Articles for September 22, 2021

Selected articles for Primary Care Providers
Collected By Dr. Bruce Peyser
Good morning.

Thanks for subscribing to this collection of recent review articles in primary care.  We are going to begin to increase the number of articles that are listed in part because of the varied interests that people have, and also because of the larger number of individuals who now subscribe to this service.
Again, these articles are now all stored on our Teaching Academy website.  To access this, go to . Once on the site, go to the student section, and click on review articles, and then you will see all of our recently cited articles grouped together by organ system.
Also, on occasion, I will cite an article from the NY Times.  Unfortunately, there is no easy way to provide a link to the article within our Duke library system.  If you don’t subscribe to the Times, you might think about getting yourself a subscription.  I believe for students, the rate is quite nominal.  If you teach at Duke, you can sign up for the Times and receive a substantial educator discount.
If you have other requests or suggestions for how we might make this service more valuable to you, please give me some feedback and I will try to make changes to our workflow and process. 

Thank you!  
 B Peyser, MD

How do you effectively evaluate the elderly for alcohol use disorder?
Cleveland Clinic Journal of Medicine

Keep in mind that in the elderly, alcohol use disorder can be manifest with a variety of symptoms and or findings.  The diagnosis is missed commonly.  Also, we know that the elderly have problems with relatively small amounts of alcohol.  Think about using naltrexone to prevent relapses especially in conjunction with behavioral interventions.



Environmental Racism and Climate Change-Missed Diagnoses

A recent perspective piece in the journal, written by a provider caring for a pediatric patient with worsening asthma of unknown cause.  The author reflects upon environmental racism which “includes the use of racist practices in determining which communities receive health-protective infrastructures, such as green space, and which receive health-harming highways and industrial complexes.”



Hereditary Hemochromatosis: Rapid Evidence Review
American Family Physician

Always an important topic to review, recall a key recommendation that all first-degree relatives of patients with this should be screened for the disease.



Kawasaki Disease and Multisystem Inflammatory Syndrome In Children An Overview and Comparison
American Family Physician

Excellent review with case definition and AHA criteria for how to diagnose this.



Home Blood Pressure Monitoring
American Family Physician

Lots of important recommendations about how best to monitor bp at home.  Remind patients to sit quietly for 5 min, with no talking, feet on the floor, and then check their bp.



Stress testing and noninvasive coronary imaging: What's the best test for my patient?
Cleveland Clinic Journal of Medicine

I always have trouble keeping track of the different modalities we can use to test our patients.  This is a great review for use by primary care providers.



A new triple threat
Annals of Internal Medicine 

Used to be the ideal academic provider was a triple threat if he/she conducted original research, and taught students and residents, and provided top-notch patient care.  This author argues that this has changed, especially as the writer spends more time juggling work and caring for his three-year-old during COVID.  His definition of the new triple threat which I totally endorse is one who is a well-rounded provider, who is a connected self-care giver, and who is a fully engaged parent!



I Could Hear The Tears
Academic Medicine

This is a moving article written for the teaching and learning moments within this journal.  This third-year medical student writes about what she has learned as a contact tracer during COVID.  She writes: “To my future patients I say this: When you give me the gift of your feelings, I may still freeze up for a moment, wondering how to best show that I Care.  But I will take this lesson that a global pandemic taught me and give space and significance to your emotion- and we will look at it, together.”



The Disaster We Must Think About Every Day
The New York Times
I found this to be meaningful and aim to make some specific changes as to how I might be better able to respect and preserve our fragile environment.


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