The levels of service within an evaluation and management (E/M) visit are based on the documentation of key components, which include history, physical examination and medical decision making. The history component is comparable to telling a story and should include a beginning and some form of development to adequately describe the patient’s presenting problem. To…
First Appearances I watched the old man, his back painfully bent, shuffle toward the scale. A blocky rigidity draped over him. His feet seemed stuck to the floor. His head hung heavily over his chest. Observing him from the end of the hallway, instead of a face, I saw only a mound of shaggy, matted…
A recent study examined the relationship between increased BMI and antineutrophil cytoplasmic antibody–associated vasculitis treatment with glucocorticoids. The results: Weight gain was independently associated with reductions in disease activity, increased glucocorticoid exposure and randomization to rituximab. The most significant increases in BMI occurred during the first six months of treatment, and newly diagnosed patients were more likely to experience an increase in BMI…
An international task force convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends systematic repeated intra-articular hyaluronic acid (HA) injections as second-line treatment for patients with knee osteoarthritis (OA). This is the first time a group of experts has made this recommendation, which is directed toward treatment of…
When she was in elementary school, Sandra Pagnussat, MD, began experiencing unrelenting pain and stiffness, first in her pinky and then in her other fingers. Her pediatrician diagnosed her with polyarticular juvenile idiopathic arthritis (JIA). In high school, Sandra decided to pursue a career in medicine and began taking advanced placement classes in biology and chemistry….
Years ago, the Mayo Clinic was exploring effective ways to minimize burnout among the more than 3,000 doctors employed at its three medical and research facilities in Rochester, Minn., Scottsdale, Ariz., and Jacksonville, Fla. One strategy involved inviting physicians to participate in small groups to discuss topics that were fairly ubiquitous among doctors, from medical…
NEW YORK (Reuters Health)—Itch intensity in moderate to severe plaque psoriasis can be substantial, and may be on a par with the notoriously itchy skin condition atopic dermatitis, new research suggests. “Both conventional wisdom and some of our classic dermatologic textbooks have stated that psoriasis is not particularly itchy,” corresponding author Dr. Alexa B. Kimball…
An 83-year-old established female patient who resides in a skilled nursing facility (SNF) and is diagnosed with rheumatoid arthritis with rheumatoid factor in multiple joints returns to the office for her first infliximab infusion. She denies fevers, cough, dyspnea or concurrent illness, but has joint pain and swelling in both elbows and her left wrist….
(Reuters Health)—A daily supplement of pharmaceutical grade chondroitin is as good as celecoxib (Celebrex) at relieving arthritic knee pain and doesn’t have dangerous side effects, researchers say. Dr. Jean-Yves Reginster of Liege State University in Belgium and colleagues recruited 604 people over age 50 with knee osteoarthritis (OA) from five European countries and randomly assigned…
(Reuters)—Pfizer Inc. has hiked the price of nearly a hundred drugs by an average of 20 percent so far this year in the U.S., the Financial Times reported on Friday. The U.S. drug maker raised the list price of 91 medicines—including that of its erectile dysfunction treatment, Viagra, and its pain drug, Lyrica—on June 1…