February 2018

Treating acute pain requires physicians to achieve a difficult balance between helping the patient resume activities of daily living and guarding against potential long-term opioid use or abuse Image by iStock

Guidance limited for treating acute pain

Prescribing a short-term opioid to patients who haven't recently or ever taken a controlled substance might boost their vulnerability to later addiction.

Bringing medicine back to the bedside

The physical exam itself is widely considered to be underutilized, but many of the country's medical educators and master clinicians are determined to bring it back to prominence.

Pick six

Six core competencies in medical education have stood the test of time. Six more could help physicians understand what it means to be a competent internist.

Preserving the Affordable Care Act despite the headwinds

Despite a treacherous political environment that posed a direct threat to ACP's efforts to preserve the historic gains in coverage from the Affordable Care Act (ACA), a group of six medical societies was able to preserve key components of the program.

New herpes zoster vaccine brings familiar challenges

A new vaccine should be considered the preferred option for prevention of shingles in adults and should be given in place of the existing one, but it brings with it familiar considerations: efficacy, insurance, and patient communication.

Pinpointing pancreatitis difficult, but key to good outcomes

Several review papers help internists identify patients with pancreatitis who are most likely to progress to severe disease and how to best manage their care.

‘UTI’ an overused diagnosis in the era of the microbiome

An evolving understanding of urinary tract infections has led one expert to describe them as an “ambiguous, expansive, overused diagnosis” that can lead to the myriad harms of antibiotic overtreatment.

QI project helps raise vaccination rates

With patients likely to decline all vaccinations, of any kind, due mainly to concerns about safety or adverse effects, physicians opted to work with ACP's “I Raise the Rates” initiative as a quality improvement project.

Gout drug concerns; monthly buprenorphine injection OK'd

This column reviews details on recent recalls, warnings, and approvals.

Options vary for acute pain management

This issue covers guidelines on chronic pain, the utility of the bedside exam, and a new shingles vaccination.

MKSAP Quiz: 5-day history of a lesion

A 31-year-old woman is evaluated for a 5-day history of a nonpainful cutaneous lesion on the back of her left hand. She works as a packer in a parcel distribution center. She does not recall injury to this area and reports no unusual employment or recreational exposures. She has not had fever, cough, shortness of breath, headache, chest discomfort, or gastrointestinal symptoms. Yesterday, two coworkers were evaluated for similar lesions. Her husband has recently been prescribed an antibiotic after being diagnosed with a “boil” from which methicillin-resistant Staphylococcus aureus was cultured. Her only medication is an oral contraceptive pill. What is the most appropriate management?