By: Dr. Geoffrey Modest A recent article, which got some general press, looked at the utility of exercise and/or vitamin D in fall prevention in older women (see JAMA Intern Med. 2015;175(5):703-711). The backdrop here is that falls are common in the elderly, and 20% lead to injury requiring medical attention. A systematic review and […]
Primary Care Corner with Geoffrey Modest MD: Celiac disease and neuropathy
By: Dr. Geoffrey Modest Peripheral neuropathy has been associated with celiac disease in past studies, typically based in referral centers. The current population-based study in Sweden looked more systematically at the association (see doi:10.1001/jamaneurol.2015.0475). As background, celiac disease is pretty common, with prevalence of about 1%, and peripheral neuropathy is present in 2-7% of the population. Details […]
Primary Care Corner with Geoffrey Modest MD: Pertussis vaccine in adolescents and only transient immunity
By: Dr. Geoffrey Modest Here is a new analysis of Tdap vaccine effectiveness (VE) in the 2012 pertussis outbreak in Washington State (see DOI: 10.1542/peds.2014-3358). In a case-control study of adolescents born between 1993-2000, they correlated cases of pertussis in patients who had Tdap vaccination vs controls, matched by primary provider clinic and birth year. Those born between 1993-97 […]
Primary Care Corner with Geoffrey Modest MD: Measles and immunosuppression
By: Dr. Geoffrey Modest Of late, it seems that I have been mostly trashing immunization, specifically the pertussis component of Tdap. so, I thought I should highlight a really interesting (to me) article from the journal Science on the mysteries of the remarkably successful measles vaccine (see doi: 10.1126/science.aaa3662). Here is a brief review of the article. –mass measles vaccination […]
Primary Care Corner with Geoffrey Modest MD: Cancer screening rates
By: Dr. Geoffrey Modest MMWR just published the 2013 National Health Interview Survey (NHIS) on cancer screening rates, with targets established by Healthy People 2020 using the US Preventive Services Task Force guidelines (see here). Overall, there was not much improvement from 2010 to 2013 in breast, cervical or colorectal cancer (CRC) screening, and cervical cancer screening rates even declined. […]
Primary Care Corner with Geoffrey Modest MD: Mammography screening, again, from another perspective
By: Dr. Geoffrey Modest This editorial is from Eric Topol, and raises concerns about the utility of mammography screening . one issue not addressed by him is primary prevention of breast cancer by decreasing environmental exposure to carcinogens: there are thousands of new chemicals developed in the US each year; historically many of them have […]
Primary Care Corner with Geoffrey Modest MD: Vitamin D and atopic dermatitis in kids
By: Dr. Geoffrey Modest Atopic dermatitis (AD) is pretty common in kids (up to 25%), typically occurring early on (45% of cases begin within first 6 months of life, 60% within first year), and 70% remit spontaneously by adolescence. In those with AD there are significant immunologic changes (increase in Th2 cells and decrease in […]
Primary Care Corner with Geoffrey Modest MD: Melatonin and delirium prevention
By: Dr. Geoffrey Modest There have been a few articles looking at melatonin and one of its derivatives to decrease the development of delirium in hospitalized patients (thanks to my brother Andrew for bringing this to my attention). Delirium, from many studies, is common (30% of those hospitalized who are over 65 yo, 40% in those in […]
Primary Care Corner with Geoffrey Modest MD: Steroid injections of the knee, and elsewhere
By: Dr. Geoffrey Modest There have been a few articles in the past years which have questioned the utility of steroid joint injections. One recent one looked at knee injections in patients with osteoarthritis (OA) to see if injections improved outcomes in those about to enroll in physical therapy (see doi:10.1001/jamainternmed.2015.0461). Details: –100 patients (61% female, mean age 63, BMI […]
Primary Care Corner with Geoffrey Modest MD: Prescribing buprenorphine in the emergency room
By: Dr. Geoffrey Modest A recent study tested the hypothesis that it might be useful to initiate buprenorphine/naloxone treatment in the emergency room for patients with opioid dependence (see JAMA. 2015;313(16):1636-1644). Details: –329 opioid-dependent patients coming into a large urban teaching hospital emergency department in New Haven CT (mean age 31, 76% men, 75% white/7% black/16% hispanic, 41% high school grads/41% […]