Table of Contents
From the Editor
- The fifth vital sign: A complex story of politics and patient care
Times have changed, and the diffi culties and complexities of trying to help patients with ongoing pain have increased.
The Clinical Picture
- Multiple linear subcutaneous nodules
A 34-year-old woman has an asymptomatic swelling on her foot that has been slowly growing for 15 years.
1-Minute Consult
- Should I suspect obstructive sleep apnea if a patient has hard-to-control hypertension?
Yes. Obstructive sleep apnea is common and is associated with hypertension and resistant hypertension.
- When does chest CT require contrast enhancement?
It may be needed in cases of suspected cancer or thoracovascular disease.
Review
- Navigating pneumococcal vaccination in adults
With two nonequivalent vaccines and different schedules for different groups, vaccination can be confusing.
- Total pancreatectomy and islet cell autotransplantation: Definitive treatment for chronic pancreatitis
Most patients report less pain after this procedure, and many avoid overt diabetes.
- Opioids for persistent pain in older adults
Legitimate need must be balanced against the risks, especially in older patients.
A guide to managing acute liver failureTransfer to intensive care, start specific treatment depending on the cause, and consider transplant.
- Dietary and medical management of recurrent nephrolithiasis
Some interventions, such as increasing fl uid intake, apply to all patients, while some apply to those with specifi c types of stones.
Departments
- Cognitive bias and diagnostic error (November 2015)
Readers comment on cognitive bias and diagnostic error (November 2015).
Commentary
Anticoagulation should not be interrupted for dental surgery.