Suboptimal Opioid Prescribing: A Practice Change Project.

In the U.S. in 2015, the proportion of people dependent on opioids approached one percent, and opioid overdose rivaled auto accidents as the leading cause of accidental death.

The Physical Finding Points to the Diagnosis.

[Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

A retrospective cohort study of lung cancer incidence in nylon flock workers, 1998-2008.

During an investigation of a novel interstitial lung disease in a cohort of nylon flock workers, a former worker was found to have developed bilateral synchronous pulmonary adenocarcinomas three decades after he quit smoking, suggesting that exposures in this industry might pose excessive risk of lung cancer. We conducted a retrospective cohort study of lung cancer incidence in the original study cohort (n=162) from August 15, 1998, to August 14, 2008. The Rhode Island Cancer Registry identified cohort members with lung cancer and provided age-gender-era-specific rates of lung cancer in Rhode Island.

Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?

Study Objectives: Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy.

Lactic acidosis. Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus.

Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis.

Sexual boundary violations in the physician-patient relationship.

Sexual misconduct with a patient violates the physician-patient relationship. Such behavior maybe an isolated event in the professional life of a physician, but more frequently is part of a pattern of predatory behavior. Such behavior on the part of any physician adversely affects all physicians and the public welfare.

Acute and chronic renal failure.

Renal failure is defined as a deterioration of kidney function that results in the retention of nitrogenous waste products. It is increasingly prevalent in older populations, individuals with diabetes or hypertension, and postoperative patients. Therefore, podiatric physicians caring for these populations can expect to encounter this condition frequently.

Perioperative medical assessment of the podiatric surgical patient.

Patients undergoing podiatric surgery should receive a thorough perioperative evaluation. Medical "clearance" is no longer sufficient; rather, formal risk assessment should be performed and risk-reducing strategies provided. A collaborative, multidisciplinary approach involving practitioners in internal medicine, anesthesiology, and podiatry is generally most appropriate.