Table of Contents
From the Editor
- Test ordering: Balancing the good for the many with the good for the one
Three articles this month address how we order clinical tests, one on the question of treating the patient with asymptomatic bacteriuria, the others on the advantages and disadvantages of standing orders for “daily labs” for inpatients.
The Clinical Picture
- Asymptomatic granules on the buccal mucosa
A healthy 35-year-old man presented with multiple small, white-yellow papules.
Editorial
- Laboratory stewardship should be a priority in every hospital
Considerations include indirect costs, downstream testing or other workup based on minor abnormalities uncovered during daily testing, and shortages in staff and supplies.
1-Minute Consult
- Does my patient need to be screened or treated for a urinary tract infection?
When patients present with symptoms that suggest but are not clearly diagnostic of urinary tract infection, urine studies should be obtained.
Guidelines to Practice
- Evaluation and management of gastroesophageal reflux disease: A brief look at the updated guidelines
Updated guidelines from the American College of Gastroenterology address the evaluation and management of reflux disease, consequences of long-term PPI therapy, and emerging therapies.
Symptoms to Diagnosis
- A 60-year-old man with prostate cancer and embolic strokes
Step-by-step evaluation of a patient with stage IV prostate cancer and embolic stroke, but no history of heart valve disease, arrhythmia, or coagulopathy.
Review
On the horizon: Extracorporeal carbon dioxide removalExtracorporeal carbon dioxide removal to treat hypercapnic respiratory failure has been studied in acute respiratory distress syndrome, chronic obstructive pulmonary disease, asthma, and other conditions.
- Is your patient at risk for NAFLD?
The authors review identifying individuals at risk, treatment options founded on lifestyle modification, and when to consider referring patients to a hepatologist.
Commentary
As patients are already using these products, rather than dismiss the use of e-cigarettes, clinicians should provide accurate information to help patients make the best choices for their health.
Evidence shows that unnecessary daily testing is only a minor contributor to anemia and healthcare costs for most inpatients. The effect on patient experience has not been definitively established.