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Articles for April 20, 2021

Selected articles for Primary Care Providers
Collected By Dr. Bruce Peyser
PEDIATRICS AND ENDOCRINOLOGY
Casting a Wide Net 
NEJM

This is one of my favorite places to learn medicine within an interactive medical case for the NEJM.  These cases are never easy, so don’t be intimidated or discouraged.  But this is a great way to learn more about a common scenario that busy clinicians will face on occasion.  Also, please note that the case involves a 16-year-old patient- so pediatricians- check this out!!
                                                                                                       
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URGENT CARE TOPICS
When to pick the nose: Out of hospital and emergency department intranasal administration of medications.
Ann Emerg Med

I just love this title!  Review of the use of midazolam that can be used to provide sedation, reduction in anxiety, and can help with seizures.  Intranasal naloxone is safe and efficacious too.
       
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GASTROENTEROLOGY
Acute Pancreatitis
Annals of Internal Medicine

This comes from the In The Clinic Series.  As expected, the tables are excellent- check out Table 2, differential diagnosis of acute pancreatitis.
                   
                                                                                                   READ MORE >>

 
ENDOCRINOLOGY

Glucose-Lowering Drugs to Reduce Cardiovascular Risk in Type 2 Diabetes
NEJM

Bottom line- patients with dm and established heart disease should take the medication with proven cardiovascular benefits such as a GLP-1 receptor agonist or an SGLT2 inhibitor. In pts with dm and heart failure with reduced EF or with chronic CKD, SGLT2 inhibitors with proven benefit should be considered.  If weight loss is a consideration the GLP-1 receptor agonist class is more helpful.

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COVID
Covid-19 Conspiracies and Beyond: How Physicians Can Deal with Patients' Misinformation 
Jama Medical News Podcast Dec 2020

https://podcasts.apple.com/us/podcast/covid-19-conspiracies-beyond-how-physicians-can-deal/id1244256551?i=1000503900378

This is a hugely informative podcast focusing on some ways that we all might talk to our patients and or family members who might be hesitant to get a covid vaccination.  This involved an interview of Brian Southwell, Ph.D. an expert at our own Duke Med school.  The suggestion for this reference came from Dr. Sharon Rubin.
 

 
COVID
Beware the 'last mile, first smile' syndrome when we near the end of the Covid-19 pandemic Apple News

https://apple.news/AzMfwJhqeSNCV6i5fHZxY7w   

A lot of valuable advice here.  For instance: “Well-being, recovery, and de-stressing practices in the form of debriefings, outdoor retreats, and therapeutic/wellness resources like cognitive-behavioral training and mindfulness meditation should be proactively deployed.  Clinicians should be encouraged to share and vent their huge emotional burdens- and be given the time and space to do it.”
(article suggested by Dr. Karl Bernat)
 

 
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