Table of Contents
Editorial
- A renewed mission and a new look
The Cleveland Clinic Journal of Medicine’s new mission statement, “Dedicated to Lifelong Learning,” reflects our shift in focus to continuing education for physicians. The more functional new design uses typography and color to help readers find information quickly.
Highlights from Medical Grand Rounds
- Medicine and the Internet: why physicians should pay attention
The question for physicians is no longer whether to bother to be connected to the Internet, but whether they can afford not to.
- Understanding obesity: The interaction of diet, genetics, and hormones
The widely held belief that gluttony and sloth underlie obesity is fading, as research sheds light on the interactions between diet, genetics, hormones, and neurotransmitters.
Cardiology Dialogues
- Preoperative evaluation before noncardiac vascular surgery
How to assess a patient’s perioperative risk, deciding when clinical factors are sufficient to gauge risk and when pharmacologic stress testing is needed.
Review
- Diabetic nephropathy: strategies for preventing renal failure
Early detection, coupled with rigorous glycemic control and aggressive hypertensive management may slow the progression of diabetic nephropathy. Dietary protein restriction may also have a role.
Clinical Decision-Making at the Crossroads
- The use of intravenous immunoglobulin in rheumatic diseases
The postulated immunomodulating effects of high-dose IVIg therapy make it an attractive alternative to corticosteroids or cytotoxic agents, but cost is an important issue, especially when efficacy is uncertain.
Current Drug Therapy
- Current issues in menopausal hormone replacement therapy
For most menopausal women, the benefits of hormone replacement therapy out-weigh the risks, despite the fears aroused by an unproven link to breast cancer.
- Conscious sedation: what an internist needs to know
The use of conscious sedation rather than general anesthesia is increasing in the shift to outpatient care, but the technique poses its own special dangers.
Commentary
Clinical judgement – utilizing personal experience, analogy and extrapolation – is still necessary in a system of evidence-based medicine.