JAAPA-Journal of the American Academy of Physicians Assistants articles from December 2003

JAAPA-Journal of the American Academy of Physicians Assistants archives from December 2003

Good enough? Or good enough to increase the odds of an MI in the next ten years?
December 1, 2003... The data are clear: concurrently, even mild-to-moderate elevations of blood pressure and cholesterol can mean an increased risk of cardiovascular events. (1-3) Studies such as the Multiple Risk Factor Intervention Trial (MRFIT), an...

The quiet killer that took my friend.(Editorial)
December 1, 2003... A friend of mine, Melanie (not her real name), died the other day from ovarian cancer. She was only 42 years old. Melanie came from hearty (to put it mildly) Scandinavian stock. She was 5 ft 8 in tall and weighed about 150 lb, with a strength...

Obstructive sleep apnea increases cardiovascular risk.(Journal Club: recent articles that have an impact on primary care medicine)(Brief Article)
December 1, 2003... Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea; implications for cardiac and vascular disease. JAMA. 2003;290: 1906-1914. * Obstructive sleep apnea (OSA) has been increasingly implicated in the initiation and progression of...

Depression linked to smoking and inactivity in CHD.(Journal Club: recent articles that have an impact on primary care medicine)(coronary heart disease )(Brief Article)
December 1, 2003... Brummett BH, Babyak MA, Siegler IC, et al. Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease. Am J Cardiol 2003;92: 529-532. * This study enrolled 1,250...

Letrozole cuts risk of recurrent breast cancer almost in half.(Journal Club: recent articles that have an impact on primary care medicine)(Brief Article)
December 1, 2003... Goss PE, Ingle JN, Martino S, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med. 2003;349. * This trial tested the effectiveness of treatment for...

Study estimates lifetime risk for diabetes mellitus.(Journal Club: recent articles that have an impact on primary care medicine)(Brief Article)
December 1, 2003... Narayan KM, Boyle JP, Thompson T J. et al. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003;290:1884-1890. * Recent much-publicized reports of the 40% increase in diabetes prevalence since 1990 did not estimate the...

Urgent transfer for PCI better than thrombolysis.(Poems: patient-oriented evidence that matters)
December 1, 2003... Clinical question Is transfer to a referral center for urgent angioplasty better than thrombolysis in the community hospital in patients with ST elevation myocardial infarction? Bottom line Transfer within 2 hours (your emergency department...

Spinal manipulation effective for low back pain.(Poems: patient-oriented evidence that matters)
December 1, 2003... Clinical question Is spinal manipulation more effective than other treatments for acute or chronic low back pain? Bottom line Spinal manipulation, whether chiropractic or osteopathic, is no more effective--and no less effective--than usual...

Sentinel node biopsy accurately predicts axillary metastases.(Poems: patient-oriented evidence that matters)
December 1, 2003... Clinical question Is it a safe strategy to perform sentinel-node biopsy followed by axillary dissection only if the results are positive? Bottom line This study confirms the accuracy and cosmetic/functional benefits of sentinel-node biopsy...

Knee taping useful for osteoarthritis pain.(Poems: patient-oriented evidence that matters)(Brief Article)
December 1, 2003... Clinical question Does knee taping decrease pain and disability in patients with knee osteoarthritis? Bottom line Rigid taping by physical therapists, applied above the knee and, when necessary, below the knee, significantly decreased pain...

Clinical criteria can triage which breast lumps to biopsy.(Poems: patient-oriented evidence that matters)
December 1, 2003... Clinical question What clinical features are useful in predicting which women with breast lumps need biopsy? Bottom line Age, history of breast cancer in the mother, mass size, mammography findings, and fine needle aspiration biopsy (FNAB)...

Glucosamine and chondroitin effective for osteoarthritis.(Poems: patient-oriented evidence that matters)(Brief Article)
December 1, 2003... Clinical question is either glucosamine or chondroitin effective in decreasing symptoms of oeteoarthritis? Bottom line Glucosamine and chondroitin produce a significant and similar effect on symptoms of osteoarthritis, will Improve joint...

Endometriosis a common cause of infertility and pelvic pain: diagnosing endometriosis is a challenge. Various presentations are possible, and noninvasive testing is not definitive.(Recertification Refresher)
December 1, 2003... Endometriosis is a clinical challenge for health care providers because although it is a commonly encountered gynecologic disease affecting more than 5 million women in the United States, (1) it is poorly understood. The disease--the presence...

Postmastectomy breast reconstruction: helping patients decide whether--and when: immediate breast reconstruction is fast becoming the procedure of choice for patients who undergo mastectomy. To counsel patients effectively, you need to understand why.
December 1, 2003... The primary care clinician may be the first to identify an abnormal finding in a patient's breast or the first provider consulted regarding a lump identified on self-examination. Even if a suspicious finding was first identified on screening...

Diagnostic and management strategies for pregnant women with back pain: once a serious cause of the pregnant patient's back pain is ruled out, conservative measures may help to relieve the discomfort.
December 1, 2003... As many as 90% of women report back pain during pregnancy, and at least one third have severe or disabling pain that interferes with dally activities. (1-6) The incidence of pregnancy-related back pain increases with age (5) and parity, but...

Mastering mammography when to order, and what to make of the results: a woman's complaint of pain or a lump in her breast and the results of your thorough clinical breast exam guide your decision about which imaging tests to order.
December 1, 2003... The mammography record is among the most common screening reports interpreted by primary care providers (PCFs). In addition to its use as a screening tool, mammography is typically the first test ordered when a woman presents with a breast...

CME: post-test. Expiration date December 2004.
December 1, 2003... Please take this CME Post-test online at www.aapa.org. Wilson AL. Endometriosis: A common cause of infertility and pelvic pain. JAAPA. 2003; 16(12):20-23. Lile J, Perkins J, Hammer RL, Loubert PV. Diagnostic and management strategies for...

Understanding the role of sentinel lymph node biopsy in breast cancer and melanoma.(CSAC Special Report)
December 1, 2003... The most important indicator of survival in patients with breast cancer or melanoma is whether the cancer has spread to the regional lymph nodes. (1,2) Sentinel lymph node (SLN) biopsy requires surgical expertise and careful patient selection,...

Draining a cyst or abscess in a Bartholin's gland with a Word catheter.(Procedure In Family Practice)
December 1, 2003... A Bartholin's cyst develops hen inflammation or trauma causes an obstruction in the ostium of a Bartholin's gland. The gland continues to secrete fluid but cannot drain, causing cystic dilation. An abscess usually forms if the obstructive...

Acceptance of pathologists' assistants among pathology residents.(PA watch: brief reports on items from the medical literature relevant to PAs)
December 1, 2003... Grzybicki DM, Vrbin CM. Pathology resident attitudes and opinions about pathologists' assistants. Arch Pathol Lab Med. 2003; 127: 666-672. * To learn about the attitudes and opinions of pathology residents toward pathologists' assistants...

Examining skill mix in the health care workforce.(PA watch: brief reports on items from the medical literature relevant to PAs)
December 1, 2003... Buchan J, Dal Poz MR. Skill mix in the health care workforce: reviewing the evidence. Bull World Health Organ. 2002;80:575-580. * This paper discusses why skill mix among health workers is important for health systems. It examines the...

CME calendar.(Calendar)
December 1, 2003... CALIFORNIA February 11-15 13th Annual Physician Assistant Board Review. Provider: Keck School of Medicine of the University of Southern California PA program. Location: Pasadena. Information: www.usc.edu/cme. COLORADO January...