Table of Contents
From the Editor
- When to stop treating the bones
Don’t let the argument about how long to treat osteoporosis with bisphosphonate drugs stand in the way of initiating therapy in patients at risk of fracture.
Medical Grand Rounds
- Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean?
Central to fixing the broken US health care system are two concepts: the patient-centered medical home and accountable care organizations.
Review
- Allergy blood testing: A practical guide for clinicians
These tests can confirm the diagnosis of an allergic disorder, supplementing the clinical history. They are particularly useful when skin testing cannot or should not be done.
The Clinical Picture
- Oral plaques and dysphagia in a young man
A 23-year-old man presents with oral plaques, a sore throat, dysphagia, malaise, and weight loss. What is the most likely diagnosis?
Review
- Hepatic encephalopathy: Suspect it early in patients with cirrhosis
Prompt identification and treatment are essential, since the prognosis worsens rapidly once overt encephalopathy develops.
The Clinical Picture
- Unmasking gastric cancer
Screening with diagnostic imaging may be justified in high-risk groups, although the issue is debatable.
Review
- Venous thromboembolism: What to do after anticoagulation is started
Three issues need to be addressed: the length of therapy, measures to prevent postthrombotic syndrome, and a basic workup for possible underlying malignancy.
Current Drug Therapy
What is the optimal duration of bisphosphonate therapy?It is reasonable to stop bisphosphonates after 5 years of use and then to follow patients with markers of bone turnover.
