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September 2010 Issue of JAAPA

From the Academy

Pneumococcal disease: Swinging away at a dangerous killer

Tens of thousands of American adults needlessly suffer and die from pneumococcal disease every year. The time has come for PAs to advocate for better ...

Pharmacology Consult

Meperidine versus morphine, and PPIs with clopidogrel

This month's questions: Is meperidine better than morphine for pancreatic/biliary pain? Do clopidogrel and proton pump inhibitors interact?

Letters

Is this the scapular manipulation technique or the Stimson technique?

Evaluation and management of the acute anterior shoulder dislocation

Dermatology Digest

Round, pitting lesions on  the lower leg

A patient with diabetes mellitus presents with a pitting rash on the right lower leg that had persisted for a year.

Clinical Watch

Hypertension:  Is BP out of  control or uncontrolled?

The condition is prevalent in all patient populations despite the availability of evidence-based guidelines for effective treatment and management.

CME

Hip resurfacing: A fresh look at an alternative to total joint arthroplasty

Improved devices make the procedure a viable option for a select group of patients with hip arthritis.

Stress management: Helping patients to find effective coping strategies

The impact of stress on physical and mental health illustrates the need for a variety of effective coping techniques.

CME Posttests

CME Posttest: Stress management; Hip resurfacing

September 2010

AAPA Special Article

US physician assistant (PA) supply by state  and county in 2009

Variation in the PA-to-population ratio may be related to state practice laws, some of which may discourage PAs from practicing in communities most vulnerable to ...

Case Reports

Abnormal protein deposition causes symptoms of dyspnea and fatigue

Light chain amyloid deposition can occur in any organ but the brain, disrupting the tissue architecture and interfering with organ function.

New-onset status epilepticus develops after a motor vehicle collision

Despite suffering no head trauma, the patient began to experience new-onset  seizures from an unexpected and surprising source.

The Surgical Patient

Hyperglycemia management in  the urgent surgical patient

Stress-induced hyperglycemia presents a unique challenge. Avoidance of extreme fluctuations in blood glucose levels is critical.

Review Articles

Buprenorphine: A more accessible treatment for opioid dependence

Buprenorphine-naloxone holds the key to opening primary care clinics to a greater number of patients suffering from opioid addiction.

Quick Recertification Series

A review of pleural effusion and cirrhosis

The clinical features, assessment, causes, diagnosis, and treatment of cirrhosis and pleural effusion are outlined in a quick review format.

Sounding Board

PAs and "disruptive innovation"

The author argues that to maintain themselves as a "disruptive innovation," with all the value that brings to the American health care system, PAs must ...

POEMs

Tight glycemic control in ICU is harmful

Clinical question: Why have studies found different degrees of benefit and harm for tight glucose control in the ICU?

Oral glucose reduces pain due to venipuncture in newborns

Clinical question: Does oral glucose reduce pain in newborns undergoing venipuncture?

Naltrexone plus sertraline is more effective for abstinence than either alone

Clinical question: Is combination therapy with naltrexone and sertraline more effective than single-drug therapy for patients with alcohol dependence and depression?

Inhaled corticosteroids only decrease COPD exacerbations slightly

Clinical question: Do inhaled corticosteroids (ICS) reduce the likelihood of chronic obstructive pulmonary disease (COPD) exacerbations, and is any benefit associated with the severity of disease?

Fibrates reduce nonfatal events, but have no effect on fatal events

Clinical question: Do fibrates reduce the rate of cardiovascular events?

Prochlorperazine is better than sumatriptan for relief of acute migraine

Clinical question: Does prochlorperazine produce better pain relief than sumatriptan in patients with acute migraine?

When the Patient Asks

What is MRSA?

The causes and treatment of methicillin-resistant Staphylococcus aureus are discussed. A patient handout with frequently asked questions is included.

Diagnostic Imaging Review

A cracking sensation is the onset of severe ankle pain

Persistent ankle pain leads to a stress fracture diagnosis, but the patient's history suggests that something else is going on.

Case of the Month

A 71-year-old woman with severe lower back pain and abdominal cramping

A 71-year-old female presents with complaints of persistent severe back pain, abdominal cramping, and nausea.

Interpreting ECGs

Diagnosing left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is the abnormal enlargement of the left ventricle in response to increased peripheral vascular resistance, most commonly resulting from long-standing hypertension.

Ask a Librarian

Ask a Librarian!—September 2010

A guest columnist discusses things to think about if you are thinking of acquiring a smartphone. Among the issues to focus on, she says, are ...

Eliminating Health Disparities: What Works?

Eliminating health disparities: What works?—September 2010

This month's column looks at a tool for assisting hospitals in measuring their performance related to providing equitable care to gay and lesbian patients and ...