ACP Medicine

Occupational Medicine Part 1

Awareness of the impact of the work environment on health has increased dramatically in the past few decades. Common clinical problems, such as carpal tunnel syndrome and respiratory irritation and allergy, are increasingly being related to physical, chemical, and biologic hazards at work.1 In this topic, we cover some of the most common occupational disorders […]

Occupational Medicine Part 2

Diagnostic decision making The determination that a patient’s symptoms are work related often entails extensive ramifications for the patient’s employer,as well as potentially serious public health and medicolegal implications. These may present a significant challenge to the clinician, because for many occupational disorders, there is no gold standard for diagnosis. The decision-making process should address […]

Occupational Medicine Part 3

Liver disease The liver is highly sensitive to effects of numerous organic and inorganic substances used in the workplace [see Table 1 ]. Despite the impressive potential for harm, often at exposure levels not uncommon in the workplace, occupational liver diseases are rarely recognized except during outbreaks.49 This is almost certainly because the clinical presentation […]

Health Advice for International Travelers Part 1

The provision of health advice and the administration of prophylactic measures can help reduce the morbid and, at times, mortal risks of infectious illnesses that may be acquired during international travel. The Centers for Disease Control and Prevention (CDC) publishes Health Information for International Travel, which provides information on required and recommended vaccinations and malaria […]

Health Advice for International Travelers Part 2

Meningococcal Disease Although acquisition of meningococcal disease is uncommon in travelers from the United States, immunization should be considered for travelers to areas with recognized epidemics or to regions where such disease is hyperendemic, especially if prolonged contact with the local populace is anticipated. Epidemics of meningococcal disease are frequent in the area of sub-Saharan […]

Health Advice for International Travelers Part 3

Chloroquine For those limited geographic regions not yet experiencing CRPF [see Figure 5], the chemoprophylactic agent of choice is chloroquine, given as either chloroquine phosphate (Aralen) or hydroxychloroquine sulfate (Plaquenil).1 Chloroquine phosphate, 500 mg (300 mg of chloroquine base), or hydroxychloro-quine sulfate, 400 mg (310 mg of hydroxychloroquine base), should be taken once weekly beginning […]

Quantitative Aspects of Clinical Decision Making Part 1

An increasing amount of very useful quantitative evidence from health care research is available to practitioners. New research findings continually expand the knowledge base of what does more good than harm for patients, and institutional forces, both professional and financial, are accelerating the adoption of research findings. More and more information is available on issues […]

Quantitative Aspects of Clinical Decision Making Part 2

Measures of diagnostic test performance and interpretation Clinically useful measures of diagnostic test performance include sensitivity, specificity, and the likelihood ratio; clinically useful measures of test interpretation include pretest odds, pretest probability, probability after a positive test result, and probability after a negative test result [see Table 3]. Physicians should memorize and internalize the definitions […]

Quantitative Aspects of Clinical Decision Making Part 3

Medical Decision Analysis Clearly, there is more to clinical decision making than simply collecting numbers that measure treatment effects. Reports of treatment effects in randomized, controlled trials are important starting points that help determine whether a treatment has merit in its own right, but the actual decision whether to offer a given patient a particular […]

Palliative Medicine Part 1

One unanticipated result of the advances in health care during the past century has been the emergence of chronic illness as the leading cause of death [see Table 1]. At the same time, the enhanced ability to significantly extend life for patients with chronic diseases has blurred the boundary between curable illnesses and illnesses that […]