Class Act

A Critique of the ACGME Resident Work Hour Regulation Update

January 18, 2018
A Critique of the ACGME Resident Work Hour Regulation Update

By Simon Rodier

Peer Reviewed

On March 10, 2017, the Accreditation Council for Graduate Medical Education (ACGME) announced a controversial decision. They decided that, effective July 1, 2017, the maximum work shift for medical interns would increase from 16 to 24 hours. Work hour restriction is a decades-old debate in medicine that raises many valid arguments on both sides of the fence. Was increasing the work hour limit from 16 to 24 the right decision?

Investigations into the effects of long work hours of resident …

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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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50% of the Daily Salt Intake Recommended by the JNC-8 Is Consumed in a New York Minute

September 13, 2017
50% of the Daily Salt Intake Recommended by the JNC-8 Is Consumed in a New York Minute

By Andrew Sideris

Peer Reviewed

Reduction of dietary sodium is a well-known nonpharmacologic therapy to reduce blood pressure. The 8th Joint National Commission (JNC-8) recommends that the general population limit daily intake of sodium to less than 2.4 grams. On average, a mean reduction in systolic blood pressure of 2-8 mmHg is expected if dietary sodium intake is limited to no more than 2.4 grams per day.1 Further reduction of sodium to 1.5 grams is desirable for people with hypertension because it is associated with …

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Slow Respiration to Lower Blood Pressure

September 7, 2017
Slow Respiration to Lower Blood Pressure

By Omotayo Arowojolu

Peer Reviewed

Approximately 32% of American adults have high blood pressure (>140/90 mmHg),1 or hypertension, and only 54% of these individuals have well-controlled hypertension.2,3 Hypertension costs $48.6 billion each year in healthcare services, medications, and missed days of work. Additionally, one in three Americans have pre-hypertension (120-139/80-89 mmHg) and are considered at risk for developing hypertension.1 These individuals benefit from management of risk factors with changes in diet (reduced sodium), weight loss, increased physical activity, and smoking or alcohol cessation. On the …

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Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

August 23, 2017
Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

By Lauren Christene Strazzulla

Peer Reviewed

The lifetime risk for developing heart failure from age 55 on is 33% for men and 28.5% for women, and as the population ages, there is an increasing prevalence of this disease along with its associated health care costs . Heart failure is divisible into 2 distinct entities: those with left ventricular systolic dysfunction and those with cardiovascular compromise that does not decrease LV ejection fraction, which is termed heart failure with persevered ejection fraction (HFpEF) . While …

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When Doctors Get Personal

August 18, 2017
When Doctors Get Personal

By Leland Soiefer

Peer Reviewed

Mrs. S sat up straight and made excellent eye contact. Her tone was pleasant. She wore a colorful yellow shirt and dark green pants, and was accompanied by her husband; her gilded rings and earrings added flair to her outfit. Her neutral expression, however, stood out to me. She had seen a doctor several weeks ago regarding her first vaginal bleeding since menopause, and a uterine biopsy showing a precancerous lesion was subsequently performed. Surely by this point she had …

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Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

April 12, 2017
Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

By Christopher V. Cosgriff

Peer Reviewed

The American College of Physicians (ACP) recommends supplemental long-term oxygen therapy (LTOT) in all patients who have severe resting hypoxemia, defined as a PaO2 ≤55 mmHg or an SpO2 ≤88%. In patients with cor pulmonale or polycythemia they recommend initiation of oxygen therapy at a PaO2 ≤59 mmHg.1 Absent from the ACP recommendation is a target range to which saturation should be restored. The accepted standard of practice is restoration to a range of 88%-92%, and there are British …

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