br_041027_minuteclinicRetail Medical Clinics

'Doc in a box' is the tongue in cheek, and admittedly somewhat disparaging term many medical insiders call retail medical clinics, such as those found in Target or Wal Mart stores. These clinics purport to offer quick, accessible care for common medical problems, and as Rick points out in this week's podcast, they really should be called 'nurse in a box' since the majority are staffed by nurse practitioners.

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arterymay96Benefits of Statins Before Vascular Surgery

Rick and I have quipped frequently in the four years we've been doing PodMed that soon statins, that class of drugs used to lower cholesterol, will be added to drinking water, a lot like fluoride. That's because in many reports and studies, the benefits of statins seem legion. Now comes a study in NEJM showing another benefit. When people have vascular surgery, or surgery on their blood vessels, those who receive statins experience fewer cardiovascular events than those who don't: Fluvastatin and Perioperative Events in Patients Undergoing Vascular Surgery.

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CT-Computed-Tomography2There's a long term health consequence from exposure to the type of radiation used for many medical imaging studies. That fact emerges clearly from the burgeoning literature on the subject. Questions that remain unanswered are just how significant is the risk? Are certain types of studies most problematic? And how big is the problem anyway? This week's NEJM attempts to get a handle on this last, with some rather astonishing results.

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melanomaHow is Melanoma Most Often Detected?

Statistics surrounding melanoma, the most lethal form of skin cancer, are grim. The World Health Organization reports about 48,000 deaths due to melanoma each year, with approximately 160,000 new cases diagnosed yearly. A study in this week's Archives of Dermatology: Routine Dermatologist-Performed Full-Body Skin Examination and Early Melanoma Detection sheds new light on diagnosis.

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aspirinAnyone who's watched the excruciating process by which a new drug gains FDA approval knows that if garden variety aspirin, that mainstay of medicine cabinets everywhere, was up for review today, it would never make the cut. That's because aspirin is known to have a number of negative side effects, especially gastrointestinal bleeding. But now another study in JAMA is extolling the benefits of aspirin: Aspirin Use and Survival After Diagnosis of Colorectal Cancer.

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fluH1N1 Infection in Pregnancy

H1N1 infection in pregnant women seems to be associated with a much higher rate of mortality than any other group reported so far. That's according to a Lancet Infectious Disease study: H1N1 2009 influenza virus infection during pregnancy in the USA. In this relatively small number of women (34), 11 were admitted to the hospital and 6 of them died. So mortality was approximately 50% among those hospitalized with the flu.

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1-osteoporosisOsteoporosis is an increasing problem worldwide, largely as a consequence of many more people living long enough to develop the bone-thinning condition. Most concerning is the trajectory from the development of osteoporosis to bone fractures to nursing home care to death, delineated in many studies.

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Once again, two studies published in this week's Journal of the American Medical Association,
Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure and Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women establish that staying physically active, not smoking, choosing your food carefully, and avoiding weight gain are keys to a longer, healthier life. And then there's my personal favorite, judicious consumption of alcohol. Duh.

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pillcamCan Your Colon be Examined with a Pill?

Most of us know the recommendation by now: If you're at average risk for colon cancer, once you reach the age of fifty you should have a colonoscopy to screen for the disease, as well as precancerous lesions called polyps. But who wants to undergo this test? It's even less fun than mammography (an issue I can speak to), requires a day of preparation where it's almost impossible to leave the house, sedation and the need for a driver to provide transport home. Jokes abound about screening colonoscopy, and Katie Couric's courage notwithstanding, the majority of those eligible for screening choose not to have it.

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hair_122__02An Effective Treatment for Chronic Hair Pulling

Lots of people engage in repetitive behaviors; most of us eat on a regular basis for example. But some people engage in behaviors they repeat over and over again, sometimes resulting in personal harm, and over which they cannot seem to exert control. Such behaviors are then termed 'compulsive.' One such is trichotillomania, or chronic hair pulling. (The word itself isn't as bizarre as it sounds. Tricho always refers to hair, tillo to pull out, and mania, insanity.) Those who manifest trichotillomania will pull out their own hair, creating bald patches. But now a good news study in this week's Archives of General Psychiatry suggests an effective treatment.

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