Internal Medicine News articles from April 2009

Internal Medicine News archives from April 2009

NYC registry: 1 in 8 adults has diabetes.(NEWS)
April 1, 2009... New York City's diabetes prevalence and control numbers paint a dismal picture, but public health officials hope that the now 3-year-old hemoglobin [A.sub.1c] registry will help brighten the future for the city's nearly 700,000 adult residents...

Smoking rate hits 20%: excise tax jumps this month: increased tobacco tax seen as deterrent.(NEWS)
April 1, 2009... The prevalence of U.S. cigarette smokers reached a historic low in 2007, falling to just under 20% of the adult population, according to data released in March by the Centers for Disease Control and Prevention. Physicians on the front line...

Half of cardiac guidelines are not evidence based.(NEWS)
April 1, 2009... Nearly half of current clinical practice recommendations from the American College of Cardiology and the American Heart Association are based on expert opinion, case studies, or standards of care, and hence are not evidence based. This may...

More than half of Americans skimp on health care.(VITAL SIGNS)(Statistical table)(Survey)
April 1, 2009... In the past 12 months, has a family member in your household done any of the following because of cost? Relied on home remedies or OTC drugs instead of going to a doctor 35% Skipped dental care or checkups ...

Febuxostat wins approval for gout.(NEWS)
April 1, 2009... For the first time since 1964, the Food and Drug Administration has approved a drug for treating patients with gout. The FDA approved febuxostat for the long-term management of chronic hyperuricemia in patients with gout, based on data from...

FDA approves new vitamin D topical for plaque psoriasis.(NEWS)(Food and Drug Administration)
April 1, 2009... SINT MAARTEN, NETHERLANDS ANTILLES--Physicians can offer their psoriasis patients a new option for topical treatment following Food and Drug Administration approval of a second vitamin D ointment for plaque psoriasis. The availability of a...

Combination approved for treatment of COPD.(NEWS)
April 1, 2009... The Food and Drug Administration has approved the combination inhaled corticosteroid budesonide and the long-acting [beta.sub.2]-adrenergic agonist formoterol for treating chronic obstructive pulmonary disease. Approved in 2007 for...

Metoclopramide to carry stronger dyskinesia warning.(NEWS)
April 1, 2009... A boxed warning about an increased risk of tardive dyskinesia associated with the chronic use of metoclopramide will be added to the drug's label, according to the Food and Drug Administration. In a written statement, the FDA announced that...

Deep brain stimulator gets limited approval for OCD.(NEWS)(obsessive-compulsive disorder)
April 1, 2009... The Food and Drug Administration has approved humanitarian use of Medtronic's experimental deep brain stimulation device to treat severe obsessive-compulsive disorder. It is the first approval for deep brain stimulation for a psychiatric...

United Health's medical home gamble.(UnitedHealth Group Inc.)(Editorial)
April 1, 2009... United Health Group's proposal for a "medical home" program in Florida sounded like a reasonable idea. It's hard to argue with developing performance measures and improving quality for patients. United Health's proposal also addressed one thing...

Stop worrying and love statins.(LETTERS)
April 1, 2009... I have some further suggestions for the patient described in "Treating Elevated Biomarkers to Lower CV Risk" (Mindful Practice, Jan. 15, 2009, p. 26). His Framingham score indicates that he has a 5% risk for coronary heart disease over the...

Broken backbone of medicine.(LETTERS)(Letter to the editor)
April 1, 2009... After reading "The Nation's Health Care is 'Poor,' ACP Says" (Feb. 15, 2009, p. 7), I regret to say that such news has been heard over and over for the past several decades, without any solution. In my opinion, the proliferation of...

Mammography rates low in cancer survivors.(WOMEN'S HEALTH)
April 1, 2009... Most young women who received chest radiation for childhood cancer are not being appropriately screened for breast cancer, despite their high risk, according to a report. The main barrier to screening is not a lack of medical contact;...

Physical activity aids breast cancer recovery.(WOMEN'S HEALTH)
April 1, 2009... San Antonio -- Breast cancer patients who have a high prediagnosis level of physical activity and are able to maintain it afterward experience markedly better quality of life and fewer treatment-related symptoms, according to data from the...

Urine test may detect aggressive prostate Ca.(UROLOGY)(Report)
April 1, 2009... A molecular urine test that detects the fusion of two genes associated with more aggressive prostate cancers was highly specific for prostate cancer in a study in men undergoing prostate biopsies, investigators report based on an interim...

Best practices in: diagnosis and management of alpha-1 antitrypsin deficiency.
April 1, 2009... What Is Alpha-1 Antitrypsin Deficiency? Deficiency of alpha-1 antitrypsin (AAT) protein is a genetic disorder predisposing individuals to the development of early-onset pulmonary disease, most commonly emphysema. AAT protects pulmonary...

Guidelines back prostate ca chemoprevention.(UROLOGY)(Report)
April 1, 2009... Healthy men with a prostate-specific antigen score of 3.0 or lower should consider taking a 5-alpha reductase inhibitor to prevent prostate cancer, according to newly released clinical practice guidelines. The guidelines, issued by the...

Triple therapy reduces restenosis after PCI.(CARDIOVASCULAR MEDICINE)(percutaneous coronary intervention)(Report)
April 1, 2009... NEW ORLEANS--Adding cilostazol to a standard, dual-antiplatelet regimen following the placement of either drugeluting or bare-metal stents led to less restenosis, late loss, and need for revascularization in a meta-analysis of eight small,...

Patients overestimate the benefits of benefits PCI.(CARDIOVASCULAR MEDICINE)(percutaneous coronary intervention)(Survey)
April 1, 2009... New Orleans--Most patients undergoing elective percutaneous coronary intervention have highly unrealistic expectations about its benefits, a survey showed. Among respondents, two-thirds said the PCI would extend their life span. A larger...

Higher coffee intake tied to lower stroke risk.(NEUROLOGY)(Report)
April 1, 2009... SAN DIEGO--Coffee consumption by adults is associated with a reduced prevalence of stroke, and the more cups that are guzzled per day, the greater the protective effect, results from a large study show. In an interview at the International...

Mild brain injury can have long-term effects.(NEUROLOGY)
April 1, 2009... The consequences of mild traumatic brain injury are often anything but mild. Recent studies linking concussion to long-term neurologic deficits suggest that, for some individuals, the characteristic transient brain dysfunction and acute symptom...

Obstructive sleep apnea increases risk of death after stroke.(NEUROLOGY)(Report)
April 1, 2009... San Diego--The presence of obstructive sleep apnea independently increases the risk of death after acute ischemic stroke, results from a single-center study showed. The finding underscores the importance of screening for obstructive sleep...

FDA panel favorable toward quad flu vaccine.(INFECTIOUS DISEASES)(Food and Drug Administration)
April 1, 2009... SILVER SPRING, MO.--The idea of adding a second influenza type B strain to the seasonal influenza vaccine was met with generally positive responses by vaccine experts who discussed the utility of a quadrivalent vaccine at a meeting convened by...

HPV vaccine does not seem to increase Guillain-Barre risk.(INFECTIOUS DISEASES)(human papillomavirus)(Report)
April 1, 2009... The human papillomavirus vaccine does not appear to increase the risk of developing Guillain-Barre syndrome, despite isolated reports of the condition following vaccination, a study shows. "I found that there's some overlap between the...

Patients dropping efalizumab face rebound.(DERMATOLOGY)(Report)
April 1, 2009... Maui, Hawaii--Some psoriasis patients have discontinued efalizumab in response to the recently reported third case of progressive multifocal leukoencephalopathy in users of the drug. "I've had many patients who have decided to come off...

Drug therapy for 'prediabetes' held premature.(ENDOCRINOLOGY)(Report)
April 1, 2009... New York--Drug treatment that is designed to prevent patients with "prediabetes" from progressing to outright, type 2 diabetes by controlling hyperglycemia is not ready for routine use, according to a Food and Drug Administration official. ...

Simple rule predicts C. difficile recurrence.(GASTROENTEROLOGY)
April 1, 2009... Many patients with Clostridium difficile infection experience repeated bouts of the illness, and a rule has been developed to accurately predict a patient's risk of recurrence, reported Dr. Mary Y. Hu and her colleagues. The simple...

Managing Crohn's disease 2009.(THE EFFECTIVE PHYSICIAN)
April 1, 2009... Background Crohn's disease has an estimated incidence of 5/100,000 U.S. residents and prevalence roughly 10 times that number. This systemic disease with primarily gastrointestinal manifestations is responsible for significant morbidity...

Thrombophilia.(GENETICS IN YOUR PRACTICE)
April 1, 2009... Most of the known causes of a hypercoagulable state, such as cancer, inflammation, and autoimmune disease, result from a combination of genetic and environmental factors. Others, the hereditary thrombophilias, are due to mutations in one or...

Policy & practice.(PRACTICE TRENDS)
April 1, 2009... Health insurance, not just safety net access to care, is essential for people's health, an Institute of Medicine committee reported. Even insured people living in areas where many others aren't covered find it more difficult to get needed care...

Medical School Enrollment Up Nearly 2% in 2008.(DATA WATCH)(Statistical table)
April 1, 2009... DATA WATCH Medical School Enrollment Up Nearly 2% in 2008 Men Women 2007 Applicants Enrollees 51.0% 49.0% 51.7% 48.3% Total 42,315 17,759 2008 51.8% ...

Some states pass disclosure laws ahead of feds.(PRACTICE TRENDS)
April 1, 2009... When it conies to public disclosure of drug company payments to doctors, how much your patients know depends on where you live--at least for now. Although no federal law has yet been passed, "six states and the District of Columbia have...

Stem cell executive order gets mixed reaction.(PRACTICE TRENDS)
April 1, 2009... President Barack Obama's executive order reversing the Bush administration's restrictions on government-funded stem cell research drew cheers from some medical groups and jeers from others. Under the previous policy, government funding for...

Do it yourself: a one-doctor mission to Uganda.(WORLD WIDE MED)(Interview)
April 1, 2009... Dr. Winifred Constable grew up outside of the United States, primarily in France and Saudi Arabia, so she's not intimidated by foreign travel. But it was her teenage daughter's desire for a significant volunteer experience that led to Dr....

United Health expands medical home program.(PRACTICE TRENDS)(UnitedHealth Group Inc.)
April 1, 2009... UnitedHealth Group has decided to invest further in the medical home concept, despite a lack of demonstrated outcomes. In 2009, the insurer will spend more than $ 1 million on "enhanced primary care payments," said Eric Sullivan, national...

Home testing for OSA covered by Medicare.(PRACTICE TRENDS)(obstructive sleep apnea)
April 1, 2009... Medicare officials have validated the use of certain home-based tests to diagnose obstructive sleep apnea. The Centers for Medicare and Medicaid Services had previously established a national policy of covering continuous positive airway...

Supreme court: FDA approval doesn't bar suits.(PRACTICE TRENDS)
April 1, 2009... In an eagerly anticipated opinion, the U.S. Supreme Court has upheld a lower court ruling that Food and Drug Administration approval does not give pharmaceutical companies immunity from product liability lawsuits. The justices voted 6-3 to...

Ears to your health.(INDICATIONS)
April 1, 2009... In our continuing effort to inform readers about the world's great medically themed restaurants, we present Hospitalis, a "pseudo-hospital and medical adventure" (according to its Web site, www.hospitalis.lv) in Riga, Latvia. The restaurant is...

Priorities sought for effectiveness studies.
April 15, 2009... WASHINGTON -- As with so many other things, when it comes to performing comparative effectiveness research, more is better, according to speakers at an Institute of Medicine meeting. But more of what? That was the thorny question addressed...

Statin lowers risk of cardiovascular and VTE events: cuts in CRP, LDL were both beneficial.(venous thromboembolism, c-reactive protein, low density lipoproteins)
April 15, 2009... Orlando--Further analysis of results from JUPITER have shown that lowering a person's C-reactive protein level with a statin reduces cardiovascular event risk independent of a cholesterol effect. The finding is likely to pave the way toward...

New vitamin d guidelines expected to boost targets.
April 15, 2009... SAN DIEGO -- The Institute of Medicine is reviewing its 1997 guidelines for vitamin D intake, and will likely recommend increased supplementation when new guidelines are published in 2010. There is a growing consensus that currently...

Medicaid gets majority of health funding in the American recovery and reinvestment act of 2009.(VITAL SIGNS)(Brief article)
April 15, 2009... Medicaid Gets Majority of Health Funding in The American Recovery and Reinvestment Act of 2009 (billions of dollars) Medicaid matching rate increase $86.6 (57%) Other Medicaid $3.2 (2%) COBRA ...

Meier earns palliative care accolade.(NEWS FROM THE FDA)(Diane Meier)(Brief article)
April 15, 2009... Dr. Diane Meier has received the American Academy of Hospice and Palliative Medicine's highest honor, the Lifetime Achievement Award. Dr. Meier, director of the Center to Advance Palliative Care, is chief of the division of geriatrics at...

Make plan B available OTC to 17-year-olds, judge orders.(NEWS FROM THE FDA)(over the counter)
April 15, 2009... AU.S. federal judge ordered the Food and Drug Administration to make the emergency contraceptive Plan B (levonor-gestrel) available to 17-year-olds without a prescription within 30 days. Currently, Plan B is available without prescription to...

Two DNA-based tests for human papillomavirus approved by FDA.(NEWS FROM THE FDA)(Food and Drug Administration)(Brief article)
April 15, 2009... A test that detects the genotypes of human papillomavirus (HPV) 16 and 18, which cause the majority of cervical cancer cases, was recently approved by the Food and Drug Administration. The test, which will be marketed as the Cervista HPV...

More OTC weight-loss products deemed illegal.(NEWS FROM THE FDA)(over the counter)(Brief article)
April 15, 2009... A diuretic, an antidepressant, and an unapproved stimulant are among the latest undeclared active drug ingredients identified in over-the-counter weight loss products, the Food and Drug Administration has announced. In a statement, the...

FDA reviews bleeding events tied to Xigris.(Food and Drug Administration)(Brief article)
April 15, 2009... The Food and Drug Administration said it is working with Eli Lilly & Co. to review the incidence of serious bleeding events and mortality in patients receiving the company's sepsis drug drotrecogin alfa (Xigris). The agency will not take...

Show primary care the money.(LETTERS)(Letter to the editor)
April 15, 2009... Dr. N.S. Damle has asked for real change in the U.S. health care system from President Obama's administration, including strengthening the primary care workforce ("Primary Care Needs Real Change," March 1, 2009, p. 8). The explanation for...

Refining the family history tool.(LETTERS)(Letter to the editor)
April 15, 2009... The Department of Health and Human Services is to be commended for pursuing efforts to assist patients in developing and maintaining online personal health records (PHRs) ("Online Tool Makes Family History a Living Document," Feb. 15, 2009, p....

Word of Caution on Opioids.(LETTERS)(Letter to the editor)
April 15, 2009... A word of caution is due on the use of opioids for chronic pain resulting from arthritis ("Guidelines Focus on Using Opioids for Chronic Pain," March 1, 2009, p. 1). Except for unusually severe osteoarthritis or fibromyalgia, opioids are...

Out with the guidelines?
April 15, 2009... Guidelines designed as advisory to clinicians have achieved almost biblical or, if you will, Koranic status in the care of patients. Many physicians young and old have developed a state of mental paralysis, unable to make clinical decisions...

Guidelines address heart failure hospitalization.(CARDIOVASCULAR MEDICINE)
April 15, 2009... Updated guidelines on heart failure issued by the American College of Cardiology and the American Heart Association include new recommendations on managing hospitalized patients and strengthened guidance on the use of hydralazine and isosorbine...

Guidelines spell out prophylactic aspirin use.(CARDIOVASCULAR MEDICINE)
April 15, 2009... The U.S. Preventive Services Task Force has released the first gender- and age-specific recommendations for aspirin therapy in patients at risk of cardiovascular disease. Drawing on data from recent studies, the new recommendations...

Stroke tied to withdrawal of antithrombotics.(CARDIOVASCULAR MEDICINE)(Brief article)
April 15, 2009... San Francisco -- As many as 26,500 ischemic strokes occurring in the United States each year may be associated with patient withdrawal from antithrombotic and antiplatelet medications, according to a study presented at the International Stroke...

Role of bisphosphonates in ONJ called unclear.(ENDOCRINOLOGY)(osteonecrosis of the jaw)
April 15, 2009... Chicago -- Many people who currently take or who have taken bisphos-phonates are being denied essential dental procedures because of undue fears about bisphosphonate-induced osteonecrosis of the jaw, according to a specialist in oral pathology....

MRI, CT Compete to evaluate bone quality.(ENDOCRINOLOGY)(magnetic resonance imaging)
April 15, 2009... SAN FRANCISCO -- Advances in imaging techniques are providing new insights into trabecular and cortical bone structure and may help assess bone quality, a key component of bone strength identified by a 2001 National Institutes of Health...

New program helps simplify prediction of fracture risk.(ENDOCRINOLOGY)
April 15, 2009... KANANASKIS, ALTA. --Physicians looking for a quick and easy way o predict fracture risk may need to look no further than a new computer program that considers more than just bone mineral density in making such determinations and summarizes its...

CTC promising as adjunct to colonoscopy.(GASTROENTEROLOGY)(computed tomographic colonography )
April 15, 2009... Orlando -- CT colonography continues to show promise as an adjunct to colonoscopy for colorectal cancer screening, according to study findings. Dr. Ruben D. Acosta and his associates assessed 170 average-risk patients at the National Naval...

FOB tests useful in colon ca screening.(GASTROENTEROLOGY)(fecal occult blood )
April 15, 2009... Banff, Alta. -- A colorectal screening program in Ontario has proven successful in detecting high-risk adenomas and colorectal cancer in patients referred because of positive fecal occult blood test results or a family history of colorectal...

Skin cancer screening prevalence inches up.(DERMATOLOGY)(Brief article)
April 15, 2009... San Francisco -- The prevalence of skin cancer screening among U.S. adults inched higher during the first half of this decade, according to the Centers for Disease Control and Prevention. In 2000, one in seven adults said they had ever...

Draft guidelines address pressure ulcer care.(DERMATOLOGY)(Brief article)
April 15, 2009... Arlington, Va.--The first international guidelines for the prevention and treatment of pressure ulcers are available for public comment, and a final version will be released in May, according to presenters at the National Pressure Ulcer...

Ustekinumab beats etanercept for psoriasis.(DERMATOLOGY)(Brief article)
April 15, 2009... SAN FRANCISCO -- Ustekinumab outperformed etanercept for treatment of psoriasis in the first-ever large head-to-head comparison of the two biologies. The 12-week phase III multicenter trial involved 903 patients with moderate to severe...

Skin ca risk behaviors common in young adults.(DERMATOLOGY)
April 15, 2009... SAN FRANCISCO--Recent findings that risk behaviors for skin cancer are most prevalent among 18- to 29-year-olds will be used to create a road map for efforts to curb the rising incidence of melanoma, which has climbed by 4% per year for the...

Contingency Tx helps pregnant smokers quit.(PSYCHIATRY)
April 15, 2009... BOCA RATON, FLA.--In a pilot study of pregnant women who continued to smoke cigarettes despite knowing they were pregnant, 11 (37%) of 30 women who received contingency management achieved abstinence, compared with just 2 (10%) of 23 women who...

Is smoking reduction a viable strategy?(MINDFUL PRACTICE)
April 15, 2009... The Problem A 58-year-old woman presents to you for follow-up of multiple medical issues. She reports smoking 30 cigarettes per day for the past 20 years. As at every prior visit, you encourage her to quit smoking, but she remains...

Nicotine dependence rises in U.S. smokers.
April 15, 2009... PHILADELPHIA--American smokers have, on average, become significantly more nicotine dependent since 1989--which means that more aggressive interventions are needed to help them quit. That's because most of the smokers who could more easily...

DSM-V may take new approach to disability.(PSYCHIATRY)(Diagnostic and Statistical Manual of Mental Disorders )
April 15, 2009... Physicians and researchers charged with updating the Diagnostic and Statistical Manual of Mental Disorders expect significant changes for the next edition, to debut in about 3 years. The proposed revisions will affect not only the DSM-V's...

Occult HBV may be common in HIV patients.(INFECTIOUS DISEASES)(occult hepatitis B virus)
April 15, 2009... BANFF, ALTA.--Occult hepatitis B coinfection appears to be common in HIV-positive individuals, based on the first study of its kind to test for hepatitis B in peripheral blood mononuclear cells, reported Dr. Carla S. Coffin at the Canadian...

New smallpox vaccine immunogenic and safe.(INFECTIOUS DISEASES)(LC16m8 vaccine )(Report)
April 15, 2009... The third-generation smallpox vaccine LCl6m8 was found to be as immunogenic as existing smallpox vaccines but appeared to be safer in a study of more than 3,000 Japanese adults. The live, attenuated, tissue-cultured LCl6m8 vaccine proved to...

Medicare changes, e-prescribing info.(INFECTIOUS DISEASES)(www.cms.hhs.gov/partnerships/downloads/11399.pdf)(www.cms.hhs.gov/medicareprovidersupenroll)(Brief article)
April 15, 2009... A guide from the Centers for Medicare and Medicaid Services explains the e-prescribing incentive program and how to choose a qualified e-prescribing system. By using e-prescribing, physicians can save time, improve patient safety and quality of...

Debate continues over use of stimulus funds.(PRACTICE TRENDS)
April 15, 2009... Washington -- The health care provisions in the federal economic stimulus package continue to spark disagreement between Republicans and Democrats, as seen at a diabetes meeting sponsored by Avalere Health. Wendell Primus, senior policy...

Health status differences affect Medicaid expenditures.(DATA WATCH)(Statistical table)(Brief article)
April 15, 2009... Health status differences affect Medicaid expenditures Estimated Actual enrollment as expenditures as share of total share of total Aged 10.4% ...

Administration posts filling up.(Policy & Practice)(Brief article)
April 15, 2009... The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the administrator of the Health Re-' sources and Services Administration and the new National...

Virtual colonoscopy supported.(Policy & Practice)(Brief article)
April 15, 2009... More than 40 members of Congress have signed a letter urging the Centers for Medicare and Medicaid Services to cover computed tomography colonography (CTC), or virtual colonoscopy The letter responded to a proposed decision by the CMS not to...

Americans struggle on costs.(Policy & Practice)(Survey)(Brief article)
April 15, 2009... About one in five Americans reported having difficulty paying for necessary health care in December 2008, 3 percentage points higher than in January 2008, according to a Gallup poll commissioned by the disease-management company Healthways....

NQF adds safe practices.(Policy & Practice)(National Quality Forum )(Brief article)
April 15, 2009... The National Quality Forum has recommended seven new practices that it said have been proved effective in reducing adverse events. The practices include efforts to prevent falls, eradicate multidrug-resistant organisms, and improve glycemic...

Loneliness, poor health linked.(Policy & Practice)(Brief article)
April 15, 2009... Not having many close friends may contribute to poorer health for many older adults, and feeling lonely is associated with increased health risks, according to a study from the University of Chicago. Researchers measured the degree to which...

Upcoding alleged in MA plans.(Policy & Practice)(Medicare Advantage )(Brief article)
April 15, 2009... The problem of overpayments to Medicare Advantage plans will not be solved until Congress addresses the plans' upcoding practices, -according to a new report from the Center on Budget and Policy Priorities, a progressive think tank. "Up-coding...

Fewer U.S. seniors enter primary care residency.(PRACTICE TRENDS)
April 15, 2009... Medical student interest in primary care continued its gradual slip, according to the latest data from the National Resident Matching Program. In the 2009 resident match, the percentage of U.S. medical school seniors choosing residencies...

Communication and malpractice.(LAW & MEDICINE)
April 15, 2009... Question: Doctors who are most subject to lawsuits: A. Are ultrabusy practitioners. B. Have poor interpersonal skills. C. Talk down to patients. D. Are often in high-risk specialties such as neurosurgery and obstetrics. ...

Practicing, painting, and keeping sane at 92.(THE REST OF YOUR LIFE)(Dr. Robert R. Canas )(Column)
April 15, 2009... Practicing medicine since 1942, Dr. Robert R. Canas credits his painting and sculpture hobbies with "keeping him sane." "I was a general surgeon for many years, and after the pressure in the operating room I would come home and be very...

Tougher than the rest.(INDICATIONS)(Dr. Claudio Vitale suffered an angina attack while performing surgery but didn't stop it)(Brief article)(Column)
April 15, 2009... If you're talking about tough brain surgeons, you'd better be talking about Dr. Claudio Vitale. He was removing a brain tumor at Cardarelli Hospital in Naples, Italy, when he started having chest pain, according to the BBC. He refused to stop...

What's in an Acronym?(INDICATIONS)(Brief article)
April 15, 2009... It didn't seem like a big deal--at first. Some older Iowans don't like to be called "elders," so state lawmakers decided to change the name of the Department of Elder Affairs. To conform with federal agencies that deal with the elderly they...

Intestinal Gift-itude.(INDICATIONS)(American Society of Gastrointestinal Endoscopy)(Brief article)
April 15, 2009... We all know someone who is tough to shop for. (We're really starting to rethink this whole not-getting-up-from-the-chair business.) If your friend or loved one is over age 50 years and has a birthday coming up, why not give the gift of colon...