Handheld computers, also known as personal digital assistants (PDAs), are becoming an increasingly valuable aid to physicians at the point of care. We review the use of handheld computers and their impact in clinical practice and medical education. Clinicians commonly use PDAs to access patient data and as a clinical…
Background We sought to determine the expectations that graduates of one business of medicine program had upon enrollment and to ascertain fulfillment of those expectations after completion, as well as the extent to which participating in the program improved business skills and led to advancement in office practice or career…
Expired CME Credit Submission and Evaluation Form – Antibiotic Resistance
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system (CNS) worldwide. An estimated 50 million people are infected and 50,000 people die annually as a result of this disease. 1 It accounts for 11% of hospital admissions and 35 to 45% of all neurosurgical procedures in…
Primary human immunodeficiency virus type 1 (HIV-1) infection (acute retroviral syndrome) has been well characterized as a mononucleosis-like illness. Manifestations of HIV-1 infection such as pharyngitis, fever, morbilliform rash, myalgias, arthralgias, nausea, headache, emesis, and lymphadenopathy have been reported. Acute rhabdomyolysis has been reported as part of the acute retroviral…
A 74-year-old man was admitted with rhabdomyolysis after undergoing initial treatment for gastrointestinal cancer with irinotecan. The syndrome partially resolved after the discontinuation of all of his usual medications, including his chronic selective serotonin reuptake inhibitor (SSRI). The rhabdomyolysis was exacerbated upon reinitiation of the SSRI and disappeared when the…
Complications of central venous catheters occur in less than 1% of all insertions. Of these, pulmonary air embolism is a rare though often fatal complication. Possible mechanisms include opening of the line to the atmosphere during use and poor technique during insertion or removal. There has also been speculation that…
Surgical procedures on structures of the oral cavity or the mandible may require nasotracheal intubation to allow for surgical access. Even with appropriate technique, trauma to the nasopharynx may occur, resulting in bleeding. The authors describe an alternative technique involving the placement of the flanged end of a red rubber…
The Secretary of Veterans Affairs appointed Dr. Gerber medical center director of the James H. Quillen Veterans Affairs Medical Center at Mountain Home, TN, on November 29, 1992. FIGURE Figure. No caption available. Dr. Gerber started his career with the VA as chief of neurology at the Durham, NC, VA…
During the past few years, personal digital assistants (PDAs) have become hot commodities, similarly to desktop and laptop computers and cellular telephones. Many health care providers—physicians in particular—regularly use PDAs in their everyday work. In some countries, their use has approached the saturation level of 90%. 1 Only a fraction…
Background This study was performed to evaluate the impact of adherence to national guidelines for management of community-acquired pneumonia (CAP) on patient outcomes. Methods Compliance with published national guidelines was assessed. Mortality rate and length of hospital stay were determined. Results Patients who were administered antibiotics within 4 hours of…
Background In 1998, the South Carolina Department of Health and Environmental Control surveyed clinical microbiology laboratories statewide to determine the prevalence of antibiotic nonsusceptibility among isolates of Streptococcus pneumoniae. A follow-up study was conducted in 2001. Methods A cross-sectional study was conducted to estimate the prevalence of penicillin nonsusceptibility (PCN-N),…
Background Several previous studies of invasive Group A streptococcal (GAS) disease have been hindered by small sample sizes (≤ 100 patients) and limited generalizability. Methods We conducted a population-based study of invasive GAS disease. The objectives of the study were to describe the clinical features of individuals who were hospitalized…
Background PROTEKT US (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin in the United States) was established in 2000 to monitor antimicrobial resistance among respiratory tract pathogens across the United States. Methods During 2000 to 2001, 75 southern US centers collected 3,867 Streptococcus pneumoniae, 1,455 Streptococcus pyogenes and…
Background Choice of antibiotic therapy for acute exacerbations of chronic bronchitis (AECB) is important because of cost and concerns about development of resistance. Methods A retrospective cohort study was conducted in outpatients with chronic obstructive pulmonary disease and documented AECB treated with antibiotics. Results We compared outcomes and costs of…
Background Although prophylactic antibiotic medications have been shown to reduce the incidence of postoperative infectious morbidity after cesarean delivery, the most effective regimens have not been established. The purpose of this investigation was to compare the efficacy and costs of prophylaxis with cefazolin alone with cefazolin plus metronidazole. Methods Women…
Jami—with the a pronounced as it is in father—the Persian scholar, mystic, and poet, was the leading intellectual figure of 15th-century Herat, a city-state now in Afghanistan. He declined the offers of several Islamic kings’ patronage in preference for the simple life of a mystic and scholar. Among his many…
Only two cases of appendicitis in strangulated obturator hernia have been previously reported. In the present case, an 83-year-old woman had fatal anaerobic myonecrosis of the thigh that resulted from gangrenous appendicitis in the right obturator foramen. Early diagnosis, prompt surgical intervention, and perioperative resuscitation are critical for survival in…
Antihistamines, which are readily available over the counter in sleeping aids, are commonly found in intentional overdoses. We report three new cases of severe rhabdomyolysis related to ingestion of these agents. This is a rarely reported but potentially overlooked complication among patients who present to the emergency center after intentional…
Simvastatin is a hydroxymethyl glutaryl coenzyme A reductase inhibitor commonly used to treat patients with hyperlipidemia. It is a safe and effective medication in most patients when used appropriately. A serious side effect known as rhabdomyolysis may rarely occur in patients who take simvastatin, especially at higher doses and with…
It’s been open warfare for approximately half a century, and the news is not good. All of our troops are engaged, the reserves have been mobilized, and we can still barely contain the enemy. Our towns have been infiltrated. The enemy has established pockets everywhere. We do not know when…
Expired CME Article – Antibiotic Resistance
The James H. Quillen Veterans Affairs Medical Center is very different from its modest beginnings 100 years ago. Today the medical center stands as a visionary and leader in the health care industry. This comprehensive care medical facility serves more than 25,000 veterans in its four-state service area. Since 1995,…
This review examines the problem of increasing antibacterial resistance among the pathogens commonly associated with community-acquired respiratory tract infections, particularly Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The increases in morbidity, mortality, and treatment cost associated with increased resistance to available antibiotics are challenging prescribers to find more effective therapeutic…
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