Tag Archives: patient care
nurse showing an elderly woman something on a tablet in office

Implications of Medicare’s Value-Based Payment Initiative for Specialty Health Systems

Despite the current uncertainty about the direction of health care reform in the United States, the Centers for Medicare and Medicaid Services (CMS) appears poised to transition from standard fee-for-service reimbursement to value-based payments in the coming years. These new models, which were codified in the Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization […]

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Challenges in Ordering and Interpreting Pharmacogenomic Tests in Clinical Practice

More than 160 US Food and Drug Administration–approved medications have information in their labeling regarding genetic mutations known to be associated with efficacy or safety.1 Not surprisingly, pharmacogenomics is increasingly incorporated into clinical practice in an effort to optimize prescribing to improve treatment outcomes.2, 3, 4, 5 Clinical implementation of pharmacogenomics has been facilitated by efforts to standardize pharmacogenomic-related terminology and […]

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Dr. Joseph S. Alpert

Challenging Patients: An International Perspective

Recently, I related the sad stories of 2 challenging patients that I had helped to care for during one of my rotations as attending physician on our internal medicine service.1 The first patient was a frail elderly lady with a number of serious and potentially life-threatening illnesses who insisted on going home to her apartment where […]

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From Evidence Based Medicine to Medicine Based Evidence

Evidence based medicine, using randomized controlled trials and meta-analyses as the major tools and sources of evidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guide to decision-making about a patient at hand. However, […]

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Magnetic resonance imaging of the head performed 5 days after a hypoxic episode demonstrated T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities (A) with corresponding restricted diffusion on diffusion-weighted image (DWI) sequence (B) and apparent diffusion coefficient (ADC) sequence (C).

Delayed Transient Cortical Blindness from Hypoxic Ischemic Encephalopathy

To the Editor: An 85-year-old woman with no significant past medical history presented after a mechanical fall complicated by multiple fractures. She received intravenous pain medications with resultant decreased level of consciousness and respiratory distress. Intubation was difficult because of bilateral mandibular fractures, and she consequently experienced 10 minutes of hypoxia before secure airway control […]

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