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Articles for December 3, 2020

Selected articles for Primary Care Providers
Collected By Dr. Bruce Peyser
DERMATOLOGY
Basal Cell and Cutaneous Squamous cell Carcinomas: Diagnosis and Treatment    
American Family Physician 
Lots of good pictures of course.  Check out table 1 that compares bcc and squamous cell cancers. ( turns out the latter occur especially commonly on the back of hands and forearms.)
ENDOCRINOLOGY
Diabetes Triple Distilled
Curbsiders Podcast

This is super duper high yield- they reviewed 4 separate episodes about dm and took the most important points, and summarized them in this episode.

Lots of great pearls- HemA1c can be artificially higher in patients with essentially prolonged red blood cell survival, such as iron deficiency, and it can be artificially lower in patients with higher red blood cell turnover such as due to destruction associated with a mechanical valve.

Also lots of great comparisons between SGLT-2 inhibitors and GLP-1 agonists. Former better in folks with heart disease, but beware of the yeast infections, and they can also cause euglycemic diabetic ketoacidosis.

 
PHARMACOLOGY
Care of the Patient Using Cannabis   
Annals of Internal Medicine (In the Clinic Series)
Very helpful. I had a patient two years ago who was always taking an excessive number of hot showers and now I know that she likely was having cannabinoid hyperemesis syndrome due to her trying to stop her use of probably high strength cannabis.
MISCELLANEOUS
HOUSE CALLS
American Family Physician
The figures and charts within the article are very helpful.  Here is a handy mnemonic to recall items to check on when doing a home visit- INHOMESSS (impairments/immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, services).
PREVENTATIVE
DOES MY HEALTHY 65-YEAR OLD PATIENT STILL NEED THE 13 VALENT PNEUMOCOCCAL CONJUGATE VACCINES (PCV13)?
Cleveland Clinic Journal of Medicine
The short answer is no- Turns out that the incidence of PCV13 type pneumococcal disease in adults has diminished greatly, in part because kids started to be vaccinated in 2000 first with PCV 7 and then with PCV 13.  If a patient is immunocompromised, has a CSF leak, or cochlear implants, then you might want to vaccinate them.
 
TELEMEDICINE
CONNECTING WITH OLDER ADULTS VIA TELEMEDICINE 
Annals of Internal Medicine
This short article reviews ways that we can connect better with our patients by way of telephone visits, keeping in mind that 2/3 of adults > 70 years old have some significant hearing loss.  There are a lot of great coaching tips, such as minimize raising one's voice because it can cause distortion on the phone or by way of a video visit.  Using teach-back techniques ensures that content is effectively reviewed.
HEPATOLOGY
NONALCOHOLIC FATTY LIVER DISEASE: COMMON QUESTIONS AND ANSWERS ON DIAGNOSIS AND MANAGEMENT 
American Family Physician
I think this is one of the best, most concise reviews of this common and important topic. Remember NAFL usually is mild, while patients with NASH have a higher risk of death from ca, end-stage liver disease, and cardiac disease.
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