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‘Urinary Tract Infection’ and the Microbiome

The current paradigm for managing uncomplicated “urinary tract infection” (“UTI”) is deeply flawed. “UTI” is ambiguously defined, and coupled with a belief that “bacteria are not normal inhabitants of the urinary tract,”1 the diagnosis often leads to unnecessary, harmful antibiotic treatment. Although bacteriuria identified by standard clinical cultures (which we will call standard bacteriuria) is central […]

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The Missing Antibody: The Pitfalls of ANCA Testing

A 44-year-old white woman presented to the hospital with acute shortness of breath while on a flight back to England from a holiday in Turkey. She denied having a productive cough, hemoptysis, or chest or calf pain. She was asthmatic, and her symptoms were improved by repeated administration of her salbutamol inhaler during the flight. […]

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Silent Atrial Fibrillation and Cryptogenic Strokes

A new suspected cause of cryptic strokes is “silent atrial fibrillation.” Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients […]

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Improving Warfarin Management Within the Medical Home: A Health-System Approach

Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available […]

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Managing Increasing Liability Risks Related to Opioid Prescribing

The increase in prescription opioid-related overdose deaths has increasingly led to liability and sanctions for physicians. For instance, in January 2010, Maurice Conte, MD was found negligent for prescribing a combination of Vicodin, Xanax, and Soma, which caused an overdose death, and was fined over $9 million.1 Conte, as the Medical Director of pain clinics, rarely […]

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