Class Act

How Can You Best Address Polypharmacy in the Elderly?

December 21, 2017
How Can You Best Address Polypharmacy in the Elderly?

By Michael Nguyen

Peer Reviewed

Polypharmacy has been defined as the use of multiple unnecessary medications, the use of more medications than is clinically warranted or indicated, or the use of unnecessary, ineffective, or harmful prescribing. Problematic polypharmacy should be differentiated from appropriate polypharmacy. Consideration of overall appropriateness of therapy is more valuable than simply considering the number of medications that an older person is prescribed.

Overmedication and failure to perform prudent medication reconciliation is a growing problem in prescribing practice. In individuals over 65 …

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Age Is Just a Number: Combating Muscle Loss in The Elderly

December 14, 2017
Age Is Just a Number: Combating Muscle Loss in The Elderly

By Carl Preiksaitis

Peer Reviewed

The term “sarcopenia” was introduced in 1989 to characterize the loss of muscle mass that occurs as a consequence of advancing age.1 Use of the term has since grown to include the loss of muscular function experienced in older adults. The prevalence of sarcopenia is estimated to be approximately 29% in community-dwelling older adults and 33% in individuals living in long-term care institutions. Sarcopenia is linked to increased morbidity and mortality from physical disability, increased falls and fractures, decreased quality …

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Burnout- The Hot Topic in Medicine

December 8, 2017
Burnout- The Hot Topic in Medicine

By Monica Gupta, MD and Alice Tang, MD

Peer reviewed

Physician burnout is a phenomenon that is becoming recognized as widespread in both trainees and in practicing doctors. Long taxing hours, insurmountable educational debt, the burden of daily decisions affecting patients’ lives, and the routine sacrifice of self-care are just a few of the factors that physicians identify as causes of their burnout.

What exactly is burnout?

Burnout is assessed across multiple professional fields with the Maslach Burnout Inventory. It has 3 scales that measure …

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Cancer Survivors – Who are they, what are their needs, and how can medical providers meet these needs?

December 6, 2017
Cancer Survivors – Who are they, what are their needs, and how can medical providers meet these needs?

By Maria Garcia-Jimenez, MD/MHS, Abinav Baweja, MD, and Nicole LaNatra, MD

Peer Reviewed

Clinical vignette

A 65-year old woman with history of invasive breast cancer presents to her primary care provider for regular follow up. She was diagnosed with breast cancer over 10 years ago and received chemotherapy, radiation, and hormonal therapy with aromatase inhibitors. She follows with several providers including an oncologist, surgical oncologists, and a gynecologist. In your clinic, she reports concerns of neuropathy and arthralgia, and mentions that since retiring she worries …

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Tales of the Bellevue Hospital Internal Medicine House Staff from the ‘60s to Now

November 17, 2017
Tales of the Bellevue Hospital Internal Medicine House Staff from the ‘60s to Now

In honor of the 10th Anniversary of Clinical Correlations we are presenting a wonderful 4 part series of life as a house officer at Bellevue Hospital in the 60’s, 70’s, 80’s and 90’s.   Former resident Olivia Begasse de Dhaem conducted extensive interviews with our faculty who worked at Bellevue in each of these decades.   With guidance from David Oshinksy, Olivia has written a story of what binds our students, residents and faculty and patients together through Bellevue’s rich history.  While much has changed in our …

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Reducing Readmission in Sickle Cell Disease: The Role of the Patient-Centered Medical Home

October 6, 2017
Reducing Readmission in Sickle Cell Disease: The Role of the Patient-Centered Medical Home

By Leonard Naymagon, MD

Peer Reviewed

Vaso-occlusive crisis (VOC), or pain crisis, is the most common clinical manifestation of sickle cell disease (SCD) and is responsible for the majority of emergency department (ED) visits and inpatient hospitalizations among sickle cell patients . A retrospective analysis of over 100,000 in-hospital encounters for VOC in 2005 and 2006 demonstrated 30-day and 14-day rehospitalization rates of 33.4% and 22.1% respectively . These findings were most pronounced among 18- to 30-year-olds, with 41.1% rehospitalized within 30 days and 28.4% …

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Alzheimer’s Disease: State of Diagnosis

October 4, 2017
Alzheimer’s Disease: State of Diagnosis

By Karen McCloskey, MD

Peer Reviewed

In May 2012, The U.S. Department of Health and Human Services unveiled the “National Plan to Address Alzheimer’s Disease,” in response to legislation signed by President Obama in January, 2011 establishing the National Alzheimer’s Project Act.  The overarching goal of the Plan is to “prevent or effectively treat Alzheimer’s Disease by 2025.”   We now have an estimated 5.5 million people who are living with this illness and these numbers are only expected to grow with the aging population̶ the …

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Life and Limb: Battlefield Medicine from WWII to Today

September 29, 2017
Life and Limb:  Battlefield Medicine from WWII to Today

By Eric Jeffrey Nisenbaum, MD

Peer Reviewed

Mr. O is a 93-year-old man with a past medical history notable for severe Alzheimer’s dementia and amputation of the left upper extremity secondary to wounds received in WWII who was brought in from his nursing home with fever and dyspnea for two days.  His physical exam was notable for inspiratory crackles at the right lung base.  His CBC was notable for an elevated WBC with left-shift and a chest x-ray revealing a right lower lobe infiltrate. He …

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