An update of NHANES US data shows [1]...
...Obesity in half of black population and a third of whites & hispanics. (BMI of 30 or more)
...Morbid obesity in 14% of black and 5% of white populations. (BMI of 40 or more)
What follow-up do you offer your patient with resected colon cancer. A tabular review of guideline suggests office visits every 3-6 months and colonoscopy every 3 to 5 years, with little evidence to support most strategies. [1]
Another physician hears carotid bruits in your 53 year-old patient. Your patient is asymptomatic (no strokes or TIA symptoms) and had the examination as preoperative evaluation for general surgery (nephrectomy). A retrospective Mayo Clinic series of 284 patients suggests your patient will not benefit from endarterectomy [1]:
"The risk of stroke in unselected patients and patients with a carotid bruit undergoing general anesthesia and surgery is very low."
"...Carotid stenosis was related to a perioperative risk of stroke of approximately 3.6%. Greater degrees of stenosis did not confer significantly higher risk. Although higher than in the unselected population, this risk does not appear sufficient to mandate prophylactic endarterectomy."
Correspondence to the journal, Neurology, is full-text online. [2]
For an adult with mild traumatic brain injury (MTBI) when should we order a noncontrast head CT scan?
The American College of Emergency Physicians gives an evidenced-based review of the literature. [1] They answer with an endorsed clinical policy:
"A head CT scan is not indicated in those patients with MTBI who do not have headache, vomiting, age greater than 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicle, or seizure."
[Jagoda AS et al. Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med 2002;40(2): 231-49.]
Glascow Coma Scale
Here are two links to this scale which is used in assessment of patients with brain injury. [2, 3]
Saving Lives
Two days after his subdural hematoma had been drained a 75 year-old man was alert and sitting at his beside recounting just what it was like the day he came to the hospital. He had noticed progressive dizziness. His family encouraged him to go the hospital. He walked.
"Walking to the hospital I was saving lives."
"What do you mean you were 'saving lives?'"
"Well doctor, I was saving lives. If I saw a cicada on the sidewalk, I'd pick him up and put him on a tree. If I saw an earthworm, I'd move him off the sidewalk." [4]
Plan B, a progestational emergency contraceptive, is in fact available by prescription.[1]
May 7th the FDA issued a non-approval letter for over-the-counter emergency contraception.[2] In an online Q & A they explain their decision.[3] They expect re-submission by the manufacturer, with solutions to under age 16 access.
Groups from ACOG, to NEJM, to others have reacted.[4, 5, 6]