 85% of amputees experience phantom limb pain: sensations in the missing limb that patients may describe as burning, cramping, tingling, itching, stabbing, throbbing, or a feeling of “pins and needles.”
Pediatric Migraine and Obesity: What We Know and Where We’re Going
Data in children do support an association between pediatric obesity and headache disorders in general, but more research is needed to confirm the association specifically with pediatric migraine.
Leveraging the Placebo Effect to Reduce Opioid Requirements
Emerging evidence indicates that the placebo effect can in some instances reduce patients’ pain. The current debate is whether clinicians need to disclose to patients that they are using placebos instead of active ingredients.
Descriptive, Predictive Data at Odds in Medical Malpractice Courtroom
Because they’re busy looking in different directions, “innocent until proven guilty” and “first, do no harm” don’t always get along.
Comorbid Bipolar Disorder and Substance Abuse: A Challenge to Diagnose and Treat
Bipolar disorder is often comorbid with substance use disorders, with alcohol being the top substance. Clinicians should take a thorough history to uncover substance use disorder because it will guide the management of both disorders.
Pediatric Chronic Musculoskeletal Pain: Diagnosis and Management
Chronic, noninflammatory pain in children and adolescents encompasses a wide range of pain syndromes. Clinicians need to consider not only the physical manifestations of pain but also the psychosocial and academic impact of the child’s pain and impairment.
Identifying Intracranial Hypertension in Children: Added Challenges
Pediatric neurologist Lalitha Sivaswamy, MD, discusses challenges in diagnosing primary intracranial hypertension in pediatric patients.
Reducing Mortality After Overdose: Is Treatment for Opioid Use Disorder Effective?
Adults who received pharmacologic treatment for opioid use disorder following a non-fatal overdose may have a reduced risk for opioid-related and all-cause mortality in the subsequent 12 months compared with adults who did not receive medication-assisted treatment.
Tumor-Related Headache: Path to Diagnosis, Treatment Isn’t Always Obvious
Headaches are a common occurrence in the general population and are often present in patients with an underlying brain tumor, although it is not yet clear to what degree they are related.
Abuse-Deterrent Opioid Formulations: Barriers to Broader Use
Abuse-deterrent opioid formulations have not yet been widely accepted despite their proposed value in reducing opioid abuse and related mortality. Many of the current barriers to broader use are related to their higher cost compared with conventional formulations.
Exploring the Clinical Implications of Cannabinoid Use in Rheumatoid Arthritis
Preliminary evidence has found an association between the cannabinoid system and other rheumatic conditions, but the studies have not provided conclusive results that could drive recommendations.
Opioid Use Disorders: Advances in Pharmacotherapy Provide Long-term Results
Despite the availability of long-acting opioid antagonists, many patients with OUD never receive adequate treatment.
Should You Record Your Patient Encounters? An Interview With Dr James Ryan
Patients are increasingly recording physician visits on their phones, should physicians do the same. MPR spoke with physician who advocates for recording in clinical practice.
Managing Comorbid Migraine and Mood Disorders: A Synergistic Approach
People with migraines and comorbid mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.
Addressing Rare Headache Disorders: Acute Confusional Migraine
Acute confusional migraine has not been specifically studied and many clinicians remain unaware of the condition, which may result in underestimation of the prevalence.
Optimal Strategies for Opioid Weaning After Ambulatory Surgery
Although there is a scarcity of evidence pertaining to the management of postoperative pain medication in the ambulatory setting, some findings suggest an approach similar to that used for the treatment of acute pain.
Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?
Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.
Stat Consult: Chronic Low Back Pain
Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.
Gender Differences in Axial Spondyloarthritis: Comparing Disease Burden and Treatment
An improved understanding of the gender differences in axial spondyloarthritis can improve disease treatment and reduce disease burden.
Treating Osteoporotic Pain: Expert Interview
Pain resulting from osteoporotic fractures should be treated with a multimodal approach that includes pharmacological and nonpharmacological strategies.
Functional Restoration for Chronic Pain and Depression in the Elderly: Pharmacotherapy and Beyond
Functional restoration is a multimodal approach to chronic pain and depression, and includes psychoeducation about pain, biofeedback, mindfulness training, physical and occupational therapy, and detoxification of narcotics.
Should Physicians Treat Family and Friends? Three Experts Weigh In
Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.
Case Study: Sudden Abdominal Pain
A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior.
Confronting Postdural Puncture Headache in Clinical Practice
Nonpharmacological strategies, including bed rest, have a lack of evidence supporting their use in the treatment of postdural puncture headache.
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