|
|
| Vol. 31 No. 6 June 2008 |
 |
| David
C. Dale, MD, FACP, Editor-in-Chief Daniel
D. Federman, MD, MACP, Founding Editor Wendy Levinson, MD, FACP, Associate Medical Editor, What's New in ACP Medicine |
 |
| IN THIS ISSUE |
|
| PRACTICE OF MEDICINE |
ACP Medicine: It's Our 30th Anniversary!
DOI 10.2310/7900.2008.NCjun
ACP Medicine began as the loose-leaf textbook Scientific American Medicine (SAM) in 1978. It was the " brainchild" of editors Ed Rubenstein and Dan Federman, then both at Stanford, and the publisher at Scientific American, Jonathan Piel. SAM began with a small cluster of authors drawn principally from the faculty at Stanford and Harvard medical schools. This year marks our 30th anniversary.
From the beginning, SAM was innovative, and this tradition endures. Highlights of its history include combining continuing medical education with the regularly updated chapters in the early 1980s, extensive in-line referencing as a predecessor to emphasizing " evidence-based medicine," and publishing SAM-CD and then SAM online, early in the era of electronic publications. SAM and ACP Medicine have always attracted users by being well written, in the style of the parent, the magazine Scientific American, with many illustrations and tables to make comparisons of diagnostic tests and treatment options as clear as possible.
By the mid-1990s, the development of the medical subspecialties, advances in molecular biology, and increasing sophistication in clinical investigation and health services research led to the formation of a multispecialty editorial board and the addition of many new contributors. The pace of publication also quickened as the power of chips, computers, and the Internet made almost everything known in medicine and science " only a click away." Medical publications are still feeling the impact of these changes.
ACP Medicine was introduced as the first comprehensive internal medicine reference to carry the name of the American College of Physicians in 2004. It complements the other educational materials and activities of the College, including the Medical Knowledge Self-Assessment Program (MKSAP), the Annals of Internal Medicine, the Physician’s Information and Education Resource (PIER), and the ACP books program. In addition to covering all of the medical subspecialties, ACP Medicine includes other areas of medicine that are commonly part of adult primary care: women’s health, geriatrics, palliative medicine, dermatology, neurology, psychiatry, and topics in emergency medicine. ACP Medicine is currently published in four formats: the original loose-leaf notebook style mailed monthly, a quarterly CD-ROM, the online version available at http://www.acpmedicine.com , and a traditional bound text.
The monthly updates of the text, the monthly newsletter, What’s New in ACP Medicine, and the monthly CME program now provide students, physicians in training, residents, and busy clinicians with an organized educational program to stay current in medicine. ACP Medicine serves as an excellent pathway for maintenance of certification and licensure, and many residency programs now subscribe to ACP Medicine’s weekly curriculum. Advice on diagnostic tests and treatments is now distilled and presented in a tabular format called " Best Dx, Best Rx." The goal of this innovation is to make it easy to be current and to avoid medical errors. In our tradition of innovation, we are also now reaching out to make ACP Medicine a widely used international resource in the practice of medicine in a variety of new ways.
Many have asked, " Is there a future for medical textbooks?" or " If I buy it, how soon will it be outdated?" Certainly, textbooks of all sorts are " an endangered species" with the rise of desktop publishing and the ease of storage, organization, and retrieval of information worldwide via the Internet. On the other hand, medical publishing far surpasses the capacity of individuals to read, digest, and remember current information. There is a greater need than ever for physicians and other practioners to have current, well-written, reliable information in a format that makes it easy to use, especially when it is needed at the point of patient care. The promise of ACP Medicine is to do our best to keep our succinctly written comprehensive text current so that you can use it to guide your practice. We intend for it to provide all of the information you need to know to be an excellent general internist and primary care physician. If you are a specialist in any field, ACP Medicine should serve you well in keeping up in the broad field of internal medicine.
For the first 16 years, the publication was guided by Edward Rubenstein, professor of medicine and associate dean of postgraduate medical education at Stanford, and Daniel D. Federman, the Carl Walter Professor of Medicine and Medical Education and dean of medical education at Harvard. In 1994, David C. Dale, professor of medicine and former dean of the School of Medicine, University of Washington, succeeded Dr. Rubenstein. Members of the Editorial Board (current and past) have included Joe Alpert, Karen Antman, John Atkinson, William Bennett, Christine Cassel, Mark Feldman, Raymond Gibbons, Brian Haynes, Jan Henrich, William Henrich, Michael Holtzman, Roland Ingram, Mark Lebwold, Wendy Levinson, Lynn Loriaux, Robert Mayer, Shaun Ruddy, Hal Sox, Eric Topel, and Jerry Wolinsky. The editors and contributors are deeply indebted to the loyal and dedicated staff who have worked so diligently for SAM and ACP Medicine.
In January 2008, BC Decker of Hamilton, Ontario, became the publisher of ACP Medicine under a long-term contract with the ACP. Previously, SAM was published by Scientific American Inc, New York, and the Georg von Holtzbrinck Publishing Group, Stuttgart, Germany. SAM and ACP Medicine were previously published by WebMD Professional Publishing, New York.
| THIS MONTH'S UPDATES |
3 Endocrinology
VI Diseases of Calcium Metabolism and Metabolic Bone Disease
10.2310/7900.S03C06
New Osteoporosis Screening Guidelines
In 2008, the National Osteoporosis Foundation recommended dual-energy x-ray absorptiometry screening for women age 65 years and older and men age 70 years and older. Screening was also recommended in adults over age 50 years with fragility fracture, as well as postmenopausal women under age 65 years and men ages 50 to 70 years if they have one or more accepted risk factors for fragility fracture. These risk factors include low body weight, current smoking, and personal history of, or a first-degree family relative with, a low-trauma fracture.
11 Neurology
II Diseases of the Peripheral Nervous System
DOI 10.2310/7900.S11C02
What's Best for Bell Palsy?
Although a 2004 meta-analysis concluded that clear evidence for the efficacy of glucocorticoids had not been demonstrated, a recent randomized controlled study involving 500 patients found that administration of prednisolone 25 mg b.i.d. within 72 hours of onset resulted in recovery of facial function at 3 months in 83% of patients, compared with 64% given placebo.
Because of the evidence suggesting a role for herpes simplex virus in Bell palsy, antivirals are often prescribed along with glucocorticoids. Some clinical trial data support this approach, but the recent large trial referred to above found no advantage with using acyclovir, either alone or combined with prednisolone.
14 Respiratory Medicine
II Imaging of Lung Disease
10.2310/7900.S14C02
The Knotty Problem of Tiny Nodules
Until recently, all nodules detected by radiography or computed tomography were assumed to be malignant, unless radiographic features were convincingly benign. Newer multidetector row CT protocols have changed this philosophy as an increasing number of nodules are detected with the thinner images. In fact, these tiny nodules have very much confused the clinical picture. Studies are under way to determine the utility of following these tiny nodules versus more aggressive strategies.
For now, a good general rule is to assume that a nodule definitely seen on chest radiography is malignant unless benign features are present and that CT-detected nodules should be closely scrutinized for size, imaging features, and any history of malignancy. A fine-needle biopsy may provide a specific benign diagnosis.
5 Hematology
II Red Blood Cell Function and Disorders of Iron Metabolism
DOI 10.2310/7900.S05C02
Hemochromatosis in the Next Generation
Genotypic screening for the most common HFE mutations, C282Y and H63D, in populations of northern European ancestry can identify the vast majority of those patients at risk for the development of primary iron overload. Parents who are C282Y homozygotes may have concerns about nonmedical consequences of screening their children: although they wish to identify a child at risk for iron overload, they also wish to avoid potentially affecting the child’s ability to obtain medical insurance. In such cases, testing the other parent is a strategy that can lead to more selective investigation of children.
1 Cardiovascular Medicine
XV Congenital Heart Disease
DOI 10.2310/7900.S01C15
Red Flag after Tetralogy Repair
Patients who have undergone repair of tetralogy of Fallot must be regularly monitored for progression of residual defects. Ventricular arrhythmias, which are detected in 40 to 50% of patients, have been associated with older age at primary repair, right ventricular volume overload, and QRS prolongation. Marked widening of the QRS to more than 180 msec and dysfunction of the left ventricle have been identified as risk factors for sudden cardiac death. In such cases, consideration should be given to prophylactic placement of an implantable cardiac defibrillator.
| FDA Approval Report |
The following is selected from the FDA’s list of recently approved products. Complete, updated information on FDA approvals and notifications is available on the FDA Web site ( http://www.fda.gov ).
Treatment for Opioid-Induced Constipation
The FDA has approved methylnaltrexone bromide to help restore bowel function in patients with late-stage, advanced illness who are receiving continuous opioids to help alleviate their pain. Methylnaltrexone is an opioid antagonist with limited ability to cross the blood-brain barrier. It is given by injection. The recommended starting schedule is one dose every other day as needed; the dosage should not exceed one dose in a 24-hour period. The drug is not recommended for patients with known or suspected intestinal obstructions.
The safety and effectiveness of methylnaltrexone was demonstrated in two randomized, double-blind placebo-controlled studies involving a total of 287 patients, conducted over a 4-month period. All patients had advanced late-stage illnesses, with a life expectancy of less than 6 months. Their median age was 68 years. Before treatment with methylnaltrexone, patients had had either fewer than three bowel movements in the preceding week or no bowel movement for more than 2 days. Patients treated with methylnaltrexone had a significantly higher rate of elimination than those receiving placebo. The safety and effectiveness of methylnaltrexone have not been studied in pediatric populations.
Common side effects of methylnaltrexone include abdominal pain, gas, nausea, dizziness, and diarrhea. If severe diarrhea, vomiting, nausea, or abdominal pain occurs during methylnaltrexone treatment, patients should discontinue use of the medication in consultation with their health care professional.
Generic Name: Methylnaltrexone bromide
Brand Name: Relistor
Distributors: Wyeth Pharmaceuticals Inc., Philadelphia, PA., and Progenics Pharmaceuticals, Tarrytown, NY.
FDA Approves Relistor for Opioid-Induced Constipation. FDA News. U.S. Food and Drug Administration, April 24, 2008 ( http://www.fda.gov/bbs/topics/NEWS/2008/NEW01826.html )
Starting with the July update, revised chapters from the Women's Health Section 16, which were previously available only in electronic format, will now be published in print. Chapter IX, Medical Complications in Pregnancy, will appear in the loose-leaf update for July.
